Intravoxel Incoherent Motion Diffusion Weighted MR Imaging at 3.0 T: Assessment of Steatohepatitis and Fibrosis Compared with Liver Biopsy in Type 2 Diabetic Patients.

Daniella Braz Parente,Valeria Lanzoni,Jaime Araújo Oliveira Neto,Renata De Mello Perez,Rosana Souza Rodrigues,Lilian Machado-Silva,Fatima Aparecida Ferreira Figueiredo,Marilia De Brito Gomes,Pedro Emmanuel Alvarenga Americano Do Brasil,Carlos Frederico Ferreira Campos,Fernando Fernandes Paiva,Erica Villa

doi:10.1371/journal.pone.0125653

Abstract

ObjectiveTo evaluate the capability of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) to assess steatohepatitis and fibrosis determined by histopathology in type 2 diabetic patients.MethodsFifty-nine type 2 diabetic patients (49 women, 10 men; mean age, 54 ± 9 years) were submitted to liver biopsy for the evaluation of non-alcoholic fatty liver disease (NAFLD) and underwent DWI on a 3.0T MR system using 10 b values. Institutional approval and patient consent were obtained. Pure molecular-based (D), perfusion-related (D*), and vascular fraction (f) were calculated using a double exponential model and least squares curve fitting. D, D*, and f were compared between patients with and without steatohepatitis and between patients with and without fibrosis. The variables were compared by using the Ranksum test and Student t-test.ResultsSteatohepatitis was observed in 22 patients and fibrosis in 16 patients. A lower D median (0.70 s/mm2 vs. 0.83 s/mm2, p<0.05) and a lower D* median (34.39 s/mm2 vs. 45.23 s/mm2, p<0.05) were observed among those with steatohepatitis. A lower D median (0.70 s/mm2 vs. 0.82 s/mm2, p<0.05) and a lower D* median (35.01 s/mm2 vs. 44.76 s/mm2, p=0.05) were also observed among those with fibrosis.ConclusionIVIM-DWI has the potential to aid in the characterization of steatohepatitis and fibrosis.

Highlights

Steatohepatitis was observed in 22 patients and fibrosis in 16 patients
intravoxel incoherent motion (IVIM)-diffusion-weighted imaging (DWI) has the potential to aid in the characterization of steatohepatitis and fibrosis
Non-alcoholic fatty liver disease (NAFLD) is a clinicopathologic syndrome that varies from isolated steatosis, to steatohepatitis, which may progress to fibrosis and cirrhosis, with the risk for development of hepatocellular carcinoma [1,2,3]

Summary

Introduction

Non-alcoholic fatty liver disease (NAFLD) is a clinicopathologic syndrome that varies from isolated steatosis, to steatohepatitis, which may progress to fibrosis and cirrhosis, with the risk for development of hepatocellular carcinoma [1,2,3]. Due to limitations of liver biopsy (sampling and observer variations) and the need for staging of NAFLD, a lot of research have been done to develop non-invasive methods for the detection of inflammation and fibrosis, based on a combination of serum markers such as NASH test and Cytokeratin-18 for the diagnosis of steatohepatitis, and NAFLD-fibrosis score, BARD score, FIB-4, and HEPA score for the diagnosis of fibrosis. The identification of a non-invasive method that allows early detection of inflammation and fibrosis that are markers of more severe disease, to stage the disease, and to follow these patients is extremely important

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Conclusion