Magnetic resonance elastography (MRE), susceptibility-weighted imaging (SWI), and T1ρ are three techniques for staging of liver fibrosis (LF).
Purpose
To assess the value of MRE, SWI, and T1ρ imaging in staging LF.
Material and Methods
Sixty rabbits were injected with 50% CCl4oil solution, whereas 20 rabbits were given normal saline. All rabbits underwent pathological examination to determine LF stages. The liver stiffness (LS), liver-to-muscle signal intensity ratio (SIR), and T1ρ values were measured from MRE, SWI, and T1ρ imaging, respectively.
Results
The number of rabbits was 14, 11, 10, 9, and 11 for F0, F1, F2, F3, and F4, respectively. LS (r = 0.91) and T1ρ (r = 0.51) positively correlated with LF stages, while negative correlation was present for SIR (r = –0.81). Among the three parameters, the LS values revealed the best diagnostic efficacy in staging LF, with an AUC value of 0.95 for ≥F1, 0.95 for ≥F2, 0.99 for ≥F3, and 0.98 for ≥F4. The combination of LS and SIR could best predict LF stages ≥F1, ≥F2, ≥F3 and ≥F4, with AUC values of 0.97, 0.98, 0.99, and 0.99, respectively, which were greater than those of the other two-paired parameters. A multiparametric analysis showed that the combination of all three parameters had AUC values of 0.97, 0.98, 1.00, and 1.00 for staging ≥F1, ≥F2, ≥F3, and ≥F4, respectively.
Conclusion
Multiparametric MR imaging was superior to individual imaging for LF staging.
TackeFTrautweinC.Mechanisms of liver fibrosis resolution. J Hepatol2015;
63:1038–1039.
2.
SchuppanD.Liver fibrosis: Common mechanisms and antifibrotic therapies. Clin Res Hepatol Gastroenterol2015;
39:S51–59.
3.
HernandezGVFriedmanSL.Pathogenesis of liver fibrosis. Ann Rev Pathol2011;
6:425–456.
4.
Altamirano-BarreraABarranco-FragosoBMendez-SanchezN.Management strategies for liver fibrosis. Ann Hepatol2017;
16:48–56.
5.
KoyamaYXuJLiuX, et al.
New Developments on the Treatment of Liver Fibrosis. Dig Dis2016;
34:589–596.
6.
RockeyDCCaldwellSHGoodmanZD, et al.
Liver biopsy. Hepatology2009;
49:1017–1044.
7.
CzeczokTWVan ArnamJSWoodLD, et al.
The Almost-Normal Liver Biopsy: Presentation, Clinical Associations, and Outcome. Am J Surg Pathol2017;
41:1247–1253.
8.
SalkicNNJovanovicPHauserG, et al.
FibroTest/Fibrosure for significant liver fibrosis and cirrhosis in chronic hepatitis B: a meta-analysis. Am J Gastroenterol2014;
109:796–809.
9.
XiaoGZhuSXiaoX, et al.
Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis. Hepatology2017;
66:1486–1501.
10.
KimYSJangYNSongJS.Comparison of gradient-recalled echo and spin-echo echo-planar imaging MR elastography in staging liver fibrosis: a meta-analysis. Eur Radiol2018;
28:1709–1718.
11.
PetitclercLSebastianiGGilbertG, et al.
Liver fibrosis: Review of current imaging and MRI quantification techniques.J Magn Reson Imaging2017;
45:1276–1295.
12.
FeierDBalassyCBastatiN, et al.
The diagnostic efficacy of quantitative liver MR imaging with diffusion-weighted, SWI, and hepato-specific contrast-enhanced sequences in staging liver fibrosis–a multiparametric approach. Eur Radiol2016;
26:539–546.
13.
BanerjeeRPavlidesMTunnicliffeEM, et al.
Multiparametric magnetic resonance for the non-invasive diagnosis of liver disease. J Hepatol2014;
60:69–77.
WangMJLingWWWangH, et al.
Non-invasive evaluation of liver stiffness after splenectomy in rabbits with CCl4-induced liver fibrosis. World J Gastroenterol2016;
22:10166–10179.
16.
GandonYOlivieDGuyaderD, et al.
Non-invasive assessment of hepatic iron stores by MRI. Lancet2004;
363:357–362.
17.
ShiehG.A comparison of two indices for the intraclass correlation coefficient. Behav Res Methods2012;
44:1212–1223.
18.
DemlerOVPencinaMJD’AgostinoRBSr.Misuse of DeLong test to compare AUCs for nested models. Stat Med2012;
31:2577–2587.
19.
VenkateshSKEhmanRL.Magnetic resonance elastography of liver. Magn Reson Imaging Clin N Am2014;
22:433–446.
20.
HoodeshenasSYinMVenkateshSK.Magnetic resonance elastography of liver: current update. Top Magn Reson Imaging2018;
27:319–333.
21.
SinghSVenkateshSKWangZ, et al.
Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data. Clin Gastroenterol Hepatol2015;
13:440–451.
22.
VenkateshSKXuSTaiD, et al.
Correlation of MR elastography with morphometric quantification of liver fibrosis (Fibro-C-Index) in chronic hepatitis B. Magn Reson Med2014;
72:1123–1129.
23.
CrespoSBridgesMNakhlehR, et al.
Non-invasive assessment of liver fibrosis using magnetic resonance elastography in liver transplant recipients with hepatitis C. Clin Transplant2013;
27:652–658.
24.
Fenstad ERDzyubakBOhJK, et al.
Evaluation of liver stiffness with magnetic resonance elastography in patients with constrictive pericarditis: Preliminary findings. J Magn Reson Imaging2016;
44:81–88.
25.
MorisakaHMotosugiUIchikawaS, et al.
Magnetic resonance elastography is as accurate as liver biopsy for liver fibrosis staging. J Magn Reson Imaging2018;
47:1268–1275.
26.
CaiYHuangMPWangXF, et al.
Quantitative analysis of susceptibility-weighted magnetic resonance imaging in chronic hepatitis in rats. Magn Reson Imaging2018;
54:71–76.
27.
LiRKZengMSQiangJW, et al.
Improving detection of iron deposition in cirrhotic liver using susceptibility-weighted imaging with emphasis on histopathological correlation. J Comput Assist Tomogr2017;
41:18–24.
28.
LiRKPalmerSLZengMS, et al.
Detection of endogenous iron reduction during hepatocarcinogenesis at susceptibility-weighted MR imaging: value for characterization of hepatocellular carcinoma and dysplastic nodule in cirrhotic liver. PLoS One2015;
10:e0142882.
29.
BalassyCFeierDPeck-RadosavljevicM, et al.
Susceptibility-weighted MR imaging in the grading of liver fibrosis: a feasibility study. Radiology2014;
270:149–158.
30.
CaiYHuangMPWangXF, et al.
Quantitative analysis of susceptibility-weighted magnetic resonance imaging in chronic hepatitis in rats. Magn Reson Imaging2018;
54:71–76.
31.
LabrancheRGilbertGCernyM, et al.
Liver iron quantification with MR imaging: a primer for radiologists. Radiographic2018;
38:392–412.
32.
AllkemperTSagmeisterFCicinnatiV, et al.
Evaluation of fibrotic liver disease with whole-liver T1rho MR imaging: a feasibility study at 1.5 T. Radiology2014;
271:408–415.
33.
HuGZhangXLiangW, et al.
Assessment of liver fibrosis in rats by MRI with apparent diffusion coefficient and T1 relaxation time in the rotating frame. J Magn Reson Imaging2016;
43:1082–1089.
34.
RauscherIEiberMGanterC, et al.
Evaluation of T1rho as a potential MR biomarker for liver cirrhosis: comparison of healthy control subjects and patients with liver cirrhosis. Eur J Radiol2014;
83:900–904.
35.
WangYXYuanJChuES, et al.
T1rho MR imaging is sensitive to evaluate liver fibrosis: an experimental study in a rat biliary duct ligation model. Radiology2011;
259:712–719.
36.
TakayamaYNishieAAsayamaY, et al.
T1 rho Relaxation of the liver: A potential biomarker of liver function. J Magn Reson Imaging2015;
42:188–195.
