Prediction of high-stage liver fibrosis using ADC value on diffusion-weighted imaging and quantitative enhancement ratio at the hepatobiliary phase of Gd-EOB-DTPA

Abstract

Background

Recently, diffusion-weighted imaging (DWI) and quantitative enhancement ratio measured at the hepatobiliary phase (HBP) of Gd-EOB-DTPA–enhanced magnetic resonance imaging (MRI) has been established as an effective method for evaluating liver fibrosis.

Purpose

To evaluate which is a more favorable surrogate marker in predicting high-stage liver fibrosis, apparently diffusion coefficient (ADC) value or quantitative enhancement ratio measured on HBP.

Material and Methods

Eighty-three patients with 99 surgically resected hepatic lesions were enrolled in this study. DWI was performed with b-values of 100 and 800 s/mm². Regions of interest were set on ADC map, and the HBP of Gd-EOB-DTPA–enhanced MRI, to calculate ADC value, liver-to-muscle ratio (LMR), liver-to-spleen ratio (LSR), and contrast enhancement index (CEI) of liver. We compared these parameters between low-stage fibrosis (F0, F1, and F2) and high-stage fibrosis (F3 and F4). Receiver operating characteristic analysis was performed to compare the diagnostic performance when distinguishing low-stage fibrosis from high-stage fibrosis.

Results

LMR and CEI were significantly lower at high-stage fibrosis than at the low stage (P < 0.01 and P = 0.04, respectively), whereas LSR did not show a significant difference (P = 0.053). No significant difference was observed in diagnostic performance between LMR and CEI (P = 0.185). The best sensitivity and specificity, when an LMR of 2.80 or higher was considered to be low-stage fibrosis, were 82.4% and 75.6%, respectively. ADC value showed no significant differences among fibrosis grades (P = 0.320).

Conclusion

LMR and CEI were both adequate surrogate parameters to distinguish high-stage fibrosis from low-stage fibrosis.

Keywords

Liver fibrosis diffusion-weighted imaging (DWI)magnetic resonance imaging (MRI)Gd-EOB-DTPA enhancement ratio hepatosteatosis

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References

Wong

Bennett

Koff

et al.

Pretreatment evaluation of chronic hepatitis C: risks, benefits, and costs. JAMA 1998; 280: 2088–2093.

Regev

Berho

Jeffers

et al.

Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002; 97: 2614–2618.

Howlett

Drinkwater

Lawrence

et al.

Findings of the UK national audit evaluating image-guided or image-assisted liver biopsy. Part II. Minor and major complications and procedure-related mortality. Radiology 2013; 266: 226–235.

Luciani

Vignaud

Cavet

et al.

Liver cirrhosis: intravoxel incoherent motion MR imaging–pilot study. Radiology 2008; 249: 891–899.

Bakan

Inci

Bakan

et al.

Utility of diffusion-weighted imaging in the evaluation of liver fibrosis. Eur Radiol 2012; 22: 682–687.

Sandrasegaran

Akisik

Lin

et al.

Value of diffusion-weighted MRI for assessing liver fibrosis and cirrhosis. Am J Roentgenol 2009; 193: 1556–1560.

Lewin

Poujol-Robert

Boelle

et al.

Diffusion-weighted magnetic resonance imaging for the assessment of fibrosis in chronic hepatitis C. Hepatology 2007; 46: 658–665.

Goshima

Kanematsu

Watanabe

et al.

Gd-EOB-DTPA-enhanced MR imaging: prediction of hepatic fibrosis stages using liver contrast enhancement index and liver-to-spleen volumetric ratio. J Magn Reson Imaging 2012; 36: 1148–1153.

Nishie

Asayama

Ishigami

et al.

MR prediction of liver fibrosis using a liver-specific contrast agent: Superparamagnetic iron oxide versus Gd-EOB-DTPA. J Magn Reson Imaging 2012; 36: 664–671.

10.

Watanabe

Kanematsu

Goshima

et al.

Staging hepatic fibrosis: comparison of gadoxetate disodium-enhanced and diffusion-weighted MR imaging–preliminary observations. Radiology 2011; 259: 142–150.

11.

Kwee

Takahara

Niwa

et al.

Influence of cardiac motion on diffusion-weighted magnetic resonance imaging of the liver. MAGMA 2009; 22: 319–325.

12.

Chen

Liu

et al.

Preoperative evaluation of the histological grade of hepatocellular carcinoma with diffusion-weighted imaging: a meta-analysis. PLoS One 2015; 10: e0117661–e0117661.

13.

Nojiri

Kusakabe

Fujiwara

et al.

Noninvasive evaluation of hepatic fibrosis in hepatitis C virus-infected patients using ethoxybenzyl-magnetic resonance imaging. J Gastroenterol Hepatol 2013; 28: 1032–1039.

14.

Tamada

Ito

Higaki

et al.

Gd-EOB-DTPA-enhanced MR imaging: evaluation of hepatic enhancement effects in normal and cirrhotic livers. Eur J Radiol 2011; 80: e311–316.

15.

Ichida

FTT

Omata

Ichida

et al.

New Inuyama classification; new criteria for histological assessment of chronic hepatitis. Int Hepatol Commun 1996; 6: 112–119.

16.

Poyraz

Onur

Kocakoc

et al.

Diffusion-weighted MRI of fatty liver. J Magn Reson Imaging 2012; 35: 1108–1111.

17.

Moore

Khatri

Madhuranthakam

et al.

Added value of diffusion-weighted acquisitions in MRI of the abdomen and pelvis. Am J Roentgenol 2014; 202: 995–1006.

18.

Boulanger

Amara

Lepanto

et al.

Diffusion-weighted MR imaging of the liver of hepatitis C patients. NMR Biomed 2003; 16: 132–136.

19.

Hansmann

Hernando

Reeder

. Fat confounds the observed apparent diffusion coefficient in patients with hepatic steatosis. Magn Reson Med 2013; 69: 545–552.

20.

Chandarana

Mussi

et al.

The effect of liver iron deposition on hepatic apparent diffusion coefficient values in cirrhosis. Am J Roentgenol 2012; 199: 803–808.

21.

Verloh

Haimerl

Zeman

et al.

Multivariable analysis of clinical influence factors on liver enhancement of Gd-EOB-DTPA-enhanced 3T MRI. Rofo 2015; 187: 29–35.

22.

Tschirch

Struwe

Petrowsky

et al.

Contrast-enhanced MR cholangiography with Gd-EOB-DTPA in patients with liver cirrhosis: visualization of the biliary ducts in comparison with patients with normal liver parenchyma. Eur Radiol 2008; 18: 1577–1586.

23.

Chen

Kuo

et al.

Early response of hepatocellular carcinoma to transcatheter arterial chemoembolization: choline levels and MR diffusion constants–initial experience. Radiology 2006; 239: 448–456.

24.

Nakanishi

Chuma

Hige

et al.

Relationship between diffusion-weighted magnetic resonance imaging and histological tumor grading of hepatocellular carcinoma. Ann Surg Oncol 2012; 19: 1302–1309.

25.

Aloysius

Zaitoun

Beckingham

et al.

The pathological response to neoadjuvant chemotherapy with FOLFOX-4 for colorectal liver metastases: a comparative study. Virchows Arch 2007; 451: 943–948.

26.

Aloia

Sebagh

Plasse

et al.

Liver histology and surgical outcomes after preoperative chemotherapy with fluorouracil plus oxaliplatin in colorectal cancer liver metastases. J Clin Oncol 2006; 24: 4983–4990.

27.

Kandutsch

Klinger

Hacker

et al.

Patterns of hepatotoxicity after chemotherapy for colorectal cancer liver metastases. Eur J Surg Oncol 2008; 34: 1231–1236.

Prediction of high-stage liver fibrosis using ADC value on diffusion-weighted imaging and quantitative enhancement ratio at the hepatobiliary phase of Gd-EOB-DTPA–enhanced MRI at 1.5 T

Abstract

Background

Purpose

Material and Methods

Results

Conclusion

Keywords

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References