Abstract
PurposeThe diagnosis and monitoring of liver fibrosis is an important clinical issue; however, this is usually achieved by invasive methods such as biopsy. We aimed to determine whether histogram analysis of hepatobiliary phase images of gadoxetic acid-enhanced magnetic resonance imaging (MRI) can provide non-invasive quantitative measurement of liver fibrosis.MethodsThis retrospective study was approved by the institutional ethics committee, and a waiver of informed consent was obtained. Hepatobiliary phase images of preoperative gadoxetic acid-enhanced MRI studies of 105 patients (69 males, 36 females; age 56.1±12.2) with pathologically documented liver fibrosis grades were analyzed. Fibrosis staging was F0/F1/F2/F3/F4 (METAVIR system) for 11/20/13/15/46 patients, respectively. Four regions-of-interest (ROI, each about 2 cm2) were placed on predetermined locations of representative images. The measured signal intensity of pixels in each ROI was used to calculate corrected coefficient of variation (cCV), skewness, and kurtosis. An average value of each parameter was calculated for comparison. Statistical analysis was performed by ANOVA, receiver operating characteristic (ROC) curve analysis, and linear regression.ResultsThe cCV showed statistically significant differences among pathological fibrosis grades (P<0.001) whereas skewness and kurtosis did not. Univariable linear regression analysis suggested cCV to be a meaningful parameter in predicting the fibrosis grade (P<0.001, β = 0.40 and standard error = 0.06). For discriminating F0-3 from F4, the area under ROC score was 0.857, standard deviation 0.036, 95% confidence interval 0.785–0.928.ConclusionHistogram analysis of hepatobiliary phase images of gadoxetic acid-enhanced MRI can provide non-invasive quantitative measurements of hepatic fibrosis.
Highlights
Liver fibrosis is a common response to almost any kind of chronic hepatic insult
Histograms based on regions of interest (ROI) data obtained from fibrosis-free livers showed a tall and sharp peak and the overall outline of the graph appeared narrow and slender
The histograms of fibrotic livers were relatively blunted with shorter peaks, and the outline of the graph itself was relatively wider, and the fibrosis grade seemed to affect the overall shape of the graph (Figure 4)
Summary
Liver fibrosis is a common response to almost any kind of chronic hepatic insult. If the underlying chronic pathology is uncorrected, progressive inflammation and fibrosis may lead to liver cirrhosis [1]. The degree of liver fibrosis is a critical factor that substantially influences the prognosis and clinical management of chronic liver diseases. Accurate assessment of liver fibrosis is essential [2]. Liver biopsy is the gold standard for evaluating hepatic fibrosis, it has several limitations such as invasiveness, patient compliance, potential sampling errors and intra/inter-observer variations [1,2,3,4]. Demands for less invasive and more feasible methods have stimulated research on imagingbased approaches for fibrosis measurement
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