Diffusion-weighted MRI for quantification of liver fibrosis: preliminary experience.

OBJECTIVE The purpose of this study was to evaluate our preliminary experience using diffusion-weighted MRI for quantification of liver fibrosis. SUBJECTS AND METHODS Diffusion-weighted MRI with single-shot echo-planar technique at b values of 50, 300, 500, 700, and 1,000 s/mm2 was prospectively performed on 23 patients with chronic hepatitis and on seven healthy volunteers. The apparent diffusion coefficient (ADC) was measured in four locations in the liver. Liver biopsy results (n = 19) were retrospectively reviewed by two hepatopathologists in consensus to determine stage of fibrosis and grade of inflammation. A Mann-Whitney test was used to compare the ADCs between patients classified with respect to having stage 2 or greater versus stage 1 or less fibrosis and stage 3 or greater versus stage or less 2 fibrosis. Receiver operating characteristics analysis was used to assess the performance of ADC in prediction of the presence of stage 2 or greater and stage 3 or greater fibrosis. RESULTS Using a b value of 500 s/mm2 and all combined b values, we found significantly lower hepatic ADCs in stage 2 or greater versus stage 1 or less fibrosis and stage 3 or greater versus stage 2 or less fibrosis. The mean ADCs (x 10(-3) mm2/s) with all b values were 1.47 +/- 0.11 (SD) versus 1.65 +/- 0.10 for stage 2 or greater versus stage 1 or less fibrosis (p < 0.001) and 1.44 +/- 0.07 versus 1.66 +/- 0.10 for stage 3 or greater versus stage 2 or less fibrosis (p <0.001). Hepatic ADC was a significant predictor of stage 2 or greater and stage 3 or greater fibrosis, with areas under the curve of 0.896 and 0.896, sensitivity of 83.3% and 88.9%, and specificity of 83.3% and 80.0% (ADC with all b values, 1.54-1.53 x 10(-3) mm2/s or less). CONCLUSION Diffusion-weighted MRI can be used for prediction of the presence of moderate and advanced liver fibrosis.

[1]  C. Sirlin,et al.  Review article: epidemiology, pathogenesis and potential treatments of paediatric non‐alcoholic fatty liver disease , 2008, Alimentary pharmacology & therapeutics.

[2]  D. Ouzan,et al.  Validation and comparison of indexes for fibrosis and cirrhosis prediction in chronic hepatitis C patients: proposal for a pragmatic approach classification without liver biopsies , 2006, Journal of viral hepatitis.

[3]  F. Degos,et al.  Practices of Liver Biopsy in France: Results of a Prospective Nationwide Survey , 2000, Hepatology.

[4]  Eugene R. Schiff,et al.  Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection , 2002, American Journal of Gastroenterology.

[5]  B. Maharaj,et al.  SAMPLING VARIABILITY AND ITS INFLUENCE ON THE DIAGNOSTIC YIELD OF PERCUTANEOUS NEEDLE BIOPSY OF THE LIVER , 1986, The Lancet.

[6]  B. V. Van Beers,et al.  Liver fibrosis: non‐invasive assessment with MR elastography , 2006, NMR in biomedicine.

[7]  D. Le Bihan,et al.  Diffusion/perfusion MR imaging of the brain: from structure to function. , 1990 .

[8]  M. Fried,et al.  Practice and complications of liver biopsy , 1993, Digestive Diseases and Sciences.

[9]  H. Schild,et al.  Abdomen: diffusion-weighted MR imaging with pulse-triggered single-shot sequences. , 2002, Radiology.

[10]  D G Mitchell,et al.  Enlargement of hilar periportal space: A sign of early cirrhosis at MR imaging , 2000, Journal of magnetic resonance imaging : JMRI.

[11]  Isamu Ohashi,et al.  Apparent diffusion coefficient measurements with diffusion‐weighted magnetic resonance imaging for evaluation of hepatic fibrosis , 2005, Journal of magnetic resonance imaging : JMRI.

[12]  Christos Christidis,et al.  Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C , 2005, Hepatology.

[13]  C. Zuiani,et al.  Relevance of b‐values in evaluating liver fibrosis: A study in healthy and cirrhotic subjects using two single‐shot spin‐echo echo‐planar diffusion‐weighted sequences , 2008, Journal of magnetic resonance imaging : JMRI.

[14]  K. Lindor,et al.  Outcome of Patients Hospitalized for Complications after Outpatient Liver Biopsy , 1993, Annals of Internal Medicine.

[15]  D. Thabut,et al.  Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis (ActiTest) in patients with chronic hepatitis C , 2004, Comparative hepatology.

[16]  R. Semelka,et al.  Magnetic Resonance Imaging of the Liver , 1995, Topics in magnetic resonance imaging : TMRI.

[17]  D. Mitchell,et al.  Right posterior hepatic notch sign: A simple diagnostic MR finding of cirrhosis , 2003, Journal of magnetic resonance imaging : JMRI.

[18]  Peter R Luijten,et al.  Comparison and reproducibility of ADC measurements in breathhold, respiratory triggered, and free‐breathing diffusion‐weighted MR imaging of the liver , 2008, Journal of magnetic resonance imaging : JMRI.

[19]  T. Murakami,et al.  Diffusion-weighted single-shot echoplanar MR imaging for liver disease. , 1999, AJR. American journal of roentgenology.

[20]  M Takahashi,et al.  Focal liver masses: characterization with diffusion-weighted echo-planar MR imaging. , 1997, Radiology.

[21]  Alastair J. Martin,et al.  Chronic hepatitis: Role of diffusion‐weighted imaging and diffusion tensor imaging for the diagnosis of liver fibrosis and inflammation , 2008, Journal of magnetic resonance imaging : JMRI.

[22]  W. Kim,et al.  The burden of hepatitis C in the United States , 2002, Hepatology.

[23]  D. Mitchell,et al.  Hepatic morphologic changes in cirrhosis: MR imaging findings , 2000, Abdominal Imaging.

[24]  G. Beaudoin,et al.  Diffusion‐weighted MR imaging of the liver of hepatitis C patients , 2003, NMR in biomedicine.

[25]  V. Paradis,et al.  Sampling variability of liver fibrosis in chronic hepatitis C , 2003, Hepatology.

[26]  T. Ichikawa,et al.  Diffusion-weighted MR imaging with a single-shot echoplanar sequence: detection and characterization of focal hepatic lesions. , 1998, AJR. American journal of roentgenology.

[27]  Katsuyoshi Ito,et al.  Cirrhosis: A Modified Caudate-to-Right-Lobe Ratio , 2001 .

[28]  Denis Le Bihan,et al.  Intravoxel incoherent motion perfusion MR imaging: a wake-up call. , 2008 .

[29]  Ke-min Chen,et al.  Feasibility of diagnosing and staging liver fibrosis with diffusion weighted imaging. , 2008, Chinese medical sciences journal = Chung-kuo i hsueh k'o hsueh tsa chih.

[30]  Jean-Luc Daire,et al.  Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences: prospective study in 66 patients. , 2003, Radiology.

[31]  H. Saito,et al.  Assessment of histological features and outcome of interferon therapy in chronic hepatitis C , 1996, Journal of Gastroenterology.

[32]  B. V. Van Beers,et al.  Hepatic flow parameters measured with MR imaging and Doppler US: correlations with degree of cirrhosis and portal hypertension. , 2003, Radiology.

[33]  M. Rugge,et al.  Histology predicts cirrhotic evolution of post transplant hepatitis C , 2002, Gut.

[34]  Richard L Ehman,et al.  MR elastography of the liver: preliminary results. , 2006, Radiology.

[35]  D. Mitchell,et al.  Cirrhosis: MR imaging features. , 2002, Magnetic resonance imaging clinics of North America.

[36]  L. Seeff,et al.  Aasld Practice Guideline Diagnosis, Management, and Treatment of Hepatitis C , 2003 .

[37]  A. Luciani,et al.  Liver Cirrhosis : Intravoxel Incoherent Motion MR Imaging — Pilot Study 1 , 2008 .

[38]  B. V. Van Beers,et al.  Assessment of diffusion‐weighted MR imaging in liver fibrosis , 2007, Journal of magnetic resonance imaging : JMRI.

[39]  S. Saab,et al.  Treatment of hepatitis C. , 2005, The American journal of medicine.

[40]  T. Poynard,et al.  Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study , 2001, The Lancet.

[41]  K. Batts,et al.  Chronic hepatitis. An update on terminology and reporting. , 1995, The American journal of surgical pathology.

[42]  Claude B Sirlin,et al.  Liver fibrosis: noninvasive diagnosis with double contrast material-enhanced MR imaging. , 2006, Radiology.

[43]  I. Yamada,et al.  Diffusion coefficients in abdominal organs and hepatic lesions: evaluation with intravoxel incoherent motion echo-planar MR imaging. , 1999, Radiology.

[44]  R. Semelka,et al.  Chronic hepatitis: Correlation of early patchy and late linear enhancement patterns on gadolinium‐enhanced MR images with histopathology initial experience , 2001, Journal of magnetic resonance imaging : JMRI.

[45]  M. Manns,et al.  Biochemical surrogate markers of liver fibrosis and activity in a randomized trial of peginterferon alfa‐2b and ribavirin , 2003, Hepatology.

[46]  V. de Lédinghen,et al.  Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. , 2005, Gastroenterology.

[47]  Single-shot diffusion-weighted echo-planar imaging of normal and cirrhotic livers using a phased-array multicoil , 1998, Acta radiologica.

[48]  R. Gish.  Current treatment and future directions in the management of chronic hepatitis B viral infection. , 2005, Clinics in liver disease.

[49]  Benjamin M Yeh,et al.  Parallel imaging and diffusion tensor imaging for diffusion-weighted MRI of the liver: preliminary experience in healthy volunteers. , 2004, AJR. American journal of roentgenology.