Liver Fibrosis Assessment with Diffusion-Weighted Imaging: Value of Liver Apparent Diffusion Coefficient Normalization Using the Spleen as a Reference Organ.

Shin Shin,Hwang Hwang,Song Song,Kim Kim,Moon Moon

doi:10.3390/diagnostics9030107

Abstract

Liver fibrosis staging is of great clinical importance because it is used to assess the severity of the underlying chronic liver disease. Among various imaging-based methods, apparent diffusion coefficient (ADC) measurement using diffusion-weighted imaging (DWI) has the potential to be used as an imaging biomarker for liver fibrosis assessment. In this study, we investigated the usefulness of liver ADC normalization using the spleen as a reference organ in liver fibrosis staging with 66 patients who underwent liver magnetic resonance imaging (MRI), transient elastography (TE), and surgical resection of a hepatic mass. ADC values of the liver (ADCliver) and spleen were analyzed, and the spleen was used for ADCliver normalization (nADCliver). ADCliver showed a weak negative correlation with TE (r = −0.246; p = 0.047) and fibrosis stage (r = −0.269; p = 0.029), while n ADCliver showed a moderate negative correlation with TE (r = −0.504; p < 0.001) and fibrosis stage (r = −0.579; p < 0.001). AUC values for nADCliver (0.777–0.875) were higher than those for ADCliver for each stage of fibrosis (0.596–0.713, p = 0.037–0.157). AUC values for TE (0.726–0.884) and nADCliver were not statistically different. In conclusion, normalized liver ADC can be useful in diagnosing liver fibrosis stage in patients with variable DWI acquisitions.

Highlights

Liver fibrosis is characterized by excessive deposition of extracellular matrix proteins in response to injury and failure of cellular repair efforts to degrade these deposits
Based on the results of AUC, the diagnostic performance of nADCliver was superior to ADCliver, with significant differences in fibrosis staging results for ≥F2 (p = 0.031) and ≥F4 (p = 0.041). nADCliver demonstrated good diagnostic performance in diagnosing all stages of fibrosis
Based on the results of AUC, the diagnostic performance of nADCliver was superior to ADCliver, with significant differences in fibrosis staging results for ≥F2 (p = 0.031) and ≥F4 (p = 0.041). nADCliver demonstrated good diagnostic performance in diagnosing all stages of fibrosis in comparison to transient elastography (TE) (p > 0.05, no significant differences between the parameters)

Summary

Introduction

Liver fibrosis is characterized by excessive deposition of extracellular matrix proteins in response to injury and failure of cellular repair efforts to degrade these deposits. Liver fibrosis can progress to cirrhosis, which puts patients at a higher risk for hepatocellular carcinoma (HCC) and hepatic decompensation. Identification of fibrosis precisely over the entire pathologic spectrum, from early-stage fibrosis to cirrhosis, is of considerable clinical importance for managing patients with chronic liver disease [1]. Early detection of fibrosis is important because of the potential to prevent fibrosis progression, or even its reversal by elimination of causative factors [2]. Many noninvasive image-based methods to assess liver fibrosis have been investigated, including transient elastography (TE), magnetic resonance elastography (MRE), diffusion-weighted imaging (DWI), perfusion-weighted imaging, and MR spectroscopy [3,4,5].

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