Quantitative liver MR imaging with DWI sequence and Normalized ADC in diagnosis and staging of hepatitis C virus liver fibrosis and cirrhosis, a comparative study with transient elastography (Fibroscan) in egyptian patients

Abstract

Abstract Purpose To evaluate the diagnostic efficacy of quantitative liver MR imaging using diffusion-weighted imaging (DWI) and normalized apparent diffusion coefficient (ADC) in diagnosis and staging of liver fibrosis and cirrhosis in egyptian patients with hepatitis C virus (HCV) infection and compare the results with transient elastography (FibroScan). Materials and Methods Twenty-five patients known to have hepatitis C virus were enrolled after fulfilling inclusion and exclusion criteria.. Quantification of liver, spleen and muscle ADC values was done using MRI DWI sequences using 4 different b-values (0, 200, 400, 800). Normalized ADC was calculated as the ratio of liver ADC to spleen ADC.. Post processing was performed using 3D synapse ADC viewer Tool. Results Liver ADC failed to distinguish different stages of fibrosis, except between stages 2 and 3 (p = 0.016). Normalized liver ADC distinguished between individual groups of fibrosis , with significant differences between mild stages (stage 0/1) and sever stages of fibrosis (stages 3) and between stages 0/1 and cirrhosis (stage 4). There were significant differences between stages 0–2 and 3–4 using normalized liver ADC. There was a statistically significant moderate correlation between fibrosis stage and normalized liver ADC (r = −0.403; p = 0.009). ROC analysis revealed higher performance using normalized liver ADC compared with liver ADC, with higher AUC, sensitivity, and specificity for detection of cirrhosis (stage 0 vs 4 and stages 0–3 vs 4), moderate-to-advanced fibrosis (stages 2–4), and advanced fibrosis and cirrhosis (stages 3–4), reaching significance for all comparisons except for diagnosis of stage 4 (cirrhosis). Conclusion Our results suggest that normalizing liver ADC with spleen ADC improves diagnostic accuracy for detection of liver fibrosis and cirrhosis in egyptian population when using breath-hold diffusion-weighted imaging.