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A comparison of MR elastography and 31P MR spectroscopy with histological staging of liver fibrosis

  • Hepatobiliary-Pancreas
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Abstract

Objectives

Conventional imaging techniques are insensitive to liver fibrosis. This study assesses the diagnostic accuracy of MR elastography (MRE) stiffness values and the ratio of phosphomonoesters (PME)/phosphodiesters (PDE) measured using 31P spectroscopy against histological fibrosis staging.

Methods

The local research ethics committee approved this prospective, blinded study. A total of 77 consecutive patients (55 male, aged 49 ± 11.5 years) with a clinical suspicion of liver fibrosis underwent an MR examination with a liver biopsy later the same day. Patients underwent MRE and 31P spectroscopy on a 1.5 T whole body system. The liver biopsies were staged using an Ishak score for chronic hepatitis or a modified NAS fibrosis score for fatty liver disease.

Results

MRE increased with and was positively associated with fibrosis stage (Spearman’s rank = 0.622, P < 0.001). PME/PDE was not associated with fibrosis stage (Spearman’s rank = −0.041, p = 0.741). Area under receiver operating curves for MRE stiffness values were high (range 0.75–0.97). The diagnostic utility of PME/PDE was no better than chance (range 0.44–0.58).

Conclusions

MRE-estimated liver stiffness increases with fibrosis stage and is able to dichotomise fibrosis stage groupings. We did not find a relationship between 31P MR spectroscopy and fibrosis stage.

Key Points

• Magnetic resonance elastography (MRE) and MR spectroscopy can both assess the liver.

• MRE is superior to 31 P MR spectroscopy in staging hepatic fibrosis.

• MRE is able to dichotomise liver fibrosis stage groupings.

• Gradient-echo MRE may be problematic in genetic haemochromatosis.

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References

  1. Friedman SL, Bansal MB (2006) Reversal of hepatic fibrosis – fact or fantasy? Hepatology 43:S82–S88

    Article  PubMed  CAS  Google Scholar 

  2. Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD (2009) Liver biopsy. Hepatology 49:1017–1044

    Article  PubMed  Google Scholar 

  3. Gilmore IT, Burroughs A, Murray-Lyon IM, Williams R, Jenkins D, Hopkins A (1995) Indications, methods, and outcomes of percutaneous liver biopsy in England and Wales: an audit by the British Society of Gastroenterology and the Royal College of Physicians of London. Gut 36:437–441

    Article  PubMed  CAS  Google Scholar 

  4. Weigand K (2009) Percutaneous liver biopsy: retrospective study over 15 years comparing 287 inpatients with 428 outpatients. J Gastroenterol Hepatol 24:792–799

    Article  PubMed  Google Scholar 

  5. Regev A, Berho M, Jeffers LJ et al (2002) Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 97:2614–2618

    Article  PubMed  Google Scholar 

  6. Bravo AA, Sheth SG, Chopra S (2001) Liver biopsy. N Engl J Med 344:495–500

    Article  PubMed  CAS  Google Scholar 

  7. Bonekamp S, Kamel I, Solga S, Clark J (2009) Can imaging modalities diagnose and stage hepatic fibrosis and cirrhosis accurately? J Hepatol 50:17–35

    Article  PubMed  Google Scholar 

  8. Muthupillai R, Lomas DJ, Rossman PJ, Greenleaf JF, Manduca A, Ehman RL (1995) Magnetic resonance elastography by direct visualization of propagating acoustic strain waves. Science 269:1854–1857

    Article  PubMed  CAS  Google Scholar 

  9. Rouviere O, Yin M, Dresner MA et al (2006) MR elastography of the liver: preliminary results. Radiology 240:440–448

    Article  PubMed  Google Scholar 

  10. Salameh N, Larrat B, Abarca-Quinones J et al (2009) Early detection of steatohepatitis in fatty rat liver by using MR elastography. Radiology 253:90–97

    Article  PubMed  Google Scholar 

  11. Noren B, Dahlqvist O, Lundberg P et al (2008) Separation of advanced from mild fibrosis in diffuse liver disease using 31P magnetic resonance spectroscopy. Eur J Radiol 66:313–320

    Article  PubMed  Google Scholar 

  12. Taylor-Robinson SD (2001) Applications of magnetic resonance spectroscopy to chronic liver disease. Clin Med 1:54–60

    PubMed  CAS  Google Scholar 

  13. Wai CT, Greenson JK, Fontana RJ et al (2003) A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 38:518–526

    Article  PubMed  Google Scholar 

  14. Rockey DC, Bissell DM (2006) Noninvasive measures of liver fibrosis. Hepatology 43:S113–120

    Article  PubMed  CAS  Google Scholar 

  15. Cardoso AC, Carvalho-Filho RJ, Marcellin P (2011) Transient elastography in chronic viral hepatitis: a critical appraisal. Gut 60:759–764

    Article  PubMed  Google Scholar 

  16. Maruyama H, Matsutani S, Okugawa H et al (2006) Microbubble disappearance-time is the appropriate timing for liver-specific imaging after injection of Levovist. Ultrasound Med Biol 32:1809–1815

    Article  PubMed  Google Scholar 

  17. Van Beers BE, Leconte I, Materne R, Smith AM, Jamart J, Horsmans Y (2001) Hepatic perfusion parameters in chronic liver disease: dynamic CT measurements correlated with disease severity. AJR Am J Roentgenol 176:667–673

    PubMed  Google Scholar 

  18. Friedrich-Rust M, Muller C, Winckler A et al (2010) Assessment of liver fibrosis and steatosis in PBC with FibroScan, MRI, MR-spectroscopy, and serum markers. J Clin Gastroenterol 44:58–65

    Article  PubMed  Google Scholar 

  19. Girometti R, Furlan A, Bazzocchi M et al (2007) Diffusion-weighted MRI in evaluating liver fibrosis: a feasibility study in cirrhotic patients. Radiol Med 112:394–408

    Article  PubMed  CAS  Google Scholar 

  20. Hagiwara M, Rusinek H, Lee VS et al (2008) Advanced liver fibrosis: diagnosis with 3D whole-liver perfusion MR imaging—initial experience. Radiology 246:926–934

    Article  PubMed  Google Scholar 

  21. Manduca A, Oliphant TE, Dresner MA et al (2001) Magnetic resonance elastography: non-invasive mapping of tissue elasticity. Med Image Anal 5:237–254

    Article  PubMed  CAS  Google Scholar 

  22. Vanhamme L, van den Boogaart A, Van Huffel S (1997) Improved method for accurate and efficient quantification of MRS data with use of prior knowledge. J Magn Reson 129:35–43

    Article  PubMed  CAS  Google Scholar 

  23. Naressi A, Couturier C, Devos JM et al (2001) Java-based graphical user interface for the MRUI quantitation package. Magma 12:141–152

    PubMed  CAS  Google Scholar 

  24. Ishak K, Baptista A, Bianchi L et al (1995) Histological grading and staging of chronic hepatitis. J Hepatol 22:696–699

    Article  PubMed  CAS  Google Scholar 

  25. Kleiner DE, Brunt EM, Van Natta M et al (2005) Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology 41:1313–1321

    Article  PubMed  Google Scholar 

  26. Asbach P, Klatt D, Schlosser B et al (2010) Viscoelasticity-based staging of hepatic fibrosis with multifrequency MR elastography. Radiology 257:80–86

    Article  PubMed  Google Scholar 

  27. Huwart L, Peeters F, Sinkus R et al (2006) Liver fibrosis: non-invasive assessment with MR elastography. NMR Biomed 19:173–179

    Article  PubMed  Google Scholar 

  28. Wang Y, Ganger DR, Levitsky J et al (2011) Assessment of chronic hepatitis and fibrosis: comparison of MR elastography and diffusion-weighted imaging. AJR Am J Roentgenol 196:553–561

    Article  PubMed  Google Scholar 

  29. Yin M, Talwalkar JA, Glaser KJ et al (2007) Assessment of hepatic fibrosis with magnetic resonance elastography. Clin Gastroenterol Hepatol 5:1207–1213, e1202

    Article  PubMed  Google Scholar 

  30. Everhart JE, Wright EC, Goodman ZD et al (2010) Prognostic value of Ishak fibrosis stage: findings from the hepatitis C antiviral long-term treatment against cirrhosis trial. Hepatology 51:585–594

    Article  PubMed  Google Scholar 

  31. Nitta Y, Kawabe N, Hashimoto S et al (2009) Liver stiffness measured by transient elastography correlates with fibrosis area in liver biopsy in patients with chronic hepatitis C. Hepatol Res 39:675–684

    Article  PubMed  Google Scholar 

  32. O'Brien MJ, Keating NM, Elderiny S et al (2000) An assessment of digital image analysis to measure fibrosis in liver biopsy specimens of patients with chronic hepatitis C. Am J Clin Pathol 114:712–718

    Article  PubMed  Google Scholar 

  33. Huwart L, Sempoux C, Salameh N et al (2007) Liver fibrosis: noninvasive assessment with MR elastography versus aspartate aminotransferase-to-platelet ratio index. Radiology 245:458–466

    Article  PubMed  Google Scholar 

  34. Huwart L, Sempoux C, Vicaut E et al (2008) Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterology 135:32–40

    Article  PubMed  Google Scholar 

  35. Yin MGK, Talwalkar JA, Manduca A, Ehman RL (2009) Validity of a 3-D wave field model in MR elastography of the liver. ISMRM, Honolulu, p710

    Google Scholar 

  36. Lim AK, Patel N, Hamilton G, Hajnal JV, Goldin RD, Taylor-Robinson SD (2003) The relationship of in vivo 31P MR spectroscopy to histology in chronic hepatitis C. Hepatology 37:788–794

    Article  PubMed  CAS  Google Scholar 

  37. Noren B, Lundberg P, Ressner M, Wirell S, Almer S, Smedby O (2005) Absolute quantification of human liver metabolite concentrations by localized in vivo 31P NMR spectroscopy in diffuse liver disease. Eur Radiol 15:148–157

    Article  PubMed  Google Scholar 

  38. Corbin IR, Ryner LN, Singh H, Minuk GY (2004) Quantitative hepatic phosphorus-31 magnetic resonance spectroscopy in compensated and decompensated cirrhosis. Am J Physiol Gastrointest Liver Physiol 287:G379–384

    Article  PubMed  CAS  Google Scholar 

  39. Dezortova M, Taimr P, Skoch A, Spicak J, Hajek M (2005) Etiology and functional status of liver cirrhosis by 31P MR spectroscopy. World J Gastroenterol 11:6926–6931

    PubMed  CAS  Google Scholar 

  40. Kiyono K, Shibata A, Sone S et al (1998) Relationship of 31P MR spectroscopy to the histopathological grading of chronic hepatitis and response to therapy. Acta Radiol 39:309–314

    PubMed  CAS  Google Scholar 

  41. Menon DK, Sargentoni J, Taylor-Robinson SD et al (1995) Effect of functional grade and etiology on in vivo hepatic phosphorus-31 magnetic resonance spectroscopy in cirrhosis: biochemical basis of spectral appearances. Hepatology 21:417–427

    PubMed  CAS  Google Scholar 

  42. van Wassenaer-van Hall HN, van der Grond J, van Hattum J, Kooijman C, Hoogenraad TU, Mali WP (1995) 31P magnetic resonance spectroscopy of the liver: correlation with standardized serum, clinical, and histological changes in diffuse liver disease. Hepatology 21:443–449

    Article  PubMed  Google Scholar 

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Acknowledgments

Addenbrooke’s Charitable Trust

NIHR - Cambridge Biomedical Research Centre

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Authors and Affiliations

  1. St James’ Hospital, Beckett Street, Leeds, LS9 7TF, UK

    Edmund M. Godfrey

  2. Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UK

    Andrew J. Patterson, Andrew N. Priest, Susan E. Davies, Ilse Joubert, Anant S. Krishnan, Ashley S. Shaw, Graeme J. Alexander, Michael E. Allison, William J. H. Griffiths & Alexander E. S. Gimson

  3. St Thomas’s Hospital, Westminster Bridge Road, London, SE1 7EH, UK

    Nyree Griffin

  4. Department of Radiology, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UK

    David J. Lomas

  5. Department of Radiology, St James’ Hospital, Beckett Street, Leeds, LS9 7TF, UK

    Edmund M. Godfrey

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  1. Edmund M. Godfrey
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Correspondence to Edmund M. Godfrey.

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Godfrey, E.M., Patterson, A.J., Priest, A.N. et al. A comparison of MR elastography and 31P MR spectroscopy with histological staging of liver fibrosis. Eur Radiol 22, 2790–2797 (2012). https://doi.org/10.1007/s00330-012-2527-x

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  • DOI: https://doi.org/10.1007/s00330-012-2527-x

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