Abstract
PurposeThis study was aimed to determine whether pure molecular-based diffusion coefficient (D) and perfusion-related diffusion parameters (perfusion fraction f, perfusion-related diffusion coefficient D*) differ in healthy livers and fibrotic livers through intra-voxel incoherent motion (IVIM) MR imaging.Material and Methods17 healthy volunteers and 34 patients with histopathologically confirmed liver fibrosis patients (stage 1 = 14, stage 2 = 8, stage 3& 4 = 12, METAVIR grading) were included. Liver MR imaging was performed at 1.5-T. IVIM diffusion weighted imaging sequence was based on standard single-shot DW spin echo-planar imaging, with ten b values of 10, 20, 40, 60, 80, 100, 150, 200, 400, 800 sec/mm2 respectively. Pixel-wise realization and regions-of-interest based quantification of IVIM parameters were performed.Results D, f, and D* in healthy volunteer livers and patient livers were 1.096±0.155 vs 0.917±0.152 (10−3 mm2/s, p = 0.0015), 0.164±0.021 vs 0.123±0.029 (p<0.0001), and 13.085±2.943 vs 9.423±1.737 (10−3 mm2/s, p<0.0001) respectively, all significantly lower in fibrotic livers. As the fibrosis severity progressed, D, f, and D* values decreased, with a trend significant for f and D*.ConclusionFibrotic liver is associated with lower pure molecular diffusion, lower perfusion volume fraction, and lower perfusion-related diffusion. The decrease of f and D* in the liver is significantly associated liver fibrosis severity.
Highlights
Chronic liver disease is a major public health problem worldwide [1]
[20], stage 1 of liver fibrosis is mild fibrosis only seen at the portal area; stage 2 indicates fibrosis extending out from the portal areas with rare bridges between portal areas, but without the destruction of the lobular structure; stage 3 of liver fibrosis is severe fibrosis, there is fibrostic bridging between portal areas and between portal areas and center veins; In stage 4 there are pseudo-lobules formed and this stage is the final stage of cirrhosis
The intra-voxel incoherent motion (IVIM) model assumes that each imaging voxel comprises nonexchanging intravascular and extravascular compartments
Summary
Chronic liver disease is a major public health problem worldwide [1]. Liver fibrosis, a common feature of almost all chronic liver diseases, involves the accumulation of collagen, proteoglycans, and other macromolecules in the extracellular matrix. Liver biopsy is currently the standard of reference for the diagnosis and staging of liver fibrosis. It is an invasive procedure with possible complications [7]. The extent of variations from observer interpretation by expert histopathologists may be as high as 20% [8]. These limitations make liver biopsy somewhat suboptimal for diagnosis and longitudinal monitoring in the general population. A noninvasive and quantitative technique for assessing liver fibrosis and monitoring disease progression or therapeutic intervention will be valuable [1, 9, 10]
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