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Grove RL, Vespa F, Aineseder M, Villamil A, Spina JC. Prognostic role of magnetic resonance imaging of the abdomen with intravenous contrast and magnetic resonance cholangiopancreatography in primary sclerosing cholangitis. Radiol Bras 2023; 56:301-307. [PMID: 38504819 PMCID: PMC10948161 DOI: 10.1590/0100-3984.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 03/21/2024] Open
Abstract
Objective To evaluate the usefulness of Anali scores, determined by magnetic resonance imaging, for predicting the prognosis of primary sclerosing cholangitis (PSC) and to analyze interobserver variability, as well as to assess the impact of periportal edema and heterogeneous signal intensity on diffusion-weighted imaging of the liver. Materials and Methods This was a retrospective cohort study of 29 patients with PSC and baseline magnetic resonance imaging. Anali scores, without gadolinium (0-5 points) and with gadolinium (0-2 points), were calculated by two radiologists. Clinical end-points included liver transplantation, cirrhotic decompensation, and death. We calculated intraclass correlation coefficients (ICCs) for interobserver agreement on the Anali scores, performed Kaplan-Meier survival analysis comparing event-free survival among the score strata, and calculated the areas under receiver operating characteristic curves to determine sensitivity and specificity. Results Among the patients with a clinical event, the median Anali score was 4 (interquartile range [IQR], 2-5) without gadolinium and 2 (IQR, 1-2) with gadolinium, compared with 1 (IQR, 1.0-2.5) and 1 (IQR, 0.25-1.0), respectively, among those without a clinical event. The ICC was 0.79 (95% confidence interval: 0.57-0.91) for the Anali score with gadolinium and 0.99 (95% confidence interval: 0.98-0.99) for the Anali score without gadolinium. Periportal edema and heterogeneous signal intensity in the liver on diffusion-weighted imaging showed no statistical impact on clinical events (p = 0.65 and p = 0.5, respectively). Conclusion Anali scores correlate with clinical events in PSC, with a high level of interobserver agreement.
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Affiliation(s)
- Roy López Grove
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
| | - Florência Vespa
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
| | - Martina Aineseder
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
| | - Alejandra Villamil
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
| | - Juan Carlos Spina
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos
Aires, Argentina
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Kalage D, Gupta P, Gulati A, Yadav TD, Gupta V, Kaman L, Nada R, Singh H, Irrinki S, Gupta P, Das C, Dutta U, Sandhu M. Multiparametric MR imaging with diffusion-weighted, intravoxel incoherent motion, diffusion tensor, and dynamic contrast-enhanced perfusion sequences to assess gallbladder wall thickening: a prospective study based on surgical histopathology. Eur Radiol 2023:10.1007/s00330-023-09455-w. [PMID: 36826499 DOI: 10.1007/s00330-023-09455-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/01/2023] [Accepted: 01/30/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To investigate the diagnostic performance of a multiparametric magnetic resonance imaging (MRI) protocol comprising quantitative MRI (diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), diffusion tensor imaging (DTI), and dynamic contrast-enhanced (DCE) perfusion MRI) and conventional MRI in the characterization of gallbladder wall thickening (GWT). METHODS This prospective study comprised consecutive adults with GWT who underwent multiparametric MRI between July 2020 and April 2022. Two radiologists evaluated the MRI independently. The final diagnosis was based on surgical histopathology. The association of MRI parameters with malignant GWT was evaluated. The area under the curve (AUC) for the quantitative MRI parameters and diagnostic performance of conventional, and multiparametric MRI were compared. The interobserver agreement between two radiologists was calculated. RESULTS Thirty-five patients (mean age, 56 years, 23 females) with GWT (25 benign and ten malignant) were evaluated. The quantitative MRI parameters significantly associated with malignant GWT were apparent diffusion coefficient on DWI (p = 0.007) and mean diffusivity (MD) on DTI (p = 0.013), perfusion fraction (f) on IVIM (p = 0.033), time to peak enhancement (TTP, p = 0.008), and wash in rate (p = 0.049) on DCE-MRI. TTP had the highest AUC of 0.790, followed by MD (0.782) and f (0.742) (p = 0.213) for predicting malignant GWT. Multiparametric MRI had significantly higher sensitivity (90% vs. 80%, p = 0.045) than conventional MRI for diagnosing malignant GWT. The two radiologists' reading had substantial to near-perfect agreement (kappa = 0.639-1) and moderate to strong correlation (interclass correlation coefficient = 0.5-0.88). CONCLUSION Multiparametric protocol incorporating advanced sequences improved the diagnostic performance of MRI for differentiating benign and malignant GWT. KEY POINTS • Multiparametric MRI had 90% sensitivity and 88% specificity for diagnosing malignant GWT, compared to 80% sensitivity and 88% specificity for conventional CE-MRI. • Among the quantitative MRI parameters, TTP (perfusion-MRI) had the highest AUC of 0.790, followed by MD (0.782) and IVIM-f (0.742). • For most quantitative MRI parameters, there was moderate to strong agreement (ICC = 0.5-0.88).
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Affiliation(s)
- Daneshwari Kalage
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Ajay Gulati
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lileswar Kaman
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Santosh Irrinki
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chandan Das
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manavjit Sandhu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Saleh GA, Elmokadem AH, Razek AA, El-Morsy A, Hamdy O, Eleraky ES, Saleh M. Utility of diffusion tensor imaging in differentiating benign from malignant hepatic focal lesions. Eur Radiol 2023; 33:1400-1411. [PMID: 35982336 DOI: 10.1007/s00330-022-09091-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of diffusion tensor imaging (DTI) in the characterization of hepatic focal lesions (HFLs) and compare it to diffusion-weighted imaging (DWI). METHODS Prospective analysis was done for 49 patients (23 male and 26 female) with 74 HFLs who underwent dynamic MRI, DWI, and DTI. Apparent diffusion coefficient (ADC) values from DWI, fractional anisotropy (FA) values, and mean diffusivity (MD) values from DTI were measured by two independent radiologists. HFLs were classified into benign and malignant HFLs; the latter were subdivided into HCC and non-HCC lesions. Binary logistic regression was performed to analyze the associations between the DTI parameters and the distinction of malignant lesions. RESULTS The ADC, MD, and FA at cutoff values of ≤ 1.17 × 10-3 mm2/s, ≤ 1.71 × 10-3 mm2/s, and > 0.29, respectively, are excellent discriminators for differentiating malignant and benign HFLs. The mean ADC and MD values of hemangiomas were significantly higher than HCC and non-HCC malignant lesions. In contrast, the mean FA values of hemangiomas were significantly lower than those of non-HCC malignant lesions and HCCs. The ADC and MD were very good discriminators at cutoff values of > 1.03 × 10-3 mm2/s and > 1.12 × 10-3 mm2/s, respectively. The FA at a cutoff value > 0.38 is an excellent discriminator for HCC versus non-HCC malignant lesions. Only FA value > 0.38 was a statistically significant independent predictor of HCC versus non-HCC lesions among the three parameters. There was an excellent inter-observer agreement with ICC > 0.9. CONCLUSION MD and FA of DTI are non-invasive, very good, and excellent discriminators superior to ADC measured by DWI for the differentiation of HFLs. KEY POINTS • The ADC, MD, and FA at cutoff values of ≤ 1.17 × 10-3 mm2/s, ≤ 1.71 × 10-3 mm2/s, and > 0.29, respectively, are excellent discriminators for differentiating malignant and benign HFLs. • The mean ADC and MD values of hemangiomas were significantly higher than those of HCC and non-HCC malignant lesions. In contrast, the mean FA values of hemangiomas were significantly lower than those of non-HCC malignant lesions and HCCs, respectively. • Multivariate regression analysis revealed that only FA value > 0.38 was a statistically significant independent predictor of HCC vs. non-HCC lesions. A lesion with FA > 0.38 has 34 times higher odds of being HCC rather than non-HCC lesions.
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Affiliation(s)
- Gehad A Saleh
- Department of Radiology, Mansoura University, El Gomhoria St., Mansoura, 35516, Egypt
| | - Ali H Elmokadem
- Department of Radiology, Mansoura University, El Gomhoria St., Mansoura, 35516, Egypt.
| | - Ahmed Abdel Razek
- Department of Radiology, Mansoura University, El Gomhoria St., Mansoura, 35516, Egypt
| | - Ahmed El-Morsy
- Department of Radiology, Mansoura University, El Gomhoria St., Mansoura, 35516, Egypt
| | - Omar Hamdy
- Department of Surgical Oncology, Mansoura University, Mansoura, Egypt
| | | | - Marwa Saleh
- Department of Internal Medicine, Mansoura University, Mansoura, Egypt
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Yoon H, Lim HJ, Kim J, Lee MJ. [Diagnostic Imaging of Biliary Atresia]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:991-1002. [PMID: 36276203 PMCID: PMC9574267 DOI: 10.3348/jksr.2022.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/27/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022]
Abstract
Biliary atresia is a rare but significant cause of neonatal cholestasis. An early and accurate diagnosis is important for proper management and prognosis. To diagnose biliary atresia, various imaging studies using ultrasonography, MRI, hepatobiliary scans, and cholangiography can be performed, although ultrasonography is more important for initial imaging studies. In this article, we review the findings of biliary atresia from various imaging modalities, including ultrasonography, MRI, hepatobiliary scans, and cholangiography. The known key imaging features include abnormal gallbladder size and shape, periportal thickening visible as a 'triangular cord' sign, invisible common bile duct, increased hepatic arterial flow, and combined anomalies. Aside from the imaging findings of biliary atresia, we also reviewed the diagnostic difficulty in the early neonatal period and the role of imaging in predicting hepatic fibrosis. We hope that this review will aid in the diagnosis of biliary atresia.
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Li B, Li J, Zhang Y, Chu Z, Zhang L, Ji Q. Dynamic changes of hepatic microenvironment related to graft function in donation after cardiac death liver transplantation. Eur J Radiol 2022; 154:110424. [DOI: 10.1016/j.ejrad.2022.110424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/31/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
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Quantitative evaluation of hepatic fibrosis by fibro Scan and Gd-EOB-DTPA-enhanced T1 mapping magnetic resonance imaging in chronic hepatitis B. Abdom Radiol (NY) 2022; 47:684-692. [PMID: 34825269 DOI: 10.1007/s00261-021-03300-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Studies have found that both FibroScan (FS) and Gd-EOB-DTPA-enhanced T1 mapping magnetic resonance imaging (Gd-MRI) could assess liver fibrosis (LF) with high effectiveness. The aim of this study is to compare their accuracy in the quantitative evaluation of LF in patients with chronic hepatitis B (CHB), and to explore the diagnostic accuracy of their combination. METHODS 160 patients with CHB were included in this study. FS and Gd-MRI were performed within 3 months before the pathological LF staging, which was classified according to the Scheuer-Ludwig scale. The liver stiffness measurement (LSM) was obtained by FS. T1 mapping images of the liver before and 20 min after enhancement were obtained by Look-Locker Gd-MRI. RESULTS There were 45, 35, 31 and 49 patients with stage S1, S2, S3 and S4 LF, respectively. LSM increased and the reduction rate of T1 relaxation time of 20 min (rrT120min%) decreased with the severity of LF. The area under curve (AUC) of LSM, rrT120min% and LSM + rrT120min% for the diagnosis of ≥ S2 LF were 0.892, 0.811 and 0.900, respectively. The AUC for ≥ S3 LF was 0.883, 0.838 and 0.899, respectively. The AUC for S4 LF was 0.882, 0.894 and 0.928, respectively. CONCLUSION The diagnostic accuracy of FS is better than that of Gd-MRI in the evaluation of ≥ S2 stage LF. The combination of these two methods significantly improved the diagnostic efficiency in the evaluation of S4 stage LF.
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Kapetas P, Clauser P, Milos RI, Vigano S, Bernathova M, Helbich TH, Baltzer PAT. Microstructural breast tissue characterization: A head-to-head comparison of Diffusion Weighted Imaging and Acoustic Radiation Force Impulse elastography with clinical implications. Eur J Radiol 2021; 143:109926. [PMID: 34438330 DOI: 10.1016/j.ejrad.2021.109926] [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: 07/14/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Head-to-head comparison of Diffusion Weighted Imaging (DWI) and Acoustic Radiation Force Impulse (ARFI) elastography regarding the characterization of breast lesions in an assessment setting. METHOD Patients undergoing an ultrasound examination including ARFI and an MRI protocol including DWI for the characterization of a BI-RADS 3-5 breast lesion between 06/2013 and 10/2016 were eligible for inclusion in this retrospective, IRB-approved study. 60 patients (30-84 years, median 50) with a median lesion size of 16 mm (range 5-55 mm) were included. The maximum shear wave velocity (SWVmax) and mean apparent diffusion coefficient (ADCmean) for each lesion were retrospectively evaluated by a radiologist experienced in the technique. Histology was the reference standard. Diagnostic performances of ARFI and DWI were assessed using ROC curve analysis. Spearman's rank correlation coefficient and multivariate logistic regression were used to investigate the independence of both tests regarding their diagnostic information to distinguish benign from malignant lesions. RESULTS Corresponding areas under the ROC curve for differentiation of benign (n = 16) and malignant (n = 49) lesions were 0.822 (ARFI) and 0.871 (DWI, p-value = 0.48). SWVmax and ADCmean values showed a significant negative correlation (ρ = -0.501, p-value < 0.001). In multivariate analysis, combination of ARFI and DWI did not improve the results of each single modality, thus no significant independent diagnostic information was present. CONCLUSION Significant correlation between quantitative findings of ARFI and DWI in breast lesions exists. Thus, ARFI provides similar diagnostic information as a DWI-including protocol of an additional "problem-solving" MRI for the characterization of a sonographically evident breast lesion, improving the immediate patient management in the assessment setting.
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Affiliation(s)
- Panagiotis Kapetas
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Paola Clauser
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Ruxandra-Iulia Milos
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Sara Vigano
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via della Commenda 10, 20122 Milan, Italy
| | - Maria Bernathova
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Thomas H Helbich
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Pascal A T Baltzer
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Razek AAKA, Hafez MM, Mahmoud W, Ismail AR, Ali KM, Barakat TE. Diffusion tensor imaging of the spleen in prediction and grading of esophageal varices in cirrhotic children with portal hypertension. Jpn J Radiol 2021; 39:907-913. [PMID: 33914254 DOI: 10.1007/s11604-021-01123-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess diffusion tensor imaging (DTI) of spleen in prediction and grading of esophageal varices (OV) in cirrhotic children. METHODS This prospective study was conducted upon 30 children with cirrhotic children with OV and 10 age-gender matched controls that underwent DTI of abdomen. Mean diffusivity (MD) and fractional anisotropy (FA) of spleen were calculated and matched with the grading of OV at endoscopy and laboratory biomarkers of portal hypertension. RESULTS Mean ADC of spleen in patient was significantly different (p = 0.001) from that of controls by both reviewers respectively. The cutoff ADC measurement of the spleen used for prediction of OV was ≥ 0.75 and ≥ 0.76 × 10-3mm2/s with AUC was 0.993 and 0.997 for both reviewers respectively. The FA of the spleen in patient was different (p = 0.01) from of controls of both reviewers respectively. Cutoff FA of spleen used for prediction of OV was ≤ 0.35 and ≤ 0.36 for both observers respectively. ADC and FA of spleen was correlated with platelets count (r = - 0.713, 0.392; p = 0.001, 0.012) and prothrombin time (r = 0.518, - 0.380; p = 0.001, 0.016). CONCLUSION DTI metrics of spleen can predict and grade OV and correlated with laboratory biomarkers of portal hypertension.
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Affiliation(s)
| | - Mona Mohamed Hafez
- Cardiology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Walaa Mahmoud
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, 13551, Egypt
| | - Ahmed Ramadan Ismail
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khadiga M Ali
- Department of Pathology, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Tarek Elsayed Barakat
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Mostafa MA, Kamal O, Yassin A, Nagi MA, Ahmed OA, Ahmed HA. The diagnostic value of normalized ADC using spleen as reference organ in assessment liver fibrosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00212-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To investigate the value of liver ADC normalization using spleen as a reference organ in liver fibrosis assessment compared to Fibroscan.
A total of 60 participants were included, 30 HCV positive patients and 30 in control group. We calculated mean spleen apparent diffusion coefficient (ADC), liver mean ADC, and normalized liver ADC (defined as the ratio of liver ADC to spleen ADC) which were compared between cirrhotic patients and the control group. Data was analyzed, and ROC was used to evaluate the performance of nADC.
Results
No significant difference between spleen ADC values of patient and control groups or in-between different fibrosis stages. A negative correlation between liver ADC and nADC values with increasing fibrosis stages. We also found that the mean liver ADC and nADC value in patients with hepatic fibrosis were significantly lower than that of control group (1.53 × 10−3 mm2/s vs 1.65 × 10−3 mm2/s). After analysis with ROC, nADC shows higher diagnostic performance compared to liver ADC. nADC area under the curve (AUC) was 0.878 for detection of stage ≥ F2 with sensitivity and specificity of 87% and 80% respectively while ADC AUC was 0.548 with sensitivity and specificity of 62% and 72% respectively (p = 0.021); ≥ F3 AUC of nADC was 0.891 with sensitivity and specificity of 88.7% and 80% respectively while ADC AUC is 0.603 with sensitivity and specificity of 72% and 72% respectively (p = 0.023), and F4 stage nADC AUC was 0.879 for with sensitivity and specificity of 90% and 80% respectively, while ADC AUC was 0.648 with sensitivity and specificity of 80% and 72% respectively (p = 0.054).
Conclusion
Normalized liver ADC using the spleen as reference organs increases the diagnostic performance of MR in evaluation liver fibrosis compared to ADC alone.
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Xie S, Li Q, Cheng Y, Zhou L, Xia S, Li J, Shen W. Differentiating mild and substantial hepatic fibrosis from healthy controls: a comparison of diffusion kurtosis imaging and conventional diffusion-weighted imaging. Acta Radiol 2020; 61:1012-1020. [PMID: 31825764 DOI: 10.1177/0284185119889566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Early and accurate detection of liver fibrosis are important for clinical treatment. PURPOSE To compare the diagnostic accuracy of liver diffusion kurtosis imaging (DKI) and conventional diffusion-weighted imaging (cDWI) in differentiating patients with mild and substantial fibrosis from normal individuals. MATERIAL AND METHODS Twenty-seven healthy volunteers with no fibrosis (S0) and 45 patients with mild (S1) or substantial (S2) liver fibrosis underwent DWI with multiple b-values. Liver mean apparent diffusion (MD) and mean kurtosis (MK) values derived from DKI and apparent diffusion coefficient (ADC) derived from cDWI were measured and compared. Their discriminative abilities were analyzed and compared by receiver operating characteristic (ROC) curve analysis. RESULTS Significant differences in MD and ADC values were found between groups (P < 0.05). MD value was statistically different between S0 and S1 (P = 0.028) and S0 and S2 (P = 0.005). ADC value was statistically different between S0 and S2 (P = 0.012). MK value was similar between groups (P = 0.646). MD and ADC values significantly correlated with fibrosis stages (rs = -0.668, -0.341; P < 0.01). MK values had no correlation with fibrosis stages (rs = 0.180; P = 0.130). The area under ROC curves (AUC) for MD and ADC was 0.937 and 0.707 for characterization of S1-2 and 0.817 and 0.658 for S2, respectively. MD performed better than ADC for characterization of S1-2 and S2 (P < 0.05). CONCLUSION Differentiating patients with mild or substantial fibrosis from normal individuals is feasible using DKI, which performs better than cDWI.
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Affiliation(s)
- Shuangshuang Xie
- Department of Radiology, Tianjin First Central Hospital, Tianjin Imaging Medical Institute, Nankai District, Tianjin, PR China
| | - Qing Li
- Department of Radiology, Tianjin First Central Hospital, Tianjin Imaging Medical Institute, Nankai District, Tianjin, PR China
| | - Yue Cheng
- Department of Radiology, Tianjin First Central Hospital, Tianjin Imaging Medical Institute, Nankai District, Tianjin, PR China
| | - Li Zhou
- Department of Hepatology, Tianjin Second People’s Hospital, Nankai District, Tianjin, PR China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Tianjin Imaging Medical Institute, Nankai District, Tianjin, PR China
| | - Jia Li
- Department of Hepatology, Tianjin Second People’s Hospital, Nankai District, Tianjin, PR China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, Tianjin Imaging Medical Institute, Nankai District, Tianjin, PR China
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Abdel Razek AAK, Abdalla A, Elfar R, Ashmalla GA, Ali K, Barakat T. Assessment of Diffusion Tensor Imaging Parameters of Hepatic Parenchyma for Differentiation of Biliary Atresia from Alagille Syndrome. Korean J Radiol 2020; 21:1367-1373. [PMID: 32729270 PMCID: PMC7689146 DOI: 10.3348/kjr.2019.0824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 03/22/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To assess diffusion tensor imaging (DTI) parameters of the hepatic parenchyma for the differentiation of biliary atresia (BA) from Alagille syndrome (ALGS). Materials and Methods This study included 32 infants with BA and 12 infants with ALGS groups who had undergone DTI. Fractional anisotropy (FA) and mean diffusivity (MD) of the liver were calculated twice by two separate readers and hepatic tissue was biopsied. Statistical analyses were performed to determine the mean values of the two groups. The optimum cut-off values for DTI differentiation of BA and ALGS were calculated by receiver operating characteristic (ROC) analysis. Results The mean hepatic MD of BA (1.56 ± 0.20 and 1.63 ± 0.2 × 10−3 mm2/s) was significantly lower than that of ALGS (1.84 ± 0.04 and 1.79 ± 0.03 × 10−3 mm2/s) for both readers (r = 0.8, p = 0.001). Hepatic MD values of 1.77 and 1.79 × 10−3 mm2/s as a threshold for differentiating BA from ALGS showed accuracies of 82 and 79% and area under the curves (AUCs) of 0.90 and 0.91 for both readers, respectively. The mean hepatic FA of BA (0.34 ± 0.04 and 0.36 ± 0.04) was significantly higher (p = 0.01, 0.02) than that of ALGS (0.30 ± 0.06 and 0.31 ± 0.05) for both readers (r = 0.80, p = 0.001). FA values of 0.30 and 0.28 as a threshold for differentiating BA from ALGS showed accuracies of 75% and 82% and AUCs of 0.69 and 0.68 for both readers, respectively. Conclusion Hepatic DTI parameters are promising quantitative imaging parameters for the detection of hepatic parenchymal changes in BA and ALGS and may be an additional noninvasive imaging tool for the differentiation of BA from ALGS.
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Affiliation(s)
| | - Ahmed Abdalla
- Gastroenterology and Hepatology Unit, Mansoura Children Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Reda Elfar
- Gastroenterology and Hepatology Unit, Mansoura Children Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | | | - Khadiga Ali
- Department of Pathology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Tarik Barakat
- Gastroenterology and Hepatology Unit, Mansoura Children Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
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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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Ye Z, Wei Y, Chen J, Yao S, Song B. Value of intravoxel incoherent motion in detecting and staging liver fibrosis: A meta-analysis. World J Gastroenterol 2020; 26:3304-3317. [PMID: 32684744 PMCID: PMC7336331 DOI: 10.3748/wjg.v26.i23.3304] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/26/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver fibrosis (LF) is a common pathological feature of all chronic liver diseases. With the accumulation of extracellular matrix in the fibrotic liver, true molecular water diffusion and perfusion-related diffusion are restricted. Intravoxel incoherent motion (IVIM) can capture the information on tissue diffusivity and microcapillary perfusion separately and reflect the fibrotic severity with diffusion coefficients.
AIM To investigate the diagnostic performance of IVIM in detecting and staging LF with histology as a reference standard.
METHODS A comprehensive literature search was conducted to identify studies on the diagnostic accuracy of IVIM for assessment of histologically proven LF. The stages of LF were classified as F0 (no fibrosis), F1 (portal fibrosis without septa), F2 (periportal fibrosis with few septa), F3 (septal fibrosis), and F4 (cirrhosis) according to histopathological findings. Data were extracted to calculate the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio, as well as the area under the summary receiver operating characteristic curve (AUC) in each group.
RESULTS A total of 12 studies with 923 subjects were included in this meta-analysis with 5 studies (n = 465) for LF ≥ F1, 9 studies (n = 757) for LF ≥ F2, 4 studies (n = 413) for LF ≥ F3, and 6 studies (n = 562) for LF = F4. The pooled sensitivity and specificity were estimated to be 0.78 (95% confidence interval: 0.73-0.82) and 0.81 (0.74-0.86) for LF ≥ F1 detection with IVIM; 0.82 (0.79-0.86) and 0.80 (0.75-0.84) for staging F2 fibrosis; 0.85 (0.79-0.90) and 0.83 (0.77-0.87) for staging F3 fibrosis, and 0.90 (0.84-0.94) and 0.75 (0.70-0.79) for detecting F4 cirrhosis, respectively. The AUCs for LF ≥ F1, F2, F3, F4 detection were 0.862 (0.811-0.914), 0.883 (0.856-0.909), 0.886 (0.865-0.907), and 0.899 (0.866-0.932), respectively. Moderate to substantial heterogeneity was observed with inconsistency index (I2) ranging from 0% to 77.9%. No publication bias was detected.
CONCLUSION IVIM is a noninvasive tool with good diagnostic performance in detecting and staging LF. Optimized and standardized IVIM protocols are needed to further improve its diagnostic accuracy in clinical practice.
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Affiliation(s)
- Zheng Ye
- West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi Wei
- West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jie Chen
- West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Shan Yao
- West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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The role of diffusion tensor imaging for the assessment of liver fibrosis and inflammation in chronic viral hepatitis: A preliminary study. MARMARA MEDICAL JOURNAL 2020. [DOI: 10.5472/marumj.741724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Tosun M, Onal T, Uslu H, Alparslan B, Çetin Akhan S. Intravoxel incoherent motion imaging for diagnosing and staging the liver fibrosis and inflammation. Abdom Radiol (NY) 2020; 45:15-23. [PMID: 31705248 DOI: 10.1007/s00261-019-02300-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of intravoxel incoherent motion (IVIM) model parameters for the diagnosis and staging of liver fibrosis and inflammation in patients with chronic hepatitis B. METHODS Fifty-four patients with chronic hepatitis B and 42 healthy volunteers were included in the study. All subjects were examined by 3 T magnetic resonance imaging. Diffusion-weighted imaging was undertaken with sixteen b values. IVIM parameters [D (true diffusion coefficient), D* (pseudo-diffusion coefficient), f (perfusion fraction)] were calculated. Histological evaluation of biopsy samples was considered the reference standard for the staging of liver fibrosis and inflammation. Differences in IVIM parameters between patient and control groups were analyzed. In the patient group, fibrosis stage and inflammation grade groups were analyzed with respect to IVIM parameters. The correlation was assessed between IVIM parameters and Ishak-modified scale of fibrosis stages and inflammation grades. RESULTS The D was significantly lower in the patient group than the control group, p = 0.038 with Cohen's d effect size of 0.452. D was significantly different between fibrosis stage levels. D values decreased in fibrosis stages from the minimal to moderate to marked fibrosis. Fibrosis grades significantly negatively correlated with D and D* values, p = 0.001, and 0.021, respectively. In addition, inflammation grades negatively correlated with f values, p = 0.047. CONCLUSION D values measured with IVIM imaging may help to diagnose liver fibrosis. IVIM imaging could be an alternative to liver biopsy for the staging of liver fibrosis.
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Affiliation(s)
- Mesude Tosun
- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey.
| | | | - Hande Uslu
- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Burcu Alparslan
- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Sıla Çetin Akhan
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Kocaeli, Turkey
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Li J, Jiang J, Chu Z, Zhang Y, Cai W, Zhu J, Grimm R, Ji Q. Multiparametric MRI Evaluation of Liposomal Prostaglandins E1 Intervention on Hepatic Warm Ischemia‐Reperfusion Injury in Rabbits. J Magn Reson Imaging 2019; 52:217-228. [PMID: 31829483 DOI: 10.1002/jmri.27022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 01/19/2023] Open
Affiliation(s)
- Jingyao Li
- First Central Clinical College of Tianjin Medical University Nankai DistrictTianjin China
- Department of RadiologyTianjin First Central Hospital Nankai DistrictTianjin China
| | - Jiabing Jiang
- First Central Clinical College of Tianjin Medical University Nankai DistrictTianjin China
- Department of RadiologyTianjin First Central Hospital Nankai DistrictTianjin China
| | - Zhiqiang Chu
- Department of TransplantationTianjin First Central Hospital Nankai DistrictTianjin China
| | - Yuling Zhang
- First Central Clinical College of Tianjin Medical University Nankai DistrictTianjin China
- Department of RadiologyTianjin First Central Hospital Nankai DistrictTianjin China
| | - Wenjuan Cai
- Department of PathologyTianjin First Central Hospital Nankai DistrictTianjin China
| | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare Beijing China
| | | | - Qian Ji
- Department of RadiologyTianjin First Central Hospital Nankai DistrictTianjin China
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17
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Diffusion Tensor Imaging of the Kidney: Design and Evaluation of a Reliable Processing Pipeline. Sci Rep 2019; 9:12789. [PMID: 31484949 PMCID: PMC6726597 DOI: 10.1038/s41598-019-49170-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/15/2019] [Indexed: 12/14/2022] Open
Abstract
Diffusion tensor imaging (DTI) is particularly suitable for kidney studies due to tubules, collector ducts and blood vessels in the medulla that produce spatially restricted diffusion of water molecules, thus reflecting the high grade of anisotropy detectable by DTI. Kidney DTI is still a challenging technique where the off-resonance susceptibility artefacts and subject motion can severely affect the reproducibility of results. The aim of this study is to design a reliable processing pipeline by assessing different image processing approaches in terms of reproducibility and image artefacts correction. The results of four different processing pipelines (eddy: correction of eddy-currents and motion between DTI volume; eddy-s2v: eddy and within DTI volume motion correction; topup: eddy and geometric distortion correction; topup-s2v: topup and within DTI volume motion correction) are compared in terms of reproducibility by test-retest analysis in 14 healthy subjects. Within-subject coefficient of variation (wsCV) and intra-class correlation coefficient (ICC) are measured to assess the reproducibility and Dice similarity index is evaluated for the spatial alignment between DTI and anatomical images. Topup-s2v pipeline provides highest reproducibility (wsCV = 0.053, ICC = 0.814) and best correction of image distortion (Dice = 0.83). This study definitely provides a recipe for data processing, enabling for a clinical suitability of kidney DTI.
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18
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Shin MK, Song JS, Hwang SB, Hwang HP, Kim YJ, Moon WS. Liver Fibrosis Assessment with Diffusion-Weighted Imaging: Value of Liver Apparent Diffusion Coefficient Normalization Using the Spleen as a Reference Organ. Diagnostics (Basel) 2019; 9:diagnostics9030107. [PMID: 31466404 PMCID: PMC6787628 DOI: 10.3390/diagnostics9030107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
Liver fibrosis staging is of great clinical importance because it is used to assess the severity of the underlying chronic liver disease. Among various imaging-based methods, apparent diffusion coefficient (ADC) measurement using diffusion-weighted imaging (DWI) has the potential to be used as an imaging biomarker for liver fibrosis assessment. In this study, we investigated the usefulness of liver ADC normalization using the spleen as a reference organ in liver fibrosis staging with 66 patients who underwent liver magnetic resonance imaging (MRI), transient elastography (TE), and surgical resection of a hepatic mass. ADC values of the liver (ADCliver) and spleen were analyzed, and the spleen was used for ADCliver normalization (nADCliver). ADCliver showed a weak negative correlation with TE (r = −0.246; p = 0.047) and fibrosis stage (r = −0.269; p = 0.029), while n ADCliver showed a moderate negative correlation with TE (r = −0.504; p < 0.001) and fibrosis stage (r = −0.579; p < 0.001). AUC values for nADCliver (0.777–0.875) were higher than those for ADCliver for each stage of fibrosis (0.596–0.713, p = 0.037–0.157). AUC values for TE (0.726–0.884) and nADCliver were not statistically different. In conclusion, normalized liver ADC can be useful in diagnosing liver fibrosis stage in patients with variable DWI acquisitions.
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Affiliation(s)
- Min Ki Shin
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju 54907, Korea
| | - Ji Soo Song
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju 54907, Korea.
- Research Institute of Clinical Medicine of Chonbuk National University, Jeonju 54907, Korea.
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Korea.
| | - Seung Bae Hwang
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju 54907, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Jeonju 54907, Korea
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 54907, Korea
| | - Hong Pil Hwang
- Department of Surgery, Chonbuk National University Medical School, Jeonju 54907, Korea
| | - Young Jun Kim
- Department of Radiology, Presbyterian Medical Center, Jeonju 54907, Korea
| | - Woo Sung Moon
- Department of Pathology, Chonbuk National University Medical School, Jeonju 54907, Korea
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Verloh N, Probst U, Utpatel K, Zeman F, Brennfleck F, Werner JM, Fellner C, Stroszczynski C, Evert M, Wiggermann P, Haimerl M. Influence of hepatic fibrosis and inflammation: Correlation between histopathological changes and Gd-EOB-DTPA-enhanced MR imaging. PLoS One 2019; 14:e0215752. [PMID: 31083680 PMCID: PMC6513096 DOI: 10.1371/journal.pone.0215752] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/08/2019] [Indexed: 02/07/2023] Open
Abstract
Objective To evaluate the influence of an active inflammatory process in the liver on Gd-EOB-DTPA-enhanced MR imaging in patients with different degrees of fibrosis/cirrhosis. Material and methods Overall, a number of 91 patients (61 men and 30 women; mean age 58 years) were included in this retrospective study. The inclusion criteria for this study were Gd-EOB-DTPA-enhanced MRI of the liver and histopathological evaluation of fibrotic and inflammatory changes. T1-weighted VIBE sequences of the liver with fat suppression were evaluated to determine the relative signal change (RE) between native and hepatobiliary phase (20min). In simple and multiple linear regression analyses, the influence of liver fibrosis/cirrhosis (Ishak score) and the histopathological degree of hepatitis (Modified Hepatic Activity Index, mHAI) on RE were evaluated. Results RE decreased significantly with increasing liver fibrosis/cirrhosis (p < 0.001) and inflammation (mHAI, p = 0.004). In particular, a correlation between RE and periportal or periseptal boundary zone hepatitis (moth feeding necrosis, mHAI A, p = 0.001) and portal inflammation (mHAI D, p < 0.001) was observed. In multiple linear regression analysis, both the degree of inflammation and the degree of fibrosis were significant predictors for RE (p < 0.01). Conclusion The results of this study suggest that the MR-based hepatic enhancement index RE is not only influenced by the degree of fibrosis, but also by the degree of inflammation.
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Affiliation(s)
- N. Verloh
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
- * E-mail:
| | - U. Probst
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - K. Utpatel
- Department of Pathology, University Regensburg, Regensburg, Germany
| | - F Zeman
- Center for Clinical Trials, University Hospital Regensburg, Regensburg, Germany
| | - F. Brennfleck
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - J. M. Werner
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - C. Fellner
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - C. Stroszczynski
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - M. Evert
- Department of Pathology, University Regensburg, Regensburg, Germany
| | - P. Wiggermann
- Department of Radiology and Nuclear Medicine, Hospital Braunschweig, Braunschweig, Germany
| | - M. Haimerl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Monoexponential and Biexponential Fitting of Diffusional Magnetic Resonance Imaging Signal Analysis for Prediction of Liver Fibrosis Severity. J Comput Assist Tomogr 2019; 43:857-862. [DOI: 10.1097/rct.0000000000000937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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21
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Intravoxel Incoherent Motion (IVIM) Diffusion-Weighted Imaging (DWI) in Patients with Liver Dysfunction of Chronic Viral Hepatitis: Segmental Heterogeneity and Relationship with Child-Turcotte-Pugh Class at 3 Tesla. Gastroenterol Res Pract 2018; 2018:2983725. [PMID: 30647733 PMCID: PMC6311737 DOI: 10.1155/2018/2983725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/19/2018] [Indexed: 12/11/2022] Open
Abstract
Background Few studies focused on the region of interest- (ROI-) related heterogeneity of liver intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI). The aim of the study was to evaluate the differences of liver IVIM parameters among liver segments in cirrhotic livers (chronic viral hepatitis). Material and Methods This was a retrospective study of 82 consecutive patients with chronic liver disease who underwent MRI examination at the Jinan Infectious Diseases Hospital between January 2015 and December 2016. IVIM DWI (seven different b values) was performed on a Siemens 3.0-T MRI scanner. Pure molecular diffusion (D), pseudodiffusion (D∗), and perfusion fraction (f) in different liver segments were evaluated. Results f, D, and D∗ were different among the liver segments (all p < 0.05), indicating heterogeneity in IVIM parameters among liver segments. f was consistently higher in Child-Turcotte-Pugh (CTP) class A compared with CTP class B + C (p < 0.01). D and D∗ were higher in CTP class A compared with CTP class B + C (p < 0.05). In patients with mean f value of >0.29, the AUC was 0.88 (95% CI: 0.81-0.96), with 86.8% sensitivity and 81.8% specificity for predicting CTP class A from CTP class B + C. Conclusion Liver IVIM could be a promising method for classifying the severity of segmental liver dysfunction of chronic viral hepatitis as evaluated by the CTP class, which provides a noninvasive alternative for evaluating segmental liver dysfunction with accurate selection of ROIs. Potentially it can be used to monitor the progression of CLD and LC in the future.
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Li XH, Liang Q, Chen TW, Wang J, Zhang XM. Diagnostic value of imaging examinations in patients with primary hepatocellular carcinoma. World J Clin Cases 2018; 6:242-248. [PMID: 30211204 PMCID: PMC6134275 DOI: 10.12998/wjcc.v6.i9.242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/05/2018] [Accepted: 08/01/2018] [Indexed: 02/05/2023] Open
Abstract
Primary hepatocellular carcinoma (PHC) includes hepatocellular carcinoma, intrahepatic cholangiocarcinoma and other pathological types and is characterized by rapid progression. Most of the clinical diagnoses are made at late stage or when distant metastasis occurs, increasing the difficulty of treatment and resulting in a poor prognosis. Therefore, the early diagnosis of PHC plays an important role in timely treatment and the improvement of prognosis. The gold standard for the diagnosis of primary liver cancer is liver biopsy, but it has limitations as an invasive examination. Presently, imaging has become the first choice for the diagnosis of liver cancer. We here summarize the new methods and techniques of imaging in diagnosis and evaluation of primary liver cancer in recent years, including ultrasonography, computed tomography perfusion imaging, diffusion-weighted imaging technology-voxel incoherent motion, diffusion tensor imaging, iterative decomposition of water and fat with echo asymmetry and least squares estimation-iron quantification, dynamic enhanced magnetic resonance imaging and hepatocyte-specific contrast medium imaging. Imaging diagnosis can not only evaluate the degree of differentiation, blood supply and perfusion, and invasiveness of the lesion, but also predict the prognosis, evaluate liver function, and provide references for clinical diagnosis and treatment.
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Affiliation(s)
- Xing-Hui Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Radiology, Southwest Hospital of Army Medical University, Chongqing 400038, China
| | - Qi Liang
- Department of Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Tian-Wu Chen
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital of Army Medical University, Chongqing 400038, China
| | - Xiao-Ming Zhang
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
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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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Ji Q, Chu ZQ, Ren T, Xu SC, Zhang LJ, Shen W, Lu GM. Multiparametric functional magnetic resonance imaging for evaluation of hepatic warm ischemia-reperfusion injury in a rabbit model. BMC Gastroenterol 2017; 17:161. [PMID: 29246201 PMCID: PMC5732447 DOI: 10.1186/s12876-017-0720-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 11/29/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To assess the feasibility of noninvasive and quantitative evaluation of hepatic pathophysiological changes in rabbit hepatic warm ischemia-reperfusion injury (WIRI) models by using intravoxel incoherent motion (IVIM), diffusion tensor imaging (DTI) and blood oxygen level dependent (BOLD) MRI. METHODS Twenty rabbits were randomly divided into hepatic WIRI model group and sham-operation group (n = 10 for each group). Hepatic WIRI was induced in rabbit by occluding hepatic inflow for 30 min and reperfusion for 6 h. The control group only underwent laparotomy and liver ligament dissection. IVIM with 11 b values (0 to 800 s/mm2), DTI with 2 b values (0 and 500 s/mm2) on 12 diffusion directions, and BOLD MRI with 9 TE (2.57 to 24.25 ms) were performed at 3 T clinical MR scanner. Rabbits were sacrificed for biochemical and histopathological analysis after MR scanning. All of functional MR, biochemical and histopathological parameters were analyzed by independent sample t test, Mann-Whitney U test, Pearson and Spearman correlation methods. RESULTS All of MR parameters showed moderate to excellent interobserver reproducibility. True diffusion (Dslow), pseudodiffusion (Dfast), perfusion fraction (PF), and mean diffusitivity (MD) were lower in WIRI models than in control rabbits (P < 0.01), R2* was higher in WIRI models than in control rabbits (P < 0.001), while fractional anisotropy (FA) showed no statistical difference. There were significant differences in I score and all of biochemical parameters between the two groups (P < 0.01). Functional MR parameters corresponded well with all of biochemical parameters and some of histopathological parameters (P < 0.05). Histopathological analysis showed the structure and morphology of hepatic lobule was normal and clear in control rabbits, while diffuse hepatocyte swelling, central vein and sinusoids congestion, and inflammatory cell infiltration in WIRI models. CONCLUSIONS IVIM, DTI, and BOLD MRI are noninvasive and useful techniques for assessing the microenvironment changes of hepatic WIRI in rabbit models.
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Affiliation(s)
- Qian Ji
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, China.,Department of Radiology, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China
| | - Zhi Qiang Chu
- Department of Transplantation, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China
| | - Tao Ren
- Department of Radiology, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China
| | - Shi Chao Xu
- Department of Transplantation, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, 24 Fukang Road, Nankai District, Tianjin, China.
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu, China.
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Takumi K, Fukukura Y, Hakamada H, Ideue J, Kumagae Y, Yoshiura T. Value of diffusion tensor imaging in differentiating malignant from benign parotid gland tumors. Eur J Radiol 2017; 95:249-256. [DOI: 10.1016/j.ejrad.2017.08.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 08/09/2017] [Accepted: 08/12/2017] [Indexed: 02/07/2023]
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Wang YT, Li YC, Kong WF, Yin LL, Pu H. Diffusion tensor imaging beyond brains: Applications in abdominal and pelvic organs. World J Meta-Anal 2017; 5:71-79. [DOI: 10.13105/wjma.v5.i3.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/12/2017] [Accepted: 04/24/2017] [Indexed: 02/06/2023] Open
Abstract
Functional magnetic resonance imaging (MRI) provided critical functional information in addition to the anatomic profiles offered by conventional MRI, and has been enormously used in the initial diagnosis and followed evaluation of various diseases. Diffusion tensor imaging (DTI) is a newly developed and advanced technique that measures the diffusion properties including both diffusion motion and its direction in situ, and has been extensively applied in central nerve system with acknowledged success. Technical advances have enabled DTI in abdominal and pelvic organs. Its application is increasing, yet remains less understood. A systematic overview of clinical application of DTI in abdominal and pelvic organs such as liver, pancreas, kidneys, prostate, uterus, etc., is therefore presented. Exploration of techniques with less artifacts and more normative post-processing enabled generally satisfactory image quality and repeatability of measurement. DTI appears to be more valuable in the evaluation of diffused diseases of organs with highly directionally arranged structures, such as the assessment of function impairment of native and transplanted kidneys. However, the utility of DTI to diagnose focal lesions, such as liver mass, pancreatic and prostate tumor, remains limited. Besides, diffusion of different layers of the uterus and the fiber structure disruption can be depicted by DTI. Finally, a discussion of future directions of research is given. The underlying heterogeneous pathologic conditions of certain diseases need to be further differentiated, and it is suggested that DTI parameters might potentially depict certain pathologic characterization such as cell density. Nevertheless, DTI should be better integrated into the current multi-modality evaluation in clinical practice.
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Lanzman RS, Wittsack HJ. Diffusion tensor imaging in abdominal organs. NMR IN BIOMEDICINE 2017; 30:e3434. [PMID: 26556181 DOI: 10.1002/nbm.3434] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 06/05/2023]
Abstract
Initially, diffusion tensor imaging (DTI) was mainly applied in studies of the human brain to analyse white matter tracts. As DTI is outstanding for the analysis of tissue´s microstructure, the interest in DTI for the assessment of abdominal tissues has increased continuously in recent years. Tissue characteristics of abdominal organs differ substantially from those of the human brain. Further peculiarities such as respiratory motion and heterogenic tissue composition lead to difficult conditions that have to be overcome in DTI measurements. Thus MR measurement parameters have to be adapted for DTI in abdominal organs. This review article provides information on the technical background of DTI with a focus on abdominal imaging, as well as an overview of clinical studies and application of DTI in different abdominal regions. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rotem Shlomo Lanzman
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University of Dusseldorf, Dusseldorf, Germany
| | - Hans-Jörg Wittsack
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University of Dusseldorf, Dusseldorf, Germany
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França M, Martí-Bonmatí L, Alberich-Bayarri Á, Oliveira P, Guimaraes S, Oliveira J, Amorim J, Gonzalez JS, Vizcaíno JR, Miranda HP. Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel incoherent motion diffusion-weighted MR imaging. Abdom Radiol (NY) 2017; 42:468-477. [PMID: 27638516 DOI: 10.1007/s00261-016-0899-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the role of intravoxel incoherent motion (IVIM) diffusion model for the assessment of liver fibrosis and inflammation in diffuse liver disorders, also considering the presence of liver steatosis and iron deposits. METHODS Seventy-four patients were included, with liver biopsy and a 3 Tesla abdominal magnetic resonance imaging examination, with an IVIM diffusion-weighted sequence (single-shot spin-echo echo-planar sequence, with gradient reversal fat suppression; 6 b-values: 0, 50, 200, 400, 600, and 800 s/mm2). Histological evaluation comprised the Ishak modified scale, for grading inflammation and fibrosis, plus steatosis and iron loading classification. The liver apparent diffusion coefficient (ADC) and IVIM parameters (D, D*, f) were calculated from the IVIM images. The relationship between IVIM parameters and histopathological scores were evaluated by ANOVA and Spearman correlation tests. A test-retest experiment assessed reproducibility and repeatability in 10 healthy volunteers and 10 randomly selected patient studies. RESULTS ADC and f values were lower with higher fibrosis stages (p = 0.009, p = 0.006, respectively) and also with higher necro-inflammatory activity grades (p = 0.02, p = 0.017, respectively). Considered together, only fibrosis presented a significant effect on ADC and f measurements (p < 0.05), whereas inflammation had no significant effect (p > 0.05). A mild correlation was found between ADC and f with fibrosis (R S = -0.32 and R S = -0.38; p < 0.05) and inflammation (R S = -0.31 and R S = -0.32, p < 0.05; respectively). The AUROC for ADC and f measurements with the different dichotomizations between fibrosis or inflammation grades were only fair (0.670 to 0.749, p < 0.05). Neither D nor D* values were significantly different between liver fibrosis or inflammation grades. D measurements were significantly different across histologic grades of steatosis (p < 0.001) and iron overload (p < 0.001), whereas f measurements showed significant differences across histologic steatosis grades (p = 0.005). There was an excellent agreement between the different readers for ADC, f, and D. CONCLUSIONS Although fibrosis presented a significant effect on ADC and f, IVIM measurements are not accurate enough to stage liver fibrosis or necro-inflammatory activity in diffuse liver diseases. D values were influenced by steatosis and iron overload.
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Affiliation(s)
- Manuela França
- Imaging Department, Centro Hospitalar do Porto, Largo Prof Abel Salazar, 4099-001, Porto, Portugal.
| | - Luis Martí-Bonmatí
- Radiology Department, Hospital Universitario y Politécnico La Fe and Biomedical Imaging Research Group (GIBI230), Valencia, Spain
| | - Ángel Alberich-Bayarri
- Radiology Department, Hospital Universitario y Politécnico La Fe and Biomedical Imaging Research Group (GIBI230), Valencia, Spain
| | - Pedro Oliveira
- Population Studies Department, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Epidemiology Research Unit (EPI Unit), Institute of Public Health of the University of Porto, Porto, Portugal
| | - Susana Guimaraes
- Pathology Department, Centro Hospitalar de S. João, Porto, Portugal
| | - João Oliveira
- Radiology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - João Amorim
- Radiology Department, Centro Hospitalar do Porto, Porto, Portugal
| | | | | | - Helena Pessegueiro Miranda
- Epidemiology Research Unit (EPI Unit), Institute of Public Health of the University of Porto, Porto, Portugal
- Liver and Pancreas Transplantation Unit and Medicine Department, Centro Hospitalar do Porto, Porto, Portugal
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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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Hectors SJ, Wagner M, Corcuera-Solano I, Kang M, Stemmer A, Boss MA, Taouli B. Comparison Between 3-Scan Trace and Diagonal Body Diffusion-Weighted Imaging Acquisitions: A Phantom and Volunteer Study. ACTA ACUST UNITED AC 2016; 2:411-420. [PMID: 28480331 PMCID: PMC5416814 DOI: 10.18383/j.tom.2016.00229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Diagonal diffusion-weighted imaging (dDWI) uses simultaneous maximized application of 3 orthogonal gradient systems as opposed to sequential acquisition in 3 directions in conventional 3-scan trace DWI (tDWI). Several theoretical advantages of dDWI vs. tDWI include reduced artifacts and increased sharpness. We compared apparent diffusion coefficient (ADC) quantification and image quality between monopolar dDWI and tDWI in a dedicated diffusion phantom (b = 0/500/900/2000 s/mm2) and in the abdomen (b = 50/400/800 s/mm2) and pelvis (b = 50/1000/1600 s/mm2) of 2 male volunteers at 1.5 T and 3.0 T. Phantom estimated signal-to-noise ratio (eSNR) was also measured. Two independent observers assessed the image quality on a 5-point scale. In the phantom, image quality was similar between tDWI and dDWI, with equivalent ADC quantification (mean coefficient of variation [CV] between sequences: 1.4% ± 1.2% at 1.5 T and 0.7% ± 0.7% at 3.0 T). Phantom eSNR was similar for both tDWI and dDWI, except for a significantly lower eSNR for b900 of dDWI at 3.0 T (P = .006). In the volunteers, the CV values between tDWI and dDWI were higher than those in the phantom (CV range: abdominal organs, 1.3%-13.3%; pelvic organs, 0.6%-5.7%). A trend toward significant better image quality for dDWI compared with tDWI was observed for b800 (abdomen) at 3.0 T and for b1000 and b1600 (pelvis) at 1.5 T (P = .063 to .066). Our data suggest that dDWI may provide better image quality than tDWI without affecting ADC quantification, needing confirmation in a future clinical study.
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Affiliation(s)
- Stefanie J Hectors
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mathilde Wagner
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Idoia Corcuera-Solano
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Martin Kang
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alto Stemmer
- Siemens AG, Medical Solutions, Magnetic Resonance, Erlangen, Germany
| | - Michael A Boss
- Applied Physics Division, National Institute of Standards and Technology, Boulder, Colorado
| | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
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Gürcan Nİ, Sakçı Z, Akhan S, Altunok ES, Aynıoğlu A, Gürbüz Y, Sarisoy HT, Akansel G. Liver Apparent Diffusion Coefficient Changes during Telaprevir-Based Therapy for Chronic Hepatitis C. Balkan Med J 2016; 33:602-606. [PMID: 27994911 DOI: 10.5152/balkanmedj.2016.151082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 04/18/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) has become an established diagnostic modality for the evaluation of liver parenchymal changes in diseases such as diffuse liver fibrosis. AIMS To evaluate the parenchymal apparent diffusion coefficient value (ADC) changes using diffusion-weighted imaging (DWI) during telaprevir-based triple therapy. STUDY DESIGN Diagnostic accuracy study. METHODS Seventeen patients with chronic hepatitis C virus (HCV) virus and twenty-five normal volunteers were included. All of the patients took 12-weeks of telaprevir-based triple therapy followed by 12-weeks of PEGylated interferon and ribavirin therapy. They were examined before treatment (BT), as well as 12-weeks (W12) and 24-weeks (W24) after treatment by 3 Tesla magnetic resonance imaging (MRI). DWI was obtained using a breath-hold single-shot echo-planar spin echo sequence. Histopathologically, liver fibrosis was classified in accordance with the modified Knodell score described by Ishak. Quantitatively, liver ADCs were compared between patients and normal volunteers to detect the contribution of DWI in the detection of fibrosis. In addition, liver ADCs were compared during the therapy to analyze the effect of antiviral medication on liver parenchyma. RESULTS The liver ADC values of fibrotic liver parenchyma were significantly lower than those of the healthy liver parenchyma (p<0.001). However, we were not able to reach a sufficiently discriminative threshold value. The ADC values showed a declining trend with increasing fibrotic stage. No statistically significant correlation (p=0.204) was observed. Compared with those before treatment, the liver ADC values after telaprevir-based triple therapy were significantly decreased at W12. A significant increase in the liver ADC values was also observed after the cessation of telaprevir therapy at W24 with a return to initial values. CONCLUSION Liver ADC values appear to indicate the present but not the stage of liver fibrosis. DWI may be a helpful research tool for the assessment of antiviral drug effects.
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Affiliation(s)
- Nagihan İnan Gürcan
- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Zakir Sakçı
- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Sıla Akhan
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Elif Sargın Altunok
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Aynur Aynıoğlu
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Yeşim Gürbüz
- Department of Pathology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | | | - Gür Akansel
- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey
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Preliminary Study of MR Diffusion Tensor Imaging of Pancreas for the Diagnosis of Acute Pancreatitis. PLoS One 2016; 11:e0160115. [PMID: 27584016 PMCID: PMC5008639 DOI: 10.1371/journal.pone.0160115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/06/2016] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility of differentiating between acute pancreatitis (AP) and healthy pancreas using diffusion tensor imaging (DTI) and correlate apparent diffusion coefficient (ADC) /fractional anisotropy (FA) values with the severity of AP. MATERIAL AND METHODS 66 patients diagnosed with AP and 20 normal controls (NC) underwent DTI sequences and routine pancreatic MR sequences on a 3.0T MRI scanner. Average ADC and FA values of the pancreatic were measured. Differences of FA and ADC values between the AP group and the NC group with AP and healthy pancreas were compared by two-sample independent t-test. The severity of AP on MRI was classified into subgroups using MR severity index (MRSI), where the mean FA and ADC values were calculated. Relationship among the FA values, ADC values and MRSI were analyzed using Spearman's rank correlation coefficients. RESULTS The pancreatic mean ADC value in the AP group (1.68 ± 0.45×10-3mm2/s) was significantly lower than in the NC group (2.09 ± 0.55×10-3mm2/s) (P = 0.02); the same as mean FA value (0.39 ± 0.23 vs 0.54 ± 0.12, P = 0.00). In the subgroup analysis, the pancreatic ADC and FA value of edema AP patients was significantly higher than necrosis AP patients with P = 0.000 and P = 0.001respectively. In addition, as severity of pancreatitis increased according to MRSI, lower pancreatic ADC (r = -0.635) and FA value (r = -0.654) were noted. CONCLUSION Both FA and ADC value from DTI can be used to differentiate AP patients from NC. Both ADC and FA value of pancreas have a negative correlation with the severity of AP.
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Razek AAKA, Massoud SMA, Azziz MRA, El-Bendary MM, Zalata K, Motawea EM. Prediction of esophageal varices in cirrhotic patients with apparent diffusion coefficient of the spleen. ACTA ACUST UNITED AC 2016; 40:1465-9. [PMID: 25732406 DOI: 10.1007/s00261-015-0391-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To predict esophageal varices in cirrhotic patients with apparent diffusion coefficient (ADC) of the spleen and to correlate the ADC with clinical and laboratory biomarkers of esophageal varices. MATERIALS AND METHODS This study was conducted upon 40 patients (28 male, 12 female; age ranged 19-45 years; mean age = 33 years) with biopsy-proven cirrhotic liver. Twenty age- and sex-matched healthy volunteers were included as a control group. Patients with varices (n = 15) and without varices (n = 25) and volunteers underwent echo-planar diffusion-weighted MR imaging of the abdomen with b factors of 0, 400, and 800 s/mm(2). The ADC maps of the abdomen were reconstructed. The ADC values of the spleen were calculated and correlated with the Child score, platelet count, and prothrombin time. RESULTS The mean ADC value of the spleen in cirrhotic patients (1.34 ± 0.05 × 10(-3) mm(2)/s) was significantly different (P = 0.001) from that of volunteers (0.87 ± 0.04 × 10(-3) mm(2)/s). The ADC of the spleen in cirrhotic patients with varices (1.49 ± 0.05 × 10(-3) mm(2)/s) was significantly different (P = 0.001) from that of patients without varices (1.11 ± 0.06 × 10(-3) mm(2)/s). The cut-off ADC value of the spleen used for prediction of cirrhosis and varices was 1.15 and 1.29 × 10(-3) mm(2)/s with areas under the curve were 0.872 and 0.889, respectively. The ADC value of the spleen was correlated with the splenic volume (r = 0.862; P = 0.001), Child score (r = 0.742; P = 0.001), platelet count (r = -0.698; P = 0.01), and prothrombin time (r = 0.684; P = 0.01). CONCLUSION The ADC value of the spleen can predict esophageal varices in cirrhotic patients and is well correlated with the clinical and laboratory biomarkers of esophageal varices.
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Yuan Y. Imaging methods for evaluation of liver fibrosis. Shijie Huaren Xiaohua Zazhi 2016; 24:1532-1538. [DOI: 10.11569/wcjd.v24.i10.1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Liver fibrosis is a development stage of various chronic liver diseases. Since liver fibrosis is still a reversible process, the development of irreversible cirrhosis can be delayed or prevented if the patient is early diagnosed and receives timely and effective treatment. Therefore, how to accurately, effectively and easily evaluate the severity of liver fibrosis remains a clinical problem to be solved. Ultrasound, CT and MRI are common examinations for hepatic lesions. Imaging examinations can non-invasively and accurately evaluate the degree of liver fibrosis. With the development and application of new imaging technologies, flexible technology has been widely applied in the assessment of liver fibrosis. This article reviews the application of various imaging modalities, especially elastic technology, for assessment of hepatic fibrosis.
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Jafar MM, Parsai A, Miquel ME. Diffusion-weighted magnetic resonance imaging in cancer: Reported apparent diffusion coefficients, in-vitro and in-vivo reproducibility. World J Radiol 2016; 8:21-49. [PMID: 26834942 PMCID: PMC4731347 DOI: 10.4329/wjr.v8.i1.21] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/10/2015] [Accepted: 12/07/2015] [Indexed: 02/06/2023] Open
Abstract
There is considerable disparity in the published apparent diffusion coefficient (ADC) values across different anatomies. Institutions are increasingly assessing repeatability and reproducibility of the derived ADC to determine its variation, which could potentially be used as an indicator in determining tumour aggressiveness or assessing tumour response. In this manuscript, a review of selected articles published to date in healthy extra-cranial body diffusion-weighted magnetic resonance imaging is presented, detailing reported ADC values and discussing their variation across different studies. In total 115 studies were selected including 28 for liver parenchyma, 15 for kidney (renal parenchyma), 14 for spleen, 13 for pancreatic body, 6 for gallbladder, 13 for prostate, 13 for uterus (endometrium, myometrium, cervix) and 13 for fibroglandular breast tissue. Median ADC values in selected studies were found to be 1.28 × 10(-3) mm(2)/s in liver, 1.94 × 10(-3) mm(2)/s in kidney, 1.60 × 10(-3) mm(2)/s in pancreatic body, 0.85 × 10(-3) mm(2)/s in spleen, 2.73 × 10(-3) mm(2)/s in gallbladder, 1.64 × 10(-3) mm(2)/s and 1.31 × 10(-3) mm(2)/s in prostate peripheral zone and central gland respectively (combined median value of 1.54×10(-3) mm(2)/s), 1.44 × 10(-3) mm(2)/s in endometrium, 1.53 × 10(-3) mm(2)/s in myometrium, 1.71 × 10(-3) mm(2)/s in cervix and 1.92 × 10(-3) mm(2)/s in breast. In addition, six phantom studies and thirteen in vivo studies were summarized to compare repeatability and reproducibility of the measured ADC. All selected phantom studies demonstrated lower intra-scanner and inter-scanner variation compared to in vivo studies. Based on the findings of this manuscript, it is recommended that protocols need to be optimised for the body part studied and that system-induced variability must be established using a standardized phantom in any clinical study. Reproducibility of the measured ADC must also be assessed in a volunteer population, as variations are far more significant in vivo compared with phantom studies.
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Kahraman AS, Kahraman B, Ozdemir ZM, Gormeli CA, Ozdemir F, Dogan M. Diffusion-weighted imaging (DWI) of the liver in assessing chronic liver disease: effects of the presence and the degree of ascites on ADC values. Abdom Radiol (NY) 2016; 41:56-62. [PMID: 26830612 DOI: 10.1007/s00261-015-0613-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The aim of this study was to determine the correlation between the liver and spleen apparent diffusion coefficient (ADC) values of patients with chronic liver disease and the presence and the degree of ascites. MATERIALS AND METHOD In this retrospective study, we assessed 107 patients with chronic liver disease and 39 control subjects who underwent upper abdominal MR imaging including echo-planar diffusion-weighted imaging (DWI). Among the 107 cirrhotic patients, 56 were classified as group 1, 25 as group 2, and 26 as group 3 according to the absence, the presence of minimal, and the presence of massive ascites, respectively. The scores of model for end-stage liver disease (MELD) were matched between groups as the standard reference. The liver ADC, spleen ADC, and normalized liver ADC values were compared between the control group and patients' groups. RESULTS Patients with massive ascites had significantly higher MELD score compared with the other groups. The MELD score was also significantly higher in patient groups than in control group. The liver and normalized liver ADCs of patients' groups were significantly lower than that of the control group. With some overlap among groups, the measured ADC values decreased as the amount of the ascites increased, and these relationships were statistically significant. Furthermore, compared to control group, patients with massive ascites had significantly higher spleen ADCs. CONCLUSION Our results indicate that the ADC value of the liver and spleen correlates with the presence and the degree of ascites in patients with chronic liver disease, and merits further study.
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Affiliation(s)
- Aysegul Sagir Kahraman
- Department of Radiology, Turgut Ozal Medical Center, Inonu University School of Medicine, 44315, Malatya, Turkey.
| | - Bayram Kahraman
- Department of Radiology, Private Malatya Hospital, Malatya, Turkey.
| | - Zeynep Maras Ozdemir
- Department of Radiology, Turgut Ozal Medical Center, Inonu University School of Medicine, 44315, Malatya, Turkey.
| | - Cemile Ayse Gormeli
- Department of Radiology, Turgut Ozal Medical Center, Inonu University School of Medicine, 44315, Malatya, Turkey.
| | - Fatih Ozdemir
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey.
| | - Metin Dogan
- Department of Radiology, Turgut Ozal Medical Center, Inonu University School of Medicine, 44315, Malatya, Turkey.
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Preliminary Study of MR Diffusion Tensor Imaging of the Liver for the Diagnosis of Hepatocellular Carcinoma. PLoS One 2015; 10:e0135568. [PMID: 26317346 PMCID: PMC4552840 DOI: 10.1371/journal.pone.0135568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/23/2015] [Indexed: 12/11/2022] Open
Abstract
Objectives To evaluate the feasibility of differentiating between hepatocellular carcinomas (HCC) and healthy liver using diffusion tensor imaging (DTI). Material and Methods All subjects underwent an abdominal examination on a 3.0T MRI scanner. Two radiologists independently scored the image quality (IQ). An optimal set of DTI parameters was obtained from a group of fifteen volunteers with multiple b-values (100, 300, 500, and 800 s/mm2) and various diffusion-encoding directions (NED = 6, 9, and 12)using two way ANOVA analysis. Eighteen Patients with HCC underwent DTI scans with the optimized parameters. Fractional anisotropy(FA) and average apparent diffusion coefficient (ADC) values were measured. The differences of FA and ADC values between liver healthy region and HCC lesion were compared through paired t tests. Results There were no significant changes in liver IQ and FA/ADC values with increased NED(P >0.05), whereas the liver IQ and FA/ADC values decreased significantly with increased b-values(P <0.05). Good IQ, acceptable scan time and reasonable FA/ADC values were acquired using NED = 9 with b-value of (0,300) s/mm2. Using the optimized DTI sequence, ADC value of the tumor lesion was significantly lower than that of the healthy liver region (1.30 ± 0.34×10−3 vs 1.52 ± 0.27×10−3 mm2/s, P = 0.013), whereas the mean FA value of the tumor lesion (0.42 ± 0.11) was significantly higher than the normal liver region (0.32 ± 0.10) (P = 0.004). Conclusion Either FA or ADC value from DTI can be used to differentiate HCC from healthy liver. HCC lead to higher FA value and lower ADC value on DTI than healthy liver.
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Hoffmann R, Rempp H, Schraml C, Schwenzer N, Grözinger G, Blumenstock G, Rothgang E, Pereira PL, Claussen CD, Clasen S. Diffusion-weighted imaging during MR-guided radiofrequency ablation of hepatic malignancies: analysis of immediate pre- and post-ablative diffusion characteristics. Acta Radiol 2015; 56:908-16. [PMID: 25182804 DOI: 10.1177/0284185114545148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 06/28/2014] [Indexed: 01/26/2023]
Abstract
BACKGROUND Previous studies have shown a benefit of magnetic resonance (MR)-diffusion-weighted imaging (DWI) for follow-up after liver radiofrequency (RF) ablation. However, no data are available concerning acute changes of DWI characteristics immediately after RF ablation. PURPOSE To analyze and compare the MR-diffusion characteristics of pre-interventional hepatic malignancies and the ablation zone during successful MR-guided RF ablation. MATERIAL AND METHODS This retrospective study was conducted in accordance with the guidelines of the local institutional review board. Forty-seven patients with 29 HCC (24 patients) and 30 hepatic metastases (23 patients) underwent MR-guided radiofrequency ablation including DWI before and immediately after ablation (b = 0, 400, 800 s/mm(2)). Two reviewers (A and B) analyzed DWI with focus on detectability of the tumor before ablation and characteristics of the coagulative area after treatment. Mean apparent diffusion coefficient (ADC) was compared between liver, untreated tumor, and hyperintense areas in post-ablative DWI (b = 800 s/mm(2)) with the paired Student's t-test. RESULTS Pre-ablative: the reviewers classified 19/29 (A) and 23/29 (B) HCC and 25/30 (A and B) metastases as detectable in DWI. Post-ablative: a hyperintense rim surrounding the ablation zone was observed in 28/29 treated HCC and 30/30 treated metastases (A and B). A homogenous hypointense central ablation zone was found in 18/29 (A) and 20/29 (B) treated HCC and 17/30 (A & B) treated metastases in DWI. ADC of the rim was significantly lower than ADC of the liver (P < 0.001). CONCLUSION DWI enables visualization of the target tumor in MR-guided liver radiofrequency ablation in most cases. A common post-ablative DWI finding is a hyperintense rim with decreased ADC surrounding the ablation zone.
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Affiliation(s)
- Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Hansjörg Rempp
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Christina Schraml
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Nina Schwenzer
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology and Applied Biometry, Eberhard Karls University, Tübingen, Germany
| | - Eva Rothgang
- Center for Applied Medical Imaging, Siemens Corporate Research, Germany and Baltimore, MD, USA
| | - Philippe L Pereira
- Department of Radiology, Minimally Invasive Therapies and Nuclear Medicine, SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Claus D Claussen
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen, Germany
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Detection of Active Sacroiliitis with Ankylosing Spondylitis through Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging. Eur Radiol 2015; 25:2754-63. [PMID: 25678080 DOI: 10.1007/s00330-015-3634-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 01/10/2015] [Accepted: 01/21/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To confirm feasibility and assess intravoxel incoherent motion (IVIM) to differentiate active sacroiliitis and ankylosing spondylitis.. METHODS Forty-one patients were divided into two groups, an active group (n = 20) and a chronic group (n = 21), according to the Bath Ankylosing Spondylitis (AS) Disease Activity Index (BASDAI) and laboratory parameters. In addition, 21 healthy volunteers were chosen as the control group. Tissue diffusivity (Dslow), perfusion fraction (f), and pseudo-diffusion coefficient (Dfast) values were obtained for all three groups. One-way analysis of variance and receiver operating characteristic analysis were performed for all parameters. RESULTS There was good interobserver agreement on the measurements between the two observers. The optimal cut-off values (with respective AUC, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio) between active and chronic groups were Dslow = 0.53 × 10(-3) mm(2)/s (0.976, 90%, 95.2%, 18.9, 0.10) and f = 0.09 (0.545, 20%, 95.5%, 4.2, 0.84), and between chronic and control groups were Dslow = 0.22 × 10(-3) mm(2)/s (0.517, 9.52%, 100%, no number, 0.9) and f = 0.09 (0.935, 95.24%, 80.95%, 5, 0.059). CONCLUSION Dslow and f of IVIM diffusion-weighted (DW)-MRI in AS show a significant difference in the values of diffusion of water molecules and fractional perfusion-related volume among the three groups. KEY POINTS • D slow can be used to differentiate the activity of AS. • With perfusion fraction, the sensitivity of differentiating the AS activity is improved. • IVIM DWI plays an important role in detecting the activity in patients with AS.
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Girometti R, Maieron M, Lissandrello G, Bazzocchi M, Zuiani C. Test-retest reliability of diffusion tensor imaging of the liver at 3.0 T. Radiol Med 2014; 120:489-97. [PMID: 25421264 DOI: 10.1007/s11547-014-0479-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/17/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE This study was done to evaluate test-retest reliability of liver diffusion tensor imaging (LDTI). MATERIALS AND METHODS Ten healthy volunteers (median age 23 years) underwent two LDTI scans on a 3.0 T magnet during two imaging sessions separated by 2 weeks (session-1/-2, respectively). Fifteen gradient directions and b values of 0-1,000 s/mm(2) were used. Two radiologists in consensus assessed liver apparent diffusion coefficient (ADC) and fraction of anisotropy (FA) values on ADC and FA maps at four reference levels, namely: right upper level (RUL), right lower level (RLL), left upper level (LUL) and left lower level (LLL). We then assessed (a) whether ADC and FA values overlapped when measured on different levels within the same imaging session or between different imaging sessions; (b) the degree of variability on an intra-session and inter-session basis, respectively, using the coefficient of variation (CV). RESULTS In sessions 1 and 2, the ADC/FA values were significantly larger in the left liver lobe (LUL/LLL) compared to right liver lobe (RUL/RLL) (p < 0.05/6). Intra-session CVs were 9.51 % (session 1) and 9.73 % (session 2) for ADC, and 12.93 % (session 1) and 11.82 % (session 2) for FA, respectively. When comparing RUL, RLL, LUL and LLL on an inter-session basis, CVs were 6.52, 8.20, 6.52 and 11.06 % for ADC, and 15.42, 15.80, 15.42 and 6.80 % for FA, respectively. CONCLUSION LDTI provides consistent and repeatable measurements. However, since larger left lobe ADC/FA values can be attributed to artefacts, right lobe values should be considered the most reliable measurements of water diffusivity within the liver.
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Affiliation(s)
- Rossano Girometti
- Department of Medical and Biological Sciences, Institute of Diagnostic Radiology, University of Udine, Via Colugna n. 50, 33100, Udine, Italy,
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De Robertis R, D’Onofrio M, Demozzi E, Crosara S, Canestrini S, Pozzi Mucelli R. Noninvasive diagnosis of cirrhosis: A review of different imaging modalities. World J Gastroenterol 2014; 20:7231-7241. [PMID: 24966594 PMCID: PMC4064069 DOI: 10.3748/wjg.v20.i23.7231] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 01/08/2014] [Accepted: 04/09/2014] [Indexed: 02/06/2023] Open
Abstract
Progressive hepatic fibrosis can lead to cirrhosis, so its early detection is fundamental. Staging fibrosis is also critical for prognosis and management. The gold standard for these aims is liver biopsy, but it has several drawbacks, as it is invasive, expensive, has poor acceptance, is prone to inter observer variability and sampling errors, has poor repeatability, and has a risk of complications and mortality. Therefore, non-invasive imaging tests have been developed. This review mainly focuses on the role of transient elastography, acoustic radiation force impulse imaging, and magnetic resonance-based methods for the noninvasive diagnosis of cirrhosis.
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Apparent diffusion coefficient value of hepatic fibrosis and inflammation in children with chronic hepatitis. Radiol Med 2014; 119:903-909. [PMID: 24846081 DOI: 10.1007/s11547-014-0408-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/27/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE This study was done to prospectively evaluate the usefulness of apparent diffusion coefficient (ADC) in the diagnosis and grading of hepatic fibrosis and inflammation in children with chronic hepatitis. MATERIALS AND METHODS Institutional Review Board approval was obtained. This prospective study was carried out on 50 children with chronic hepatitis (mean age 8.3 ± 3.2 years; 33 boys and 17 girls) and 20 age- and sex-matched healthy control children. The children underwent diffusion-weighted magnetic resonance imaging of the liver. The ADC value of the liver was calculated. The hepatic fibrosis stages (F1-F6) and necroinflammatory activity grades (A1-A4) were calculated. The ADC values of different stages of hepatic fibrosis and grades of necroinflammatory activity were calculated. RESULTS The mean ADC value of the liver parenchyma was 1.53 ± 0.17 × 10(-3) mm(2)/s in children with chronic hepatitis and 1.74 ± 0.16 × 10(-3) mm(2)/s in controls. The ADC value was significantly lower in children with hepatic fibrosis compared to controls (p = 0.001). There was a significant difference (p = 0.001) in ADC between mild (F1-F3) and advanced (F4-F6) stages of fibrosis. There was a significant difference (p = 0.004) in ADC between mild (A1-A2) and advanced (A3-A4) grades of necroinflammation. The cut-off ADC values used to differentiate mild from advanced fibrosis and necroinflammation were 1.62 and 1.64 mm(2)/s with an area under the curve of 0.898 and 0.807, respectively. The ADC value negatively correlated with stages of hepatic fibrosis (r = -0.799, p = 0.001) and necroinflammatory activity grade (r = -0.468, p = 0.001). CONCLUSIONS We conclude that ADC value is an effective noninvasive parameter for the diagnosis and grading of hepatic fibrosis and inflammation in children with chronic hepatitis.
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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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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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