Comparison of diffusion-weighted imaging and MR elastography in staging liver fibrosis: a meta-analysis

Jang, Wooseung; Jo, Seongil; Song, Ji Soo; Hwang, Hong Pil; Kim, Seong Hun

doi:10.1007/s00261-021-03055-2

Cited by 9 publications

(5 citation statements)

References 87 publications

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“…CT-LSN scores may discern subtle changes of hepatic parenchymal architecture and have been suggested as valuable in liver fibrosis staging, 38,39 and may be associated with post-hepatectomy liver failure among HCC patients. 40 However, the use of different imaging parameters and variable thresholds 10,[38][39][40][41][42][43] preclude inter-study comparisons and general The intraoperative classification of the gross severity of cirrhosis was proposed as a rapid staging method to determine the extent of hepatic resection. 44 However, the single-center study was conducted using the generic term "cirrhosis", omitted external validation, and failed to present convincing evidence of liver fibrosis staging.…”

Section: Discussionmentioning

confidence: 99%

Rethinking Liver Fibrosis Staging in Patients with Hepatocellular Carcinoma: New Insights from a Large Two-Center Cohort Study

Xu¹,

Li²,

Yang³

et al. 2022

JHC

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Background Hepatocellular carcinoma (HCC) is a prevalent and aggressive malignancy closely related to background chronic liver disease. This study aimed to explore predictive factors associated with background liver fibrosis burden in patients with HCC and sought to construct a practical predictive model for clinical use. Methods This large two-center retrospective cohort study evaluated data from Chinese medical centers. Uni- and multivariate ordinal logistic regression analyses were performed to identify variables associated with liver fibrosis stages. Predictive models based on variables identified by multivariate analysis were established in the Derivation Cohort and subjected to internal and external validation. Model performance was evaluated for discriminative and calibration abilities. Results Multivariate ordinal logistic regression analysis identified liver fibrosis severity score (LFSS), portal hypertension (PH) severity, plateletcrit (PCT) and model for end-stage liver disease-sodium (MELD-Na) as independent predictors of liver fibrosis stage in HCC patients. Nomograms that integrated these factors disclosed that the area under receiver operating characteristic curves (AUROCs) to predict S1 in the Derivation and External Validation cohorts were 0.850 and 0.919, respectively. Internal validation disclosed C-indexes of 0.823 and 0.833 in the Derivation and External Validation cohorts, respectively, indicating that the nomogram had good and excellent performance for distinguishing between S1 and non-S1 patients. Nomogram performance in the Derivation and External Validation cohorts, respectively, was fair and good to predict stage S2 (AUROCs 0.726, 0.806; C-indexes 0.713, 0.791); poor for S3 (AUROCs 0.648, 0.698; C-indexes 0.616, 0.666); good for S4 (AUROCs 0.812, 0.824; C-indexes 0.804, 0.792); and good for S3+S4 (AUROCs 0.806, 0.840; C-indexes 0.795, 0.811). Conclusion We propose new predictive models for the staging of background liver fibrosis in patients with HCC that can be implemented into clinical practice as important complements to hepatic imaging to inform HCC management strategy.

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Section: Discussionmentioning

confidence: 99%

Rethinking Liver Fibrosis Staging in Patients with Hepatocellular Carcinoma: New Insights from a Large Two-Center Cohort Study

Xu¹,

Li²,

Yang³

et al. 2022

JHC

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“… 109 , 110 The pooled sensitivity and specificity were 0.63–0.82 and 0.78–0.86, respectively, with an AUROC of 0.79–0.88 for the staging of significant fibrosis (F ≥ 2), 0.71–0.88 and 0.68–0.84, respectively, with an AUROC of 0.81–0.89 for the staging of severe fibrosis (F ≥ 3), and 0.80–0.96 and 0.69–0.77, respectively, with an AUROC of 0.80–0.90 for the staging of cirrhosis (F4) in DWI and IVIM. 109 , 111 – 114 …”

Section: Clinical Needs For Diffuse Liver Diseasesmentioning

confidence: 99%

“…109,110 The pooled sensitivity and specificity were 0.63-0.82 and 0.78-0.86, respectively, with an AUROC of 0.79-0.88 for the staging of significant fibrosis (F ≥ 2), 0.71-0.88 and 0.68-0.84, respectively, with an AUROC of 0.81-0.89 for the staging of severe fibrosis (F ≥ 3), and 0.80-0.96 and 0.69-0.77, respectively, with an AUROC of 0.80-0.90 for the staging of cirrhosis (F4) in DWI and IVIM. 109,[111][112][113][114] Elastography Cirrhosis is the most important risk factor for HCC; therefore, it is important to accurately assess advanced fibrosis. For many patients, fibrosis stages are monitored using noninvasive tests, including elastography.…”

Section: Clinical Significance Of Liver Mrimentioning

confidence: 99%

“…The pooled sensitivity and specificity were 0.78-0.91 and 0.85-0.98, respectively, with an AUROC of 0.91-0.97 for the staging of significant fibrosis (F ≥ 2), 0.83-0.95 and 0.83-0.94, respectively, with an AUROC of 0.92-0.97 for the staging of severe fibrosis (F ≥ 3), and 0.80-1.00 and 0.75-0.93, respectively, with an AUROC of 0.90-0.99 for the staging of cirrhosis (F4). 109,111,[121][122][123][124][125] For clinical purposes, following cut-off values are recommended: 3.0 kPa for F1, 3.5 kPa for F2, 4.0 kPa for F3, and 4.5 kPa for F4. 126 In contrast, most imaging studies of liver stiffness have been performed with ultrasound elastography.…”

Section: Clinical Significance Of Liver Mrimentioning

confidence: 99%

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Clinical Significance of Liver MR Imaging

Ichikawa

Goshima

2023

magn reson med sci

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MRI is widely used in clinical practice for detecting liver diseases. Since the introduction of gadoxetic acid, MRI has become the most effective modality for the detection and characterization of focal liver lesions. According to previous meta-analyses, the area under the receiver operating characteristic curve (AUROC) was 0.97–0.99 for the diagnosis of small hepatocellular carcinoma (≥ 2 cm) by gadoxetic-acid-enhanced MRI. Moreover, the AUROC for the diagnosis of colorectal liver metastases was significantly high (0.98). Despite gadoxetic acid’s drawbacks, its clinical utility outweighs them, making it the contrast agent of choice in routine liver MRIs. Moreover, clinically, liver MRI has become more prevalent for a quantitative assessment. Liver fibrosis can be evaluated using MR elastography; whereas, hepatic steatosis and iron overload can be evaluated using proton density fat fraction, with high accuracy and reproducibility. This article reviewed the usefulness of liver MRI, which can be a comprehensive imaging modality in clinical practice.

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“… 85 , 86 Although a large number of studies have shown that liver fibrosis and apparent diffusion coefficient (ADC) values are inversely correlated, a recent meta-analysis reported that DWI also showed a good diagnostic performance for histological fibrosis staging but was inferior to MRE. 85 , 87 Since the liver is a highly vascularized organ, perfusion has a significant impact on diffusivity. IVIM, a biexponential model of DWI introduced by Le Bihan et al, can evaluate capillary microcirculation and water diffusion separately by analyzing the signal attenuation of multi-b-value DWI.…”

Section: Quantification Of Fibrosismentioning

confidence: 99%

Clinical Application of Quantitative MR Imaging in Nonalcoholic Fatty Liver Disease

et al. 2023

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Viral hepatitis was previously the most common cause of chronic liver disease. However, in recent years, nonalcoholic fatty liver disease (NAFLD) cases have been increasing, especially in developed countries. NAFLD is histologically characterized by fat, fibrosis, and inflammation in the liver, eventually leading to cirrhosis and hepatocellular carcinoma. Although biopsy is the gold standard for the assessment of the liver parenchyma, quantitative evaluation methods, such as ultrasound, CT, and MRI, have been reported to have good diagnostic performances. The quantification of liver fat, fibrosis, and inflammation is expected to be clinically useful in terms of the prognosis, early intervention, and treatment response for the management of NAFLD. The aim of this review was to discuss the basics and prospects of MRI-based tissue quantifications of the liver, mainly focusing on proton density fat fraction for the quantification of fat deposition, MR elastography for the quantification of fibrosis, and multifrequency MR elastography for the evaluation of inflammation.

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Comparison of diffusion-weighted imaging and MR elastography in staging liver fibrosis: a meta-analysis

Cited by 9 publications

References 87 publications

Rethinking Liver Fibrosis Staging in Patients with Hepatocellular Carcinoma: New Insights from a Large Two-Center Cohort Study

Rethinking Liver Fibrosis Staging in Patients with Hepatocellular Carcinoma: New Insights from a Large Two-Center Cohort Study

Clinical Significance of Liver MR Imaging

Clinical Application of Quantitative MR Imaging in Nonalcoholic Fatty Liver Disease

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