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Hanniman E, Costa AF, Bowen CV, Abdolell M, Stueck A, McLeod M, Peltekian K, Rioux J, Clarke SE. Prospective Evaluation of Virtual MR Elastography With Diffusion-Weighted Imaging in Subjects With Nonalcoholic Fatty Liver Disease. J Magn Reson Imaging 2022; 56:1448-1456. [PMID: 35285996 DOI: 10.1002/jmri.28154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is increasingly common worldwide and can lead to the development of cirrhosis, liver failure and cancer. Virtual magnetic resonance elastography (VMRE), which is based on a shifted apparent diffusion coefficient (sADC), is a potential noninvasive method to assess liver fibrosis without the specialized hardware and expertise required to implement traditional MR elastography (MRE). Although hepatic steatosis is known to confound ADC measurements, previous studies using VMRE have not corrected for hepatic fat fraction. PURPOSE To compare VMRE, corrected for the confounding effects of unsuppressed fat signal, to MRE and biopsy in subjects with suspected NAFLD. STUDY TYPE Prospective, cross-sectional. POPULATION A total of 49 adult subjects with suspected NAFLD (18 male; median age 55 years, range 33-74 years) who underwent liver biopsy. FIELD STRENGTH/SEQUENCE 3T, diffusion-weighted spin echo planar, chemical-shift encoded (IDEAL IQ) and MRE sequences. ASSESSMENT Two observers drew regions of interest on sADC, proton density fat fraction and MRE-derived stiffness maps. Fat-corrected sADC values were used to calculate the diffusion-based shear modulus according to the VMRE method. Predicted fibrosis stage for MRE and VMRE was determined using previously published cut-off values. STATISTICAL TESTS The relationship between VMRE and MRE was assessed with least-squares linear regression (coefficient of determination, R2 ). Agreement between MRE and VMRE-predicted fibrosis stage was evaluated with a kappa coefficient and accuracy compared using McNemar's test. A one-way ANOVA determined if the fat-corrected sADC (VMRE) and MRE differed by fibrosis stage. A P value < 0.05 was considered statistically significant. RESULTS Least squares regression of VMRE vs. MRE revealed R2 = 0.046 and a slope that was not significantly different from zero (P = 0.14). There was no agreement between MRE and VMRE-predicted fibrosis stage (kappa = -0.01). The proportion of correctly predicted fibrosis stage was significantly higher for MRE compared to VMRE. MRE was significantly associated with fibrosis stage, but fat-corrected sADC was not (P = 0.24). DATA CONCLUSION Fat-corrected VMRE was not associated with fibrosis stage in NAFLD. Further investigation is required if VMRE is to be considered in subjects with NAFLD. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Elyisha Hanniman
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Chris V Bowen
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Mohamed Abdolell
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Ashley Stueck
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Magnus McLeod
- Department of Medicine, Division of General Internal Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kevork Peltekian
- Department of Medicine, Division of Digestive Care and Endoscopy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - James Rioux
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada
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Comparison of the Effects of Hepatic Steatosis on Monoexponential DWI, Intravoxel Incoherent Motion Diffusion-weighted Imaging and Diffusion Kurtosis Imaging. Acad Radiol 2021; 28 Suppl 1:S203-S209. [PMID: 34119399 DOI: 10.1016/j.acra.2021.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 12/15/2022]
Abstract
RATIONALE AND OBJECTIVES Diffusion-weighted imaging (DWI) techniques have drawn attention for their capability of staging hepatic fibrosis. However, the diagnostic performance of DWI for hepatic fibrosis might be affected by hepatic steatosis because hepatic steatosis and fibrosis may have a similar effect on diffusion/perfusion parameters. Therefore, the purpose of our study is to investigate the effect of hepatic steatosis on DWI parameters. MATERIALS AND METHODS 51 patients with MR elastography liver stiffness values below 3.45kPa underwent DWI with multiple b-values and a multi-echo Dixon sequence for fat quantification. Correlation analysis was conducted between fat fraction and DWI parameters, and DWI parameters were compared between steatosis and non-steatosis groups. RESULTS Significant negative correlation was observed between fat fraction and apparent diffusion coefficient (ADC) (r = -0.62, p <0.001), pure molecular diffusion (D) (r = -0.62, p <0.001), corrected ADC (Dapp) (r = -0.36, p = 0.01) and a positive correlation with mean kurtosis (Kapp) (r = 0.53, p <0.001). The results of the comparison of DWI parameters were that ADC, D and Dapp were statistically lower in the steatosis group (p < 0.001, p < 0.001 and p = 0.026, respectively) and Kapp was significantly higher in the steatosis group (p <0.001) compared to the non-steatosis group. However, perfusion-related parameters (D* and f) did not show any statistical significance. CONCLUSION DWI parameters except for perfusion-related parameters (D* and f) are affected by changes in hepatic steatosis. Thus, hepatic steatosis may be considered as a possible confounding factor in DWI-based assessment of liver fibrosis.
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Makhija N, Vikram NK, Srivastava DN, Madhusudhan KS. Role of Diffusion-Weighted Magnetic Resonance Imaging in the Diagnosis and Grading of Hepatic Steatosis in Patients With Non-alcoholic Fatty Liver Disease: Comparison With Ultrasonography and Magnetic Resonance Spectroscopy. J Clin Exp Hepatol 2021; 11:654-660. [PMID: 34866843 PMCID: PMC8617527 DOI: 10.1016/j.jceh.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/20/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is becoming the most common cause of cirrhosis. Although magnetic resonance spectroscopy (MRS) is considered the gold standard, it has a few limitations. The role of diffusion-weighted imaging (DWI), which is a simpler sequence, in the diagnosis and grading of fatty liver is not well studied. The aim of the study was to investigate the value of DWI in the diagnosis and grading of hepatic steatosis in patients with NAFLD. MATERIALS AND METHODS Fifty-one adults (mean age: 38 years; 28 men, 23 women) with NAFLD, diagnosed clinically and by ultrasonography (USG), were included in the study after obtaining informed consent and approval from the institute ethics committee. USG was performed for grading of hepatic steatosis in all patients, followed by magnetic resonance imaging with DWI and MRS, on a 1.5T scanner. The mean apparent diffusion coefficient (ADC) values and proton density fat fraction (PDFF) were calculated, and MRS was used as the gold standard. The mean ADC values were compared with the PDFF and USG grades. RESULTS There was a weak correlation between ADC values and PDFF (r = -0.36; P < 0.05). In addition, there was a weak correlation between the ADC values of the liver and USG grade (r = -0.34; P < 0.05). However, an overall increase in USG grades and PDFF was associated with decrease in the mean ADC value (P < 0.001). CONCLUSION DWI is not accurate in the diagnosis and grading of hepatic steatosis in patients with NAFLD. However, a significant increase in fat deposition in the liver lowers the ADC values.
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Affiliation(s)
- Nikhil Makhija
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India
| | - Naval K. Vikram
- Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India
| | - Deep N. Srivastava
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India
| | - Kumble S. Madhusudhan
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 10029, India,Address for correspondence: Kumble S. Madhusudhan, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Steger GL, Salesov E, Richter H, Reusch CE, Kircher PR, Del Chicca F. Evaluation of the changes in hepatic apparent diffusion coefficient and hepatic fat fraction in healthy cats during body weight gain. Am J Vet Res 2020; 81:796-803. [PMID: 32969732 DOI: 10.2460/ajvr.81.10.796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the change in mean hepatic apparent diffusion coefficient (ADC) and hepatic fat fraction (HFF) during body weight gain in cats by use of MRI. ANIMALS 12 purpose-bred adult neutered male cats. PROCEDURES The cats underwent general health and MRI examination at time 0 (before dietary intervention) and time 1 (after 40 weeks of being fed high-energy food ad libitum). Sequences included multiple-echo gradient-recalled echo MRI and diffusion-weighted MRI with 3 b values (0, 400, and 800 s/mm2). Variables (body weight and the HFF and ADC in selected regions of interest in the liver parenchyma) were compared between time points by Wilcoxon paired-sample tests. Relationships among variables were assessed with generalized mixed-effects models. RESULTS Median body weight was 4.5 and 6.5 kg, mean ± SD HFF was 3.39 ± 0.89% and 5.37 ± 1.92%, and mean ± SD hepatic ADC was 1.21 ± 0.08 × 10-3 mm2/s and 1.01 ± 0.2 × 10-3 mm2/s at times 0 and 1, respectively. Significant differences between time points were found for body weight, HFF, and ADC. The HFF was positively associated with body weight and ADC was negatively associated with HFF. CONCLUSIONS AND CLINICAL RELEVANCE Similar to findings in people, cats had decreasing hepatic ADC as HFF increased. Protons associated with fat tissue in the liver may reduce diffusivity, resulting in a lower ADC than in liver with lower HFF. Longer studies and evaluation of cats with different nutritional states are necessary to further investigate these findings.
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Huang M, Lu X, Wang X, Shu J. Diffusion tensor imaging quantifying the severity of chronic hepatitis in rats. BMC Med Imaging 2020; 20:74. [PMID: 32615932 PMCID: PMC7333377 DOI: 10.1186/s12880-020-00466-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/04/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) is mainly used for detecting white matter fiber in the brain. DTI was applied to assess fiber in liver disorders in previous studies. However, the data obtained have been insufficient in determining if DTI can be used to exactly stage chronic hepatitis. This study assessed the value of DTI for staging of liver fibrosis (F), necroinflammatory activity (A) and steatosis (S) with chronic hepatitis in rats. METHODS Seventy male Sprague-Dawley rats were divided into a control group(n = 10) and an experimental group(n = 60). The rat models of chronic hepatitis were established by abdominal subcutaneous injections of 40% CCl4. All of the rats underwent 3.0 T MRI. Regions of interest (ROIs) were subjected to DTI to estimate the MR parameters (rADC value and FA value). Histopathology was used as the reference standard. Multiple linear regression was used to analyze the associations between the MR parameters and pathology. The differences in the MR parameters among the pathological stages were evaluated by MANOVA or ANOVA. The LSD test was used to test for differences between each pair of groups. ROC analysis was also performed. RESULTS The count of each pathology was as follows: F0(n = 15), F1(n = 11), F2(n = 6), F3(n = 9), F4(n = 6); A0(n = 8), A1(n = 16), A2(n = 16), A3(n = 7); S0(n = 10), S1(n = 7), S2(n = 3), S3(n = 11), S4(n = 16). The rADC value had a negative correlation with liver fibrosis (r = - 0.392, P = 0.008) and inflammation (r = - 0.359, P = 0.015). The FA value had a positive correlation with fibrosis (r = 0.409, P = 0.005). Significant differences were found in the FA values between F4 and F0 ~ F3 (P = 0.03), while no significant differences among F0 ~ F3 were found (P > 0.05). The AUC of the FA value differentiating F4 from F0 ~ F3 was 0.909 (p < 0.001) with an 83.3% sensitivity and an 85.4% specificity when the FA value was at the cut-off of 588.089 (× 10- 6 mm2/s). CONCLUSION The FA value for DTI can distinguish early cirrhosis from normal, mild and moderate liver fibrosis, but the rADC value lacked the ability to differentiate among the fibrotic grades. Both the FA and rADC values were unable to discriminate the stages of necroinflammatory activity and steatosis.
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Affiliation(s)
- Mengping Huang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, Sichuan, 646000, People's Republic of China
| | - Xin Lu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, Sichuan, 646000, People's Republic of China
| | - Xiaofeng Wang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, Sichuan, 646000, People's Republic of China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, Sichuan, 646000, People's Republic of China.
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Li C, Ye J, Prince M, Peng Y, Dou W, Shang S, Wu J, Luo X. Comparing mono-exponential, bi-exponential, and stretched-exponential diffusion-weighted MR imaging for stratifying non-alcoholic fatty liver disease in a rabbit model. Eur Radiol 2020; 30:6022-6032. [PMID: 32591883 DOI: 10.1007/s00330-020-07005-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/17/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare diffusion parameters obtained from mono-exponential, bi-exponential, and stretched-exponential diffusion-weighted imaging (DWI) in stratifying non-alcoholic fatty liver disease (NAFLD). METHODS Thirty-two New Zealand rabbits were fed a high-fat/cholesterol or standard diet to obtain different stages of NAFLD before 12 b-values (0-800 s/mm2) DWI. The apparent diffusion coefficient (ADC) from the mono-exponential model; pure water diffusion (D), pseudo-diffusion (D*), and perfusion fraction (f) from bi-exponential DWI; and distributed diffusion coefficient (DDC) and water molecular diffusion heterogeneity index (α) from stretched-exponential DWI were calculated for hepatic parenchyma. The goodness of fit of the three models was compared. NAFLD severity was pathologically graded as normal, simple steatosis, borderline, and non-alcoholic steatohepatitis (NASH). Spearman rank correlation analysis and receiver operating characteristic curves were used to assess NAFLD severity. RESULTS Upon comparison, the goodness of fit chi-square from stretched-exponential fitting (0.077 ± 0.012) was significantly lower than that for the bi-exponential (0.110 ± 0.090) and mono-exponential (0.181 ± 0.131) models (p < 0.05). Seven normal, 8 simple steatosis, 6 borderline, and 11 NASH livers were pathologically confirmed from 32 rabbits. Both α and D increased with increasing NAFLD severity (r = 0.811 and 0.373, respectively; p < 0.05). ADC, f, and DDC decreased as NAFLD severity increased (r = - 0.529, - 0.717, and - 0.541, respectively; p < 0.05). Both α (area under the curve [AUC] = 0.952) and f (AUC = 0.931) had significantly greater AUCs than ADC (AUC = 0.727) in the differentiation of NASH from borderline or less severe groups (p < 0.05). CONCLUSIONS Stretched-exponential DWI with higher fitting efficiency performed, as well as bi-exponential DWI, better than mono-exponential DWI in the stratification of NAFLD severity. KEY POINTS • Stretched-exponential diffusion model fitting was more reliable than the bi-exponential and mono-exponential diffusion models (p = 0.039 and p < 0.001, respectively). • As NAFLD severity increased, the diffusion heterogeneity index (α) increased, while the perfusion fraction (f) decreased (r = 0.811, - 0.717, p < 0.05). • Both α and f showed superior NASH diagnostic performance (AUC = 0.952, 0.931) compared with ADC (AUC = 0.727, p < 0.05).
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Affiliation(s)
- Chang Li
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, People's Republic of China.,Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, 510120, People's Republic of China
| | - Jing Ye
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Martin Prince
- Department of Radiology, Weill Medical College of Cornell University, 407 E 61st Street, New York, NY, 10065, USA
| | - Yun Peng
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Bejing, 100176, China
| | - Songan Shang
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Jingtao Wu
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Xianfu Luo
- Department of Radiology, Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, No. 98 Nantong West Road, Yangzhou, 225001, People's Republic of China.
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Ameli S, Shaghaghi M, Aliyari Ghasabeh M, Pandey P, Hazhirkarzar B, Ghadimi M, Rezvani Habibabadi R, Khoshpouri P, Pandey A, Anders RA, Kamel IR. Role of baseline volumetric functional MRI in predicting histopathologic grade and patients’ survival in hepatocellular carcinoma. Eur Radiol 2020; 30:3748-3758. [DOI: 10.1007/s00330-020-06742-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 12/22/2022]
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Evaluation of diffusion kurtosis imaging in stratification of nonalcoholic fatty liver disease and early diagnosis of nonalcoholic steatohepatitis in a rabbit model. Magn Reson Imaging 2019; 63:267-273. [PMID: 31445117 DOI: 10.1016/j.mri.2019.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To examine the feasibility of MR diffusion kurtosis imaging (DKI) for characterizing nonalcoholic fatty liver disease (NAFLD) and diagnosing nonalcoholic steatohepatitis (NASH). METHODS Thirty-two rabbits on high fat diet with different severities of NAFLD were imaged at 3 T MR including diffusion weighted imaging (DWI) and DKI using b values of 0, 400, 800 s/mm2 with 15 diffusion directions at each b value. Apparent diffusion coefficient (ADC) was derived from the linear exponential DWI model. Mean diffusion (MD) and mean kurtosis (MK) were derived from the quadratic exponential model of DKI. Correlations between MR parameters and hepatic pathology determined by the NAFLD activity scoring system were analyzed by Spearman rank correlation analysis. Receiver operating characteristic analyses were applied to determine the cutoff values of MD, MK as well as ADC in distinguishing NASH from non-NASH. The diagnostic efficacies of MD and MK in detecting NASH were compared with that of ADC. RESULTS Values for ADC and MD significantly decreased as the severity of NAFLD increased (ρ = -0.529, -0.904, respectively; P < 0.05). MK values significantly increased as the severity of NAFLD increased (ρ = 0.761; P < 0.05). In addition, both MD and MK values were significantly different between borderline NASH and NASH groups (MD: 1.729 ± 0.144 vs. 1.458 ± 0.240[×10-3 mm2/s]; MK: 1.096 ± 0.079 vs. 1.237 ± 0.180; P < 0.05). Moreover, there was a significantly higher area under the curve (AUC) for both MD (0.955) and MK (0.905), as compared to ADC (0.736). CONCLUSION Diffusion kurtosis imaging was feasible for stratifying NAFLD, and more accurately discriminated NASH from non-NASH when compared with DWI.
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Abstract
There are many ways to image the spine. Although there is not one correct and many incorrect ways, the choice of sequences and parameters allows optimization of the protocol to the particular question that is to be answered and also to the particular preferences of the Radiologist.
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Yacoub JH, Elsayes KM, Fowler KJ, Hecht EM, Mitchell DG, Santillan C, Szklaruk J. Pitfalls in liver MRI: Technical approach to avoiding misdiagnosis and improving image quality. J Magn Reson Imaging 2018; 49:41-58. [DOI: 10.1002/jmri.26343] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Joseph H Yacoub
- Department of Radiology; Medstar Georgetown University Hospital; Washington DC USA
| | - Khaled M. Elsayes
- Department of Diagnostic Radiology; University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Kathryn J. Fowler
- University of California San Diego Health System, Department of Radiology; San Diego California USA
| | - Elizabeth M. Hecht
- Department of Radiology; New York Presbyterian-Columbia University Medical Center; New York New York
| | - Donald G. Mitchell
- Department of Radiology; Thomas Jefferson University; Philadelphia Pennsylvania USA
| | - Cynthia Santillan
- Liver Imaging Group; University of California San Diego; San Diego California USA
| | - Janio Szklaruk
- Department of Diagnostic Radiology; University of Texas MD Anderson Cancer Center; Houston Texas USA
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Harada TL, Saito K, Araki Y, Matsubayashi J, Nagao T, Sugimoto K, Tokuuye K. Prediction of high-stage liver fibrosis using ADC value on diffusion-weighted imaging and quantitative enhancement ratio at the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI at 1.5 T. Acta Radiol 2018; 59:509-516. [PMID: 28853292 DOI: 10.1177/0284185117725778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Recently, diffusion-weighted imaging (DWI) and quantitative enhancement ratio measured at the hepatobiliary phase (HBP) of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) has been established as an effective method for evaluating liver fibrosis. Purpose To evaluate which is a more favorable surrogate marker in predicting high-stage liver fibrosis, apparently diffusion coefficient (ADC) value or quantitative enhancement ratio measured on HBP. Material and Methods Eighty-three patients with 99 surgically resected hepatic lesions were enrolled in this study. DWI was performed with b-values of 100 and 800 s/mm2. Regions of interest were set on ADC map, and the HBP of Gd-EOB-DTPA-enhanced MRI, to calculate ADC value, liver-to-muscle ratio (LMR), liver-to-spleen ratio (LSR), and contrast enhancement index (CEI) of liver. We compared these parameters between low-stage fibrosis (F0, F1, and F2) and high-stage fibrosis (F3 and F4). Receiver operating characteristic analysis was performed to compare the diagnostic performance when distinguishing low-stage fibrosis from high-stage fibrosis. Results LMR and CEI were significantly lower at high-stage fibrosis than at the low stage ( P < 0.01 and P = 0.04, respectively), whereas LSR did not show a significant difference ( P = 0.053). No significant difference was observed in diagnostic performance between LMR and CEI ( P = 0.185). The best sensitivity and specificity, when an LMR of 2.80 or higher was considered to be low-stage fibrosis, were 82.4% and 75.6%, respectively. ADC value showed no significant differences among fibrosis grades ( P = 0.320). Conclusion LMR and CEI were both adequate surrogate parameters to distinguish high-stage fibrosis from low-stage fibrosis.
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Affiliation(s)
- Taiyo L Harada
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Yoichi Araki
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Koichi Tokuuye
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
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Does intravoxel incoherent motion reliably stage hepatic fibrosis, steatosis, and inflammation? Abdom Radiol (NY) 2018; 43:600-606. [PMID: 28828711 DOI: 10.1007/s00261-017-1263-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate the usefulness of intravoxel incoherent motion (IVIM) in determining the severity of hepatic fibrosis, steatosis, and inflammation in patients with chronic liver disease. METHODS Forty-nine patients who had liver MRI with IVIM sequence and liver biopsy within three months of MRI were enrolled. A reviewer, blinded to histology, placed regions of interest of 1-2 cm2 in the right liver lobe. In addition, the first twenty patients were assessed with a second reviewer. Perfusion fraction (f), pseudodiffusion coefficient (D fast), true diffusion coefficient (D slow), and apparent diffusion coefficient (ADC) were calculated from normalized signal intensities that were fitted into a biexponential model. Errors in the model were minimized with global stochastic optimization using Simulated Annealing. ANOVA with post hoc Tukey-Kramer test and multivariate generalized linear model analysis were performed, using histological findings as the gold standard. RESULTS The most common etiologies for liver disease were hepatitis C and alcohol, accounting together for 76% (37/49) of patients. Low-grade fibrosis (F0, F1), hepatic steatosis, and inflammation were seen in 24% (12/49), 31% (15/49), and 29% (14/49) of patients, respectively. The interobserver correlation was poor for D fast and D slow (0.105, 0.173) and moderate for f and ADC (0.461, 0.418). ANOVA showed a strong inverse association between D fast and liver fibrosis grade (p = 0.001). A weak inverse association was seen between ADC and hepatic steatosis (p = 0.059). Multivariate general linear model revealed that the only significant association between IVIM parameters and pathological features was between D fast and fibrosis. On ROC curve analysis, D fast < 23.4 × 10-3 mm2/s had a sensitivity of 82.8% and a specificity of 64.3% in predicting high-grade fibrosis. CONCLUSION D fast has the strongest association with hepatic fibrosis but has weak interobserver correlation. IVIM parameters were not significantly associated with hepatic inflammation or steatosis.
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Manning P, Murphy P, Wang K, Hooker J, Wolfson T, Middleton MS, Newton KP, Behling C, Awai HI, Durelle J, Paiz MN, Angeles JE, De La Pena D, McCutchan JA, Schwimmer JB, Sirlin CB. Liver histology and diffusion-weighted MRI in children with nonalcoholic fatty liver disease: A MAGNET study. J Magn Reson Imaging 2017; 46:1149-1158. [PMID: 28225568 DOI: 10.1002/jmri.25663] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/25/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To determine potential associations between histologic features of pediatric nonalcoholic fatty liver disease (NAFLD) and estimated quantitative magnetic resonance diffusion-weighted imaging (DWI) parameters. MATERIALS AND METHODS This prospective, cross-sectional study was performed as part of the Magnetic Resonance Assessment Guiding NAFLD Evaluation and Treatment (MAGNET) ancillary study to the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN). Sixty-four children underwent a 3T DWI scan (b-values: 0, 100, and 500 s/mm2 ) within 180 days of a clinical liver biopsy of the right hepatic lobe. Three parameters were estimated in the right hepatic lobe: apparent diffusion coefficient (ADC), diffusivity (D), and perfusion fraction (F); the first assuming exponential decay and the latter two assuming biexponential intravoxel incoherent motion. Grading and staging of liver histology were done using the NASH CRN scoring system. Associations between histologic scores and DWI-estimated parameters were tested using multivariate linear regression. RESULTS Estimated means ± standard deviations were: ADC: 1.3 (0.94-1.8) × 10-3 mm2 /s; D: 0.82 (0.56-1.0) × 10-3 mm2 /s; and F: 17 (6.0-28)%. Multivariate analyses showed ADC and D decreased with steatosis and F decreased with fibrosis (P < 0.05). Associations between DWI-estimated parameters and other histologic features were not significant: ADC: fibrosis (P = 0.12), lobular inflammation (P = 0.20), portal inflammation (P = 0.27), hepatocellular inflammation (P = 0.29), NASH (P = 0.30); D: fibrosis (P = 0.34), lobular inflammation (P = 0.84), portal inflammation (P = 0.76), hepatocellular inflammation (P = 0.38), NASH (P = 0.81); F: steatosis (P = 0.57), lobular inflammation (P = 0.22), portal inflammation (P = 0.42), hepatocellular inflammation (P = 0.59), NASH (P = 0.07). CONCLUSION In children with NAFLD, steatosis and fibrosis have independent effects on DWI-estimated parameters ADC, D, and F. Further research is needed to determine the underlying mechanisms and clinical implications of these effects. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1149-1158.
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Affiliation(s)
- Paul Manning
- Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Paul Murphy
- Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Kang Wang
- Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Jonathan Hooker
- Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Laboratory (CASL), SDSC, University of California, San Diego, La Jolla, California, USA
| | - Michael S Middleton
- Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Kimberly P Newton
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Cynthia Behling
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Hannah I Awai
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Janis Durelle
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Melissa N Paiz
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Jorge E Angeles
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Diana De La Pena
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | | | - Jeffrey B Schwimmer
- Department of Pediatrics, UCSD and Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, California, USA
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14
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Jiang H, Chen J, Gao R, Huang Z, Wu M, Song B. Liver fibrosis staging with diffusion-weighted imaging: a systematic review and meta-analysis. Abdom Radiol (NY) 2017; 42:490-501. [PMID: 27678393 DOI: 10.1007/s00261-016-0913-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE A meta-analysis was performed to assess the diagnostic performance of diffusion-weighted imaging (DWI) in liver fibrosis (LF) staging. METHODS We conducted a comprehensive literature search to identify relevant articles. Diagnostic data were extracted for each METAVIR fibrosis stage (F0-F4). A bivariate binomial model was used to combine sensitivities and specificities. Summary receiver operating characteristics (SROC) curves were performed and areas under SROC curve (AUC) were calculated to indicate diagnostic accuracies. Subgroup analyses were performed between different study characteristics. RESULTS Twelve studies met the inclusion criteria for LF ≥F1, 16 for ≥F2, 18 for ≥F3, and 12 for F4. AUCs of DWI were 0.8554, 0.8770, 0.8836, and 0.8596 for ≥F1, ≥F2, ≥F3, and F4, respectively. Subgroup analyses showed that for LF ≥F2 and ≥F3, maximal b values (b max) ≥ 800 s/mm2 performed significantly better than b max < 800 s/mm2. The diagnostic accuracies of 3.0 T and intravoxel incoherent motion (IVIM)-DWI were significantly higher than those of 1.5 T and conventional DWI for diagnosing liver cirrhosis (F4). CONCLUSIONS DWI is a reliable noninvasive technique with good diagnostic accuracy for LF staging. Using b max ≥ 800 s/mm2, high-field strength (3.0 T) and IVIM-DWI can optimize the diagnostic performance of DWI.
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Affiliation(s)
- Hanyu Jiang
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, Sichuan, China
| | - Jie Chen
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, Sichuan, China
| | - Ronghui Gao
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, Sichuan, China
| | - Zixing Huang
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, Sichuan, China
| | - Mingpeng Wu
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, Sichuan, China
| | - Bin Song
- Department of Radiology, Sichuan University West China Hospital, No. 37 Guoxue Alley, Chengdu, Sichuan, China.
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15
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Unal E, Idilman IS, Karçaaltıncaba M. Multiparametric or practical quantitative liver MRI: towards millisecond, fat fraction, kilopascal and function era. Expert Rev Gastroenterol Hepatol 2017; 11:167-182. [PMID: 27937040 DOI: 10.1080/17474124.2017.1271710] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
New advances in liver magnetic resonance imaging (MRI) may enable diagnosis of unseen pathologies by conventional techniques. Normal T1 (550-620 ms for 1.5 T and 700-850 ms for 3 T), T2, T2* (>20 ms), T1rho (40-50 ms) mapping, proton density fat fraction (PDFF) (≤5%) and stiffness (2-3kPa) values can enable differentiation of a normal liver from chronic liver and diffuse diseases. Gd-EOB-DTPA can enable assessment of liver function by using postcontrast hepatobiliary phase or T1 reduction rate (normally above 60%). T1 mapping can be important for the assessment of fibrosis, amyloidosis and copper overload. T1rho mapping is promising for the assessment of liver collagen deposition. PDFF can allow objective treatment assessment in NAFLD and NASH patients. T2 and T2* are used for iron overload determination. MR fingerprinting may enable single slice acquisition and easy implementation of multiparametric MRI and follow-up of patients. Areas covered: T1, T2, T2*, PDFF and stiffness, diffusion weighted imaging, intravoxel incoherent motion imaging (ADC, D, D* and f values) and function analysis are reviewed. Expert commentary: Multiparametric MRI can enable biopsyless diagnosis and more objective staging of diffuse liver disease, cirrhosis and predisposing diseases. A comprehensive approach is needed to understand and overcome the effects of iron, fat, fibrosis, edema, inflammation and copper on MR relaxometry values in diffuse liver disease.
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Affiliation(s)
- Emre Unal
- a Liver Imaging Team, Department of Radiology , Hacettepe University School of Medicine , Ankara , Turkey.,b Department of Radiology , Zonguldak Ataturk State Hospital , Zonguldak , Turkey
| | - Ilkay Sedakat Idilman
- a Liver Imaging Team, Department of Radiology , Hacettepe University School of Medicine , Ankara , Turkey.,c Department of Radiology , Ankara Ataturk Education and Research Hospital , Ankara , Turkey
| | - Muşturay Karçaaltıncaba
- a Liver Imaging Team, Department of Radiology , Hacettepe University School of Medicine , Ankara , Turkey
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16
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Moriya T, Saito K, Tajima Y, Harada TL, Araki Y, Sugimoto K, Tokuuye K. 3D analysis of apparent diffusion coefficient histograms in hepatocellular carcinoma: correlation with histological grade. Cancer Imaging 2017; 17:1. [PMID: 28057085 PMCID: PMC5217316 DOI: 10.1186/s40644-016-0103-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/22/2016] [Indexed: 01/07/2023] Open
Abstract
Background To evaluate the usefulness of differentiation of histological grade in hepatocellular carcinoma (HCC) using three-dimensional (3D) analysis of apparent diffusion coefficient (ADC) histograms retrospectively. Methods The subjects consisted of 53 patients with 56 HCCs. The subjects included 12 well-differentiated, 35 moderately differentiated, and nine poorly differentiated HCCs. Diffusion-weighted imaging (b-values of 100 and 800 s/mm2) were obtained within 3 months before surgery. Regions of interest (ROIs) covered the entire tumor. The data acquired from each slice were summated to derive voxel-by-voxel ADCs for the entire tumor. The following parameters were derived from the ADC histogram: mean, standard deviation, minimum, maximum, mode, percentiles (5th, 10th, 25th, 50th, 75th, and 90th), skew, and kurtosis. These parameters were analyzed according to histological grade. After eliminating steatosis lesions, these parameters were re-analyzed. Results A weak correlation was observed in minimum ADC and 5th percentile for each histological grade (r = –0.340 and r = –0.268, respectively). The minimum ADCs of well, moderately, and poorly differentiated HCC were 585 ± 388, 411 ± 278, and 235 ± 102 × 10−6 mm2/s, respectively. Minimum ADC showed significant differences among tumor histological grades (P = 0.009). The minimum ADC of poorly differentiated HCC and that of combined well and moderately differentiated HCC were 236 ± 102 and 437 ± 299 × 10−6 mm2/s. The minimum ADC of poorly differentiated HCC was significantly lower than that of combined well and moderately differentiated HCC (P = 0.001). The sensitivity and specificity, when a minimum ADC of 400 × 10−6 mm2/s or lower was considered to be poorly differentiated HCC, were 100 and 54%, respectively. After exclusion of the effect of steatosis, the sensitivity and specificity did not change, although the statistical differences became strong (P < 0.0001). Conclusion Minimum ADC was most useful to differentiate poorly differentiated HCC in 3D analysis of ADC histograms.
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Affiliation(s)
- Tomohisa Moriya
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Yu Tajima
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Taiyo L Harada
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yoichi Araki
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Katsutoshi Sugimoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Koichi Tokuuye
- Department of Radiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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17
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Zhu J, Zhang J, Gao JY, Li JN, Yang DW, Chen M, Zhou C, Yang ZH. Apparent diffusion coefficient normalization of normal liver: Will it improve the reproducibility of diffusion-weighted imaging at different MR scanners as a new biomarker? Medicine (Baltimore) 2017; 96:e5910. [PMID: 28099354 PMCID: PMC5279099 DOI: 10.1097/md.0000000000005910] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Apparent diffusion coefficient (ADC) measurement in diffusion-weighted imaging (DWI) has been reported to be a helpful biomarker for detection and characterization of lesion. In view of the importance of ADC measurement reproducibility, the aim of this study was to probe the variability of the healthy hepatic ADC values measured at 3 MR scanners from different vendors and with different field strengths, and to investigate the reproducibility of normalized ADC (nADC) value with the spleen as the reference organ. Thirty enrolled healthy volunteers received DWI with GE 1.5T, Siemens 1.5T, and Philips 3.0T magnetic resonance (MR) systems on liver and spleen (session 1) and were imaged again after 10 to 14 days using only GE 1.5T MR and Philips 3.0T MR systems (session 2). Interscan agreement and reproducibility of ADC measurements of liver and the calculated nADC values (ADCliver/ADCspleen) were statistically evaluated between 2 sessions. In session 1, ADC and nADC values of liver were evaluated for the scanner-related variability by 2-way analysis of variance and intraclass correlation coefficients (ICCs). Coefficients of variation (CVs) of ADCs and nADCs of liver were calculated for both 1.5 and 3.0-T MR system. Interscan agreement and reproducibility of ADC measurements of liver and related nADCs between 2 sessions were found to be satisfactory with ICC values of 0.773 to 0.905. In session 1, the liver nADCs obtained from different scanners were consistent (P = 0.112) without any significant difference in multiple comparison (P = 0.117 to >0.99) by using 2-way analysis of variance with post-hoc analysis of Bonferroni method, although the liver ADCs varied significantly (P < 0.001). nADCs measured by 3 scanners were in good interscanner agreements with ICCs of 0.685 to 0.776. The mean CV of nADCs of both 1.5T MR scanners (9.6%) was similar to that of 3.0T MR scanner (8.9%). ADCs measured at 3 MR scanners with different field strengths and vendors could not be compared directly. Normalization of ADCs, however, may provide better reproducibility by overcoming these potential issues.
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Affiliation(s)
- Jie Zhu
- Department of Radiology, Beijing Hospital, National Center of Gerontology
| | - Jie Zhang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jia-Yin Gao
- Department of Radiology, Beijing Hospital, National Center of Gerontology
| | - Jin-Ning Li
- Department of Radiology, Beijing Hospital, National Center of Gerontology
| | - Da-Wei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology
| | - Cheng Zhou
- Department of Radiology, Beijing Hospital, National Center of Gerontology
| | - Zheng-Han Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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18
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Liu B, Cai J, Zhu J, Zheng H, Zhang Y, Wang L. Diffusion Tensor Imaging for Evaluating Biliary Atresia in Infants and Neonates. PLoS One 2016; 11:e0168477. [PMID: 27992499 PMCID: PMC5167545 DOI: 10.1371/journal.pone.0168477] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/01/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Preliminary studies have shown that diffusion tensor imaging (DTI) is helpful in evaluating liver disorders. However, there is no published literature on the use of DTI in the diagnosis of biliary atresia (BA). This study aimed to investigate the diagnostic value of the liver average apparent diffusion coefficient (ADC) and fractional anisotropy (FA) measured using DTI for BA in neonates and infants. METHODS Fifty-nine patients with infant jaundice were included in this study. DTI was performed with b factors of 0 and 1000 s/mm2. Liver fibrosis in the BA group was determined and graded (F0, F1, F2, F3, F4) based on the pathological findings. Statistical analyses were performed to determine the diagnostic accuracy of DTI for BA. RESULTS The ADC value was significantly lower in the BA group [(1.262±0.127)×10-3 mm2/s] than in the non-BA group [(1.430±0.149)×10-3 mm2/s, (P<0.001)]. The area under the receiver operating characteristic curve was 0.805±0.058 (P<0.001) for ADC. With a cut-off value of 1.317×10-3 mm2/s, ADC achieved a sensitivity of 75% and a specificity of 81.5% for the differential diagnosis of BA and non-BA. In the BA group, the ADC value was significantly correlated with fibrotic stage. Further analysis showed that the ADC value of stage F0 was significantly higher than that of stages F1, F2, F3 and F4, whereas there were no significant differences among stages F1, F2, F3 and F4. CONCLUSION Hepatic ADC measured with DTI can be used as an adjunct to other noninvasive imaging methods in the differential diagnosis of BA and non-BA. ADC was helpful in detecting liver fibrosis but not in differentiating the fibrotic grades.
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Affiliation(s)
- Bo Liu
- Department of Radiology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Jinhua Cai
- Department of Radiology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- * E-mail:
| | - Jin Zhu
- Department of Pathology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Helin Zheng
- Department of Radiology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yun Zhang
- Department of Radiology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Longlun Wang
- Department of Radiology, Children’s Hospital of Chongqing Medical University, Chongqing, China
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Ni P, Lin Y, Zhong Q, Chen Z, Sandrasegaran K, Lin C. Technical advancements and protocol optimization of diffusion-weighted imaging (DWI) in liver. Abdom Radiol (NY) 2016; 41:189-202. [PMID: 26830624 DOI: 10.1007/s00261-015-0602-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
An area of rapid advancement in abdominal MRI is diffusion-weighted imaging (DWI). By measuring diffusion properties of water molecules, DWI is capable of non-invasively probing tissue properties and physiology at cellular and macromolecular level. The integration of DWI as part of abdominal MRI exam allows better lesion characterization and therefore more accurate initial diagnosis and treatment monitoring. One of the most technical challenging, but also most useful abdominal DWI applications is in liver and therefore requires special attention and careful optimization. In this article, the latest technical developments of DWI and its liver applications are reviewed with the explanations of the technical principles, recommendations of the imaging parameters, and examples of clinical applications. More advanced DWI techniques, including Intra-Voxel Incoherent Motion (IVIM) diffusion imaging, anomalous diffusion imaging, and Diffusion Kurtosis Imaging (DKI) are discussed.
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Affiliation(s)
- Ping Ni
- Department of Medical Imaging, Fuzhou General Hospital, Fuzhou, Fujian, China
| | - Yuning Lin
- Department of Medical Imaging, Fuzhou General Hospital, Fuzhou, Fujian, China
| | - Qun Zhong
- Department of Medical Imaging, Fuzhou General Hospital, Fuzhou, Fujian, China
| | - Ziqian Chen
- Department of Medical Imaging, Fuzhou General Hospital, Fuzhou, Fujian, China
| | - Kumar Sandrasegaran
- Department of Radiology and Imaging Science, Indiana University School of Medicine, 950 West Walnut St. R2 E124, Indianapolis, IN, 46202, USA
| | - Chen Lin
- Department of Radiology and Imaging Science, Indiana University School of Medicine, 950 West Walnut St. R2 E124, Indianapolis, IN, 46202, USA.
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20
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Kocakoc E, Bakan AA, Poyrazoglu OK, Dagli AF, Gul Y, Cicekci M, Bahcecioglu IH. Assessment of Liver Fibrosis with Diffusion-Weighted Magnetic Resonance Imaging Using Different b-values in Chronic Viral Hepatitis. Med Princ Pract 2015; 24:522-6. [PMID: 26183515 PMCID: PMC5588272 DOI: 10.1159/000434682] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 06/01/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To examine the effectiveness of apparent diffusion coefficient (ADC) values and to compare the reliability of different b-values in detecting and identifying significant liver fibrosis. SUBJECTS AND METHODS There were 44 patients with chronic viral hepatitis (CVH) in the study group and 30 healthy participants in the control group. Diffusion-weighted magnetic resonance imaging (DWI) was performed before the liver biopsy in patients with CVH. The values of ADC were measured with 3 different b-values (100, 600, 1,000 s/mm2). In addition, liver fibrosis was classified using the modified Ishak scoring system. Liver fibrosis stages and ADC values were compared using areas under the receiver-operating characteristic (ROC) curve. RESULTS The study group's mean ADC value was not statistically significantly different from the control group's mean ADC value at b = 100 s/mm2 (3.69 ± 0.5 × 10-3 vs. 3.7 ± 0.3 × 10-3 mm2/s) and b = 600 s/mm2 (2.40 ± 0.3 × 10-3 vs. 2.5 ± 0.5 × 10-3 mm2/s). However, the study group's mean ADC value (0.99 ± 0.3 × 10-3 mm2/s) was significantly lower than that of the control group (1.2 ± 0.1 × 10-3 mm2/s) at b = 1,000 s/mm2. With b = 1,000 s/mm2 and the cutoff ADC value of 0.0011 mm2/s for the diagnosis of liver fibrosis, the mean area under the ROC curve was 0.702 ± 0.07 (p = 0.0015). For b = 1,000 s/mm2 and the cutoff ADC value of 0.0011 mm2/s to diagnose significant liver fibrosis (Ishak score = 3), the mean area under the ROC curve was 0.759 ± 0.07 (p = 0.0001). CONCLUSION Measurement of ADC values by DWI was effective in detecting liver fibrosis and accurately identifying significant liver fibrosis when a b-value of 1,000 s/mm2 was used.
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Affiliation(s)
- Ercan Kocakoc
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Elazig, Turkey
| | - Ayse Ahsen Bakan
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Elazig, Turkey
- *Ayse Ahsen Bakan, Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, TR-34093 Fatih, Istanbul (Turkey), E-Mail
| | | | - Adile Ferda Dagli
- Department of Pathology, Faculty of Medicine, Inonu University, Malatya, and Departments of, Elazig, Turkey
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Lu PX, Huang H, Yuan J, Zhao F, Chen ZY, Zhang Q, Ahuja AT, Zhou BP, Wáng YXJ. Decreases in molecular diffusion, perfusion fraction and perfusion-related diffusion in fibrotic livers: a prospective clinical intravoxel incoherent motion MR imaging study. PLoS One 2014; 9:e113846. [PMID: 25436458 PMCID: PMC4250077 DOI: 10.1371/journal.pone.0113846] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/02/2014] [Indexed: 12/21/2022] Open
Abstract
Purpose This study was aimed to determine whether pure molecular-based diffusion coefficient (D) and perfusion-related diffusion parameters (perfusion fraction f, perfusion-related diffusion coefficient D*) differ in healthy livers and fibrotic livers through intra-voxel incoherent motion (IVIM) MR imaging. Material and Methods 17 healthy volunteers and 34 patients with histopathologically confirmed liver fibrosis patients (stage 1 = 14, stage 2 = 8, stage 3& 4 = 12, METAVIR grading) were included. Liver MR imaging was performed at 1.5-T. IVIM diffusion weighted imaging sequence was based on standard single-shot DW spin echo-planar imaging, with ten b values of 10, 20, 40, 60, 80, 100, 150, 200, 400, 800 sec/mm2 respectively. Pixel-wise realization and regions-of-interest based quantification of IVIM parameters were performed. Results D, f, and D* in healthy volunteer livers and patient livers were 1.096±0.155 vs 0.917±0.152 (10−3 mm2/s, p = 0.0015), 0.164±0.021 vs 0.123±0.029 (p<0.0001), and 13.085±2.943 vs 9.423±1.737 (10−3 mm2/s, p<0.0001) respectively, all significantly lower in fibrotic livers. As the fibrosis severity progressed, D, f, and D* values decreased, with a trend significant for f and D*. Conclusion Fibrotic liver is associated with lower pure molecular diffusion, lower perfusion volume fraction, and lower perfusion-related diffusion. The decrease of f and D* in the liver is significantly associated liver fibrosis severity.
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Affiliation(s)
- Pu-Xuan Lu
- Department of Radiology, The Shenzhen No. 3 People's Hospital, Guangdong Medical College, Shenzhen, China
| | - Hua Huang
- Department of Radiology, The Shenzhen No. 3 People's Hospital, Guangdong Medical College, Shenzhen, China
| | - Jing Yuan
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Feng Zhao
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Zhi-Yi Chen
- Laboratory of Ultrasound Molecular Imaging, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qinwei Zhang
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Anil T. Ahuja
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Bo-Ping Zhou
- Department of Hepatology, The Shenzhen No. 3 People's Hospital, Guangdong Medical College, Shenzhen, China
| | - Yì-Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
- * E-mail:
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22
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Murphy P, Hooker J, Ang B, Wolfson T, Gamst A, Bydder M, Middleton M, Peterson M, Behling C, Loomba R, Sirlin C. Associations between histologic features of nonalcoholic fatty liver disease (NAFLD) and quantitative diffusion-weighted MRI measurements in adults. J Magn Reson Imaging 2014; 41:1629-38. [PMID: 25256692 DOI: 10.1002/jmri.24755] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 07/15/2014] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To investigate in adults the associations between histologic features of nonalcoholic fatty liver disease (NAFLD) and quantitative measures derived from diffusion-weighted imaging (DWI). MATERIALS AND METHODS Eighty-nine adults undergoing standard-of-care liver biopsy for NAFLD were recruited for DWI. Biopsies were scored for histologic features of NAFLD. DWI was performed using b-values of 0, 100, and 500 s/mm(2) . Images were reconstructed using either conventional magnitude averaging (CMA) or a method to address bulk motion artifacts (Beta*LogNormal, BLN). The apparent diffusion coefficient (ADC) and the diffusivity (D) and perfusion fraction (F) of the intravoxel incoherent motion (IVIM) model were measured in the right hepatic lobe using both reconstructions. Associations between histologic features and DWI-derived measures were tested statistically with several methods including multiple linear regression. RESULTS Using CMA and BLN reconstructions, respectively, the means (and ranges) were 1.7 (1.1-3.5) and 1.4 (1.0-3.2) × 10(-3) mm(2) /s for ADC, 1.1 (0.84-1.4) and 0.84 (0.53-1.1) × 10(-3) mm(2) /s for D, and 17 and 18 (2.3-35)% for F. For both reconstruction methods, D decreased with steatosis and F decreased with fibrosis (P < 0.05). ADC was not independently associated with any histologic feature. CONCLUSION Steatosis and fibrosis have significant independent effects on D and F in adults undergoing biopsy for NAFLD.
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Affiliation(s)
- Paul Murphy
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Jonathan Hooker
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Brandon Ang
- NAFLD Translational Research Unit, Division of Gastroenterology, Department of Medicine, University of California - San Diego, San Diego, California, USA
| | - Tanya Wolfson
- Computational and Applied Statistics Lab, San Diego Supercomputing Center, San Diego, California, USA
| | - Anthony Gamst
- Computational and Applied Statistics Lab, San Diego Supercomputing Center, San Diego, California, USA
| | - Mark Bydder
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | - Michael Middleton
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
| | | | | | - Rohit Loomba
- NAFLD Translational Research Unit, Division of Gastroenterology, Department of Medicine, University of California - San Diego, San Diego, California, USA.,Division of Epidemiology, Department of Family and Preventative Medicine, University of California - San Diego, San Diego, California, USA
| | - Claude Sirlin
- Liver Imaging Group, Department of Radiology, University of California - San Diego, San Diego, California, USA
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Lewis S, Dyvorne H, Cui Y, Taouli B. Diffusion-weighted imaging of the liver: techniques and applications. Magn Reson Imaging Clin N Am 2014; 22:373-95. [PMID: 25086935 PMCID: PMC4121599 DOI: 10.1016/j.mric.2014.04.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diffusion-weighted imaging (DWI) is a technique that assesses the cellularity, tortuosity of the extracellular/extravascular space, and cell membrane density based on differences in water proton mobility in tissues. The strength of the diffusion weighting is reflected by the b value. DWI using several b values enables the quantification of the apparent diffusion coefficient. DWI is increasingly used in liver imaging for multiple reasons: it can add useful qualitative and quantitative information to conventional imaging sequences; it is acquired relatively quickly; it is easily incorporated into existing clinical protocols; and it is a noncontrast technique.
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Affiliation(s)
- Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Hadrien Dyvorne
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Yong Cui
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA; Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, NY 10029, USA.
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24
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Hong Y, Shi Y, Liao W, Klahr N, Xia F, Xu C, Li Y, Guo Q. Relative ADC measurement for liver fibrosis diagnosis in chronic hepatitis B using spleen/renal cortex as the reference organs at 3 T. Clin Radiol 2014; 69:581-8. [DOI: 10.1016/j.crad.2014.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 12/20/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
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Lee Y, Kim H. Assessment of diffusion tensor MR imaging (DTI) in liver fibrosis with minimal confounding effect of hepatic steatosis. Magn Reson Med 2014; 73:1602-8. [PMID: 24733754 DOI: 10.1002/mrm.25253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/10/2014] [Accepted: 03/25/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Given the potential confounding effect of fat on apparent diffusion coefficient (ADC) in the liver, we have assessed diffusion tensor imaging in liver fibrosis with minimal effect of fat on ADC and fractional anisotropy (FA). METHODS Thirty-six mice were used, among which 20 mice were CCl4 treated for fibrosis induction. Diffusion tensor imaging was performed at 9.4T using a spin-echo diffusion tensor imaging sequence with six gradient directions. Hepatic fat fraction obtained by MR spectroscopy was used as hepatic fat content. Fibrosis scores were obtained from histopathology. RESULTS The hepatic fat fractions of the two animal groups were below 5.5% and not different (5.3 ± 1.5 vs. 4.6 ± 1.1%; P = 0.115). Fibrosis scores were higher in CCl4 -treated mice (0.0 ± 0.0 vs. 2.1 ± 0.7; P < 0.001). Nonetheless, there was no difference in ADC between the two groups (0.711 ± 0.068 × 10(-3) vs. 0.718 ± 0.095 × 10(-3) mm(2) s(-1) ; P = 0.911). The treated group had a lower FA than control (0.552 ± 0.050 vs. 0.586 ± 0.013; P = 0.023). ADC was not correlated with hepatic fat fraction and fibrosis. FA was correlated with hepatic fat fraction (r = 0.418, P = 0.011) and fibrosis (r = -0.411, P = 0.012). CONCLUSION FA may be more sensitive to mild-to-moderate liver fibrosis than ADC. In addition to ADC, FA may also be sensitive to hepatic fat content, and therefore need careful interpretation in liver fibrosis with concomitant fatty liver.
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Affiliation(s)
- Yunjung Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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26
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Dijkstra H, Handayani A, Kappert P, Oudkerk M, Sijens PE. Clinical implications of non-steatotic hepatic fat fractions on quantitative diffusion-weighted imaging of the liver. PLoS One 2014; 9:e87926. [PMID: 24505333 PMCID: PMC3913701 DOI: 10.1371/journal.pone.0087926] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 01/01/2014] [Indexed: 01/27/2023] Open
Abstract
Diffusion-weighted imaging (DWI) is an important diagnostic tool in the assessment of focal liver lesions and diffuse liver diseases such as cirrhosis and fibrosis. Quantitative DWI parameters such as molecular diffusion, microperfusion and their fractions, are known to be affected when hepatic fat fractions (HFF) are higher than 5.5% (steatosis). However, less is known about the effect on DWI for HFF in the normal non-steatotic range below 5.5%, which can be found in a large part of the population. The aim of this study was therefore to evaluate the diagnostic implications of non-steatotic HFF on quantitative DWI parameters in eight liver segments. For this purpose, eleven healthy volunteers (2 men, mean-age 31.0) were prospectively examined with DWI and three series of in-/out-of-phase dual-echo spoiled gradient-recalled MRI sequences to obtain the HFF and T2*. DWI data were analyzed using the intravoxel incoherent motion (IVIM) model. Four circular regions (ø22.3 mm) were drawn in each of eight liver segments and averaged. Measurements were divided in group 1 (HFF≤2.75%), group 2 (2.75< HFF ≤5.5%) and group 3 (HFF>5.5%). DWI parameters and T2* were compared between the three groups and between the segments. It was observed that the molecular diffusion (0.85, 0.72 and 0.49 ×10−3 mm2/s) and T2* (32.2, 27.2 and 21.0 ms) differed significantly between the three groups of increasing HFF (2.18, 3.50 and 19.91%). Microperfusion and its fraction remained similar for different HFF. Correlations with HFF were observed for the molecular diffusion (r = −0.514, p<0.001) and T2* (−0.714, p<0.001). Similar results were obtained for the majority of individual liver segments. It was concluded that fat significantly decreases molecular diffusion in the liver, also in absence of steatosis (HFF≤5.5%). Also, it was confirmed that fat influences T2*. Determination of HFF prior to quantitative DWI is therefore crucial.
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Affiliation(s)
- Hildebrand Dijkstra
- Center for Medical Imaging - North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Astri Handayani
- Center for Medical Imaging - North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter Kappert
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Center for Medical Imaging - North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul E. Sijens
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Bonekamp D, Bonekamp S, Ou HY, Torbenson MS, Corona-Villalobos CP, Mezey E, Kamel IR. Assessing liver fibrosis: Comparison of arterial enhancement fraction and diffusion-weighted imaging. J Magn Reson Imaging 2013; 40:1137-46. [DOI: 10.1002/jmri.24472] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/12/2013] [Indexed: 12/21/2022] Open
Affiliation(s)
- David Bonekamp
- Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins Hospital; Baltimore Maryland USA
| | - Susanne Bonekamp
- Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins Hospital; Baltimore Maryland USA
| | - Hsin-You Ou
- Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins Hospital; Baltimore Maryland USA
- Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College; Niao-Sung Kaohsiung Taiwan
| | - Michael S. Torbenson
- Department of Pathology; Johns Hopkins University; School of Medicine; Baltimore Maryland USA
| | | | - Esteban Mezey
- Department of Medicine; Johns Hopkins University, Sheikh Zayed Tower, School of Medicine; Baltimore Maryland USA
| | - Ihab R. Kamel
- Russell H. Morgan Department of Radiology and Radiological Science; The Johns Hopkins Hospital; Baltimore Maryland USA
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Anderson SW, Barry B, Soto J, Ozonoff A, O'Brien M, Jara H. Characterizing non-gaussian, high b-value diffusion in liver fibrosis: Stretched exponential and diffusional kurtosis modeling. J Magn Reson Imaging 2013; 39:827-34. [PMID: 24259401 DOI: 10.1002/jmri.24234] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 04/30/2013] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To employ the stretched exponential and diffusional kurtosis models to study the non-Gaussian behavior of diffusion-related signal decay of the liver in an animal model of hepatic fibrosis. MATERIALS AND METHODS High b-value diffusion imaging data (up to 3500 s/mm(2) ) of ex vivo murine liver specimens was acquired using a 9.4 T MRI scanner. A simple monoexponential model as well as the stretched exponential and diffusional kurtosis models were employed to analyze the diffusion data, the results of which were correlated with liver histopathology. RESULTS Strong correlations between histopathological assessments of hepatic fibrosis and parameters derived from the stretched exponential and diffusional kurtosis models were found. Using Akaike's Information Criterion (AIC) analyses, the kurtosis model was found to result in an improved fit of the high b-value diffusion data when compared to both the monoexponential and stretched exponential models. CONCLUSION The use of diffusional kurtosis or stretched exponential models, applied to the characterization of the non-Gaussian behavior of the molecular diffusion of liver exhibited over an extended b-factor range, affords the potential for an increased capability of magnetic resonance imaging (MRI) in the characterization of chronic liver disease.
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Affiliation(s)
- Stephan W Anderson
- Boston University Medical Center, Department of Radiology, Boston, Massachusetts, USA
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29
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Joo I, Lee JM, Yoon JH, Jang JJ, Han JK, Choi BI. Nonalcoholic fatty liver disease: intravoxel incoherent motion diffusion-weighted MR imaging-an experimental study in a rabbit model. Radiology 2013; 270:131-40. [PMID: 24091358 DOI: 10.1148/radiol.13122506] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the feasibility of using intravoxel incoherent motion (IVIM) diffusion-weighted imaging with multiple b values for the noninvasive diagnosis of nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS This study was approved by the institutional animal care and use committee. Twenty-seven 8-week-old rabbits were fed a variety of diets (from a standard diet to a high-fat, high-cholesterol diet) before IVIM diffusion-weighted imaging was performed with seven b values by using a 3-T magnetic resonance (MR) imaging unit. At histologic analysis of the animals, livers were categorized by NAFLD severity as normal, NAFLD, borderline nonalcoholic steatohepatitis (NASH), or NASH. The apparent diffusion coefficient and IVIM-derived parameters including true diffusion coefficient, pseudodiffusion coefficient, and perfusion fraction of the liver parenchyma were measured. Each parameter was correlated with NAFLD severity, and optimal cutoff values were determined by means of receiver operating characteristics analysis. RESULTS Perfusion fraction was significantly lower in rabbits with NAFLD than in those with a normal liver, and it decreased further as severity of NAFLD increased, with medians of 22.2%, 14.8%, 11.3%, and 9.5% in the rabbits in the normal, NAFLD, borderline, and NASH groups, respectively (ρ = -0.83, P < .001). Apparent diffusion coefficient, true diffusion coefficient, and pseudodiffusion coefficient were not significantly different between the NAFLD severity groups. In terms of the diagnostic performance of perfusion fraction, area under the curve values were 0.984 (normal vs NAFLD or more severe disease), 0.959 (NAFLD or less severe vs borderline or more severe disease), and 0.903 (borderline or less severe vs NASH) with optimal cutoff values of 15.2%, 13.2%, and 11.0%, respectively. CONCLUSION Perfusion fractions extracted from IVIM diffusion-weighted imaging may help in the differentiation of early stage NASH from simple steatosis.
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Affiliation(s)
- Ijin Joo
- From the Department of Radiology (I.J., J.M.L., J.H.Y., J.K.H., B.I.C.), Institute of Radiation Medicine (J.M.L., J.K.H., B.I.C.), and Department of Pathology (J.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea
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30
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Joo I, Lee JM, Yoon JH, Jang JJ, Han JK, Choi BI. Nonalcoholic Fatty Liver Disease: Intravoxel Incoherent Motion Diffusion-weighted MR Imaging-An Experimental Study in a Rabbit Model. Radiology 2013:122506. [PMID: 24475795 DOI: 10.1148/radiology.13122506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the feasibility of using intravoxel incoherent motion (IVIM) diffusion-weighted imaging with multiple b values for the noninvasive diagnosis of nonalcoholic fatty liver disease (NAFLD). Materials and Methods This study was approved by the institutional animal care and use committee. Twenty-seven 8-week-old rabbits were fed a variety of diets (from a standard diet to a high-fat, high-cholesterol diet) before IVIM diffusion-weighted imaging was performed with seven b values by using a 3-T magnetic resonance (MR) imaging unit. At histologic analysis of the animals, livers were categorized by NAFLD severity as normal, NAFLD, borderline nonalcoholic steatohepatitis (NASH), or NASH. The apparent diffusion coefficient and IVIM-derived parameters including true diffusion coefficient, pseudodiffusion coefficient, and perfusion fraction of the liver parenchyma were measured. Each parameter was correlated with NAFLD severity, and optimal cutoff values were determined by means of receiver operating characteristics analysis. Results Perfusion fraction was significantly lower in rabbits with NAFLD than in those with a normal liver, and it decreased further as severity of NAFLD increased, with medians of 22.2%, 14.8%, 11.3%, and 9.5% in the rabbits in the normal, NAFLD, borderline, and NASH groups, respectively (ρ = -0.83, P < .001). Apparent diffusion coefficient, true diffusion coefficient, and pseudodiffusion coefficient were not significantly different between the NAFLD severity groups. In terms of the diagnostic performance of perfusion fraction, area under the curve values were 0.984 (normal vs NAFLD or more severe disease), 0.959 (NAFLD or less severe vs borderline or more severe disease), and 0.903 (borderline or less severe vs NASH) with optimal cutoff values of 15.2%, 13.2%, and 11.0%, respectively. Conclusion Perfusion fractions extracted from IVIM diffusion-weighted imaging may help in the differentiation of early stage NASH from simple steatosis. © RSNA, 2013.
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Affiliation(s)
- Ijin Joo
- From the Department of Radiology (I.J., J.M.L., J.H.Y., J.K.H., B.I.C.), Institute of Radiation Medicine (J.M.L., J.K.H., B.I.C.), and Department of Pathology (J.J.J.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea
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Hayashi T, Miyati T, Takahashi J, Tsuji Y, Suzuki H, Tagaya N, Hiramoto M, Fukuzawa K, Tano M, Saitoh S. Diffusion analysis with triexponential function in hepatic steatosis. Radiol Phys Technol 2013; 7:89-94. [PMID: 24092461 DOI: 10.1007/s12194-013-0235-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 09/05/2013] [Accepted: 09/08/2013] [Indexed: 02/06/2023]
Abstract
Our purpose was to assess the influence of liver steatosis on diffusion by triexponential analysis. Thirty-three patients underwent diffusion-weighted magnetic resonance imaging with multiple b values for perfusion-related diffusion, fast free diffusion, and slow restricted diffusion coefficients (D p, D f, D s) and fractions (F p, F f, F s). They also underwent dual-echo gradient-echo imaging for measurement of the hepatic fat fraction (HFF). Of these, 13 patients were included in the control group and 20 in the fatty liver group with HFF >5 %. The parameters of the two groups were compared by use of the Mann-Whitney U test. The relationships between diffusion coefficients and HFFs were assessed by use of the Pearson correlation. D p and D f were reduced significantly in the steatotic liver group compared with those in the control group (D p = 27.72 ± 6.61 × 10(-3) vs. 33.33 ± 6.47 × 10(-3) mm(2)/s, P = 0.0072; D f = 1.70 ± 0.53 × 10(-3) vs. 2.06 ± 0.40 × 10(-3) mm(2)/s, P = 0.0224). There were no significant differences in the other parameters between the two groups. Furthermore, D p and D f were correlated with HFF (P < 0.0001, r = -0.64 and P = 0.0008, r = -0.56, respectively). Decreased liver perfusion in steatosis caused the reduction in D p, and extracellular fat accumulation and intracellular fat droplets in steatosis led to the reduction in D f. Thus, the influence of hepatic steatosis should be taken into consideration when triexponential function analysis is used for assessment of diffuse liver disease.
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Affiliation(s)
- Tatsuya Hayashi
- Department of Radiological Technology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan,
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Cakir O, Arslan A, Inan N, Anık Y, Sarısoy T, Gumustas S, Akansel G. Comparison of the diagnostic performances of diffusion parameters in diffusion weighted imaging and diffusion tensor imaging of breast lesions. Eur J Radiol 2013; 82:e801-6. [PMID: 24099642 DOI: 10.1016/j.ejrad.2013.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/28/2013] [Accepted: 09/03/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate the diagnostic efficiency of the diffusion parameters measured by conventional diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) for discrimination of malignant breast lesions from benign lesions and the normal breast. MATERIALS AND METHODS The study included 52 women with 55 breast lesions (30 malignant, 25 benign). DTI and DWI were performed complementary to dynamic contrast MRI at 3T. Apparent diffusion coefficient (ADC) of DWI, mean diffusivity (MD) and fractional anisotropy (FA) values of DTI were measured for lesions and contralateral breast parenchyma in each patient. We used b factors of 0, 50, 850, 1000 and 1500 s/mm(2) for DWI and b 0 and 1000 s/mm(2) for DTI. ADC, MD and FA values were compared between malignant and benign lesions, and the normal parenchyma by univariate and multivariate analyses. RESULTS Diffusion parameters showed no difference according to menopausal status in the normal breast. ADC and MD values of the malignant lesions were significantly lower than benign lesions and normal parenchyma (p=0.001). The FA showed no statistical significance. With the cut-off values of ≤ 1.23 × 10(-3)mm(2)/s (b 0-1000 s/mm(2)) and ≤ 1.12 × 10(-3)mm(2)/s (b 0-1500 s/mm(2)), ADC showed 92.85% and 96.15% sensitivity; 72.22% and 73.52% PPV, respectively. With a cut-off value of ≤ 1.27 × 10(-3)mm(2)/s (b 1000 s/mm(2)), MD was 100% sensitive with a PPV of 65.90%. Comparing the diagnostic performance of the parameters in DTI with DWI, we obtained similar efficiency of ADC with b values of 0,1000 and 0,1500 s/mm(2) and MD with a b value of 0, 1000 s/mm(2) (AUC = 0.82 ± 0.07). CONCLUSION ADC of DWI and MD of DTI values provide significant discriminative factors for benign and malignant breast lesions. FA measurement was not discriminative. Supported with clinical and dynamic contrast MRI findings, DWI and DTI findings provide significant contribution to the final radiologic decision.
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Affiliation(s)
- Ozgur Cakir
- Kocaeli University Faculty of Medicine, Department of Radiology, 41380 Kocaeli, Turkey.
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Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) is now widely used as a standard imaging sequence for evaluation of the liver. The technique is easy to implement across different MRI platforms, and results in enhanced disease detection and characterization. With careful implementation, the quantitative apparent diffusion coefficient derived shows good measurement reproducibility, which can be applied for tissue characterization, the assessment of tumour response and disease prognostication. There is now a body of evidence that highlights the relative strengths and limitations of the technique for the assessment of liver diseases. The potential for more sophisticated analysis of DW-MRI data is currently being widely investigated.
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Affiliation(s)
- N Bharwani
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Hansmann J, Hernando D, Reeder SB. Fat confounds the observed apparent diffusion coefficient in patients with hepatic steatosis. Magn Reson Med 2012; 69:545-52. [PMID: 23161434 DOI: 10.1002/mrm.24535] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 09/28/2012] [Indexed: 12/21/2022]
Abstract
PURPOSE Triglyceride signal contained in peaks near the water peak remains unsuppressed by conventional fat suppression techniques used in diffusion-weighted imaging. In this work, we investigated the dependence of the apparent diffusion coefficient (ADC) on liver fat content and whether it is confounded by fat signal. METHODS 43 patients underwent liver diffusion-weighted imaging (b = 0, 500 s/mm(2)) and single-voxel MR-spectroscopy. Proton density fat-fraction (PDFF; range 0.23-34.5%) was measured from MR-spectroscopy. A theoretical model was developed to account for the effects of fat on observed ADC, and used to correct the ADC. Linear correlation analysis was performed to assess the relationship between PDFF and ADC before and after correction. RESULTS Linear correlation analysis showed an inverse dependence between observed ADC and PDFF before correction (r(2) = 0.132; P = 0.017), and no dependence after correction (r(2) = 0.033; P = 0.24). CONCLUSION The observed decrease in ADC in patients with fatty liver is, at least in part, artifactual due to residual fat signal near the water peak.
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Affiliation(s)
- Jan Hansmann
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Diffusion-weighted magnetic resonance imaging for staging liver fibrosis is less reliable in the presence of fat and iron. Eur Radiol 2012; 23:1281-7. [PMID: 23138385 DOI: 10.1007/s00330-012-2700-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/20/2012] [Accepted: 10/10/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To investigate the reliability of diffusion-weighted magnetic resonance imaging (DW-MRI) for staging liver fibrosis in the presence of fat and iron. METHODS Ninety-five patients, including 48 men and 47 women, aged 57.0 ± 14.2 years, underwent liver biopsy. Ninety-six samples were histologically staged for liver fibrosis (0-Ishak score 0; 1-Ishak score 1-4; 2-Ishak score 5-6) and semiquantitatively graded for hepatic iron (0, no; 1, low; 2, moderate; 3, high iron) and for hepatic steatosis. Within 72 h after biopsy, navigator-triggered DW-MRI using b-values of 50/400/800 s/mm(2) was performed in a 1.5-T system, and apparent diffusion coefficients (ADC) were analysed. ADCs were correlated with fibrosis stage, steatosis grade, and iron grade using linear regression. RESULTS ADC did not correlate with fibrosis stages in either the overall group (n = 96; R (2) = 0.38; P = 0.17) or in the subgroup without liver iron and steatosis (n = 40; R (2) = 0.01; P = 0.75). ADC decreased significantly with steatosis grade in cases without iron and fibrosis (n = 42; R (2) = 0.28; ß = -5.3; P < 0.001). Liver iron was modestly correlated with ADC in patients without fibrosis and steatosis (n = 33; R (2) = 0.29; P = 0.04), whereas high iron concentrations were associated with low ADC values (group 3: β = -489; P = 0.005; reference:group 0) but intermediate levels were not (group 1/group 2: P = 0.93/P = 0.54; reference group: 0). CONCLUSIONS ADC values are confounded by fat and iron. However, even in patients without fat or iron, DW-MRI does not adequately discriminate the stage of fibrosis. KEY POINTS • Diffusion-weighted magnetic resonance imaging (DW-MRI) is increasingly used to evaluate liver disease. • DWI using b-values of 50/400/800 s/mm (2) does not adequately quantify fibrosis. • Assessment of the apparent diffusion coefficient (ADC) is confounded by fat and iron. • Fat may influence ADCs by altering water diffusion. • Iron may influence ADCs by signal decay and noise floor effects.
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Leitão HS, Doblas S, d'Assignies G, Garteiser P, Daire JL, Paradis V, Geraldes CFGC, Vilgrain V, Van Beers BE. Fat deposition decreases diffusion parameters at MRI: a study in phantoms and patients with liver steatosis. Eur Radiol 2012; 23:461-7. [PMID: 22935901 DOI: 10.1007/s00330-012-2626-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 06/19/2012] [Accepted: 06/29/2012] [Indexed: 02/07/2023]
Abstract
PURPOSE Assess the effect of fat deposition on the MRI diffusion coefficients in lipid emulsion-based phantoms and patients with proven isolated liver steatosis. MATERIALS AND METHODS Diffusion-weighted MRI with 11 b values from 0-500 s/mm(2) was performed in phantoms (fat fractions 0-18 %) with and without fat suppression and in 19 patients with normal liver (n = 14) or isolated liver steatosis (n = 5) proven by histopathology. The apparent, pure and perfusion-related diffusion coefficients and the perfusion fraction were measured. Spearman correlation coefficient and Mann-Whitney U test were used for comparisons. RESULTS A strong correlation between the apparent and pure diffusion coefficients and fat fractions was seen in phantoms. The pure diffusion coefficient decreased significantly in patients with liver steatosis (0.96 ± 0.16 × 10(-3) mm(2)/s versus 1.18 ± 0.09 × 10(-3) mm(2)/s in normal liver, P = 0.005), whereas the decrease in apparent diffusion coefficient did not reach statistical significance (1.26 ± 0.25 × 10(-3) mm(2)/s versus 1.41 ± 0.14 × 10(-3) mm(2)/s in normal liver, P = 0.298). CONCLUSIONS Fat deposition decreases the apparent and pure diffusion coefficients in lipid emulsion-based phantoms and patients with isolated liver steatosis proven by histopathology.
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Affiliation(s)
- Helena S Leitão
- Center for Neuroscience and Cell Biology, PhD Program in Experimental Biology and Biomedicine, University of Coimbra, Coimbra, Portugal.
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Anderson SW, Barry B, Soto JA, Ozonoff A, O'Brien M, Jara H. Quantifying hepatic fibrosis using a biexponential model of diffusion weighted imaging in ex vivo liver specimens. Magn Reson Imaging 2012; 30:1475-82. [PMID: 22921938 DOI: 10.1016/j.mri.2012.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 04/04/2012] [Accepted: 05/14/2012] [Indexed: 12/15/2022]
Abstract
The purpose of this study was to evaluate the non-Gaussian behavior of diffusion related signal decay of the ex vivo murine liver tissues from a dietary model of hepatic fibrosis. To this end, a biexponential formalism was used to model high b-value diffusion imaging (up to 3500 s/mm(2)), the findings of which were correlated with liver histopathology and compared to a simple monoexponential model. The presence of a major, fast diffusing component and a minor, slow diffusing component was demonstrated. With increasing hepatic fibrosis, the fractional contribution of the fast diffusing component decreased, as did the diffusion coefficient of the fast diffusing component. Strong correlation between the degrees of liver fibrosis and a two-predictor regression model incorporating parameters of the biexponential model was found. Using Akaike's Information Criterion analyses, the biexponential model resulted in an improved fit of the high b-value diffusion data when compared to the monoexponential model.
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Affiliation(s)
- Stephan W Anderson
- Department of Radiology, Boston University Medical Center, Boston, MA 02218, USA.
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