Abstract
Strong correlations between the grade of fibrosis and cirrhosis, classified using the Ishak scoring system, and the uptake characteristics of Gd-EOB-DTPA with the relative enhancement (RE) of the liver parenchyma have been reported. To confirm the results of a retrospective analysis, patients undergoing liver surgery were prospectively examined with Gd-EOB-DTPA-enhanced liver 3 Tesla MRI to determine the degree of liver fibrosis. Correlations between the grade of fibrosis and cirrhosis, classified using the Ishak scoring system, and RE were investigated and compared with those derived from an initial retrospective study. After validating the cut-off values in the retrospective study (Ishak ≥ 1, RE-cut-off 0.90; Ishak ≥ 2, RE-cut-off 0.79; Ishak ≥ 4, RE-cut-off 0.60; and Ishak = 6, RE-cut-off 0.47), we showed that Gd-EOB-DTPA has a high sensitivity (≥86%) and a high positive predictive value (≥86%). These results support the use of Gd-EOB-DTPA-enhanced liver MRI as a non-invasive method for determining the degree of liver fibrosis and cirrhosis.
Highlights
Information regarding the grade of liver fibrosis and cirrhosis is essential for determining the prognosis and clinical management of patients with a chronic liver disease or patients who undergo liver surgery[6,7]
A comparison of the patients with no liver fibrosis (NLF) and those with liver fibrosis (LF) stratified according to the Ishak classification revealed that relative enhancement (RE) decreased together with the extent of liver fibrosis
In adjusted pairwise comparisons (Fig. 1, Table 1), significant differences were observed between patients without fibrosis (NLF, Ishak = 0; RE, 1.25 ± 0.18) and mild liver fibrosis (MLF, Ishak = 1; RE, 0.94 ± 0.17) (p = 0.020), as well as between patients with ALF and severe liver fibrosis (SLF, Ishak 4 + 5; RE, 0.43 ± 0.20) (p = 0.004)
Summary
Information regarding the grade of liver fibrosis and cirrhosis is essential for determining the prognosis and clinical management of patients with a chronic liver disease or patients who undergo liver surgery[6,7]. In clinical practice, obtaining a liver biopsy is the gold standard for monitoring the state of liver fibrosis and observing treatment response. An image-based technique would be helpful, as it would allow a small section of the liver and the entire organ to be examined. The corresponding values for US-based vibration-controlled transient elastography have been reported to be 83.7–91.4%14–16. One disadvantage of these examinations is that liver stiffness is only an indirect sign of liver fibrosis; concomitant diseases, such as heart failure, affect liver stiffness. In addition to those limitations, some of the abovementioned examinations require additional equipment, limiting the applicability and the routine use of these techniques in clinical practice
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