Diagnosis of cirrhosis with intravoxel incoherent motion diffusion MRI and dynamic contrast‐enhanced MRI alone and in combination: Preliminary experience

Abstract

Purpose To report our preliminary experience with the use of intravoxel incoherent motion (IVIM) diffusion-weighted magnetic resonance imaging (DW-MRI) and dynamic contrast-enhanced (DCE)-MRI alone and in combination for the diagnosis of liver cirrhosis. Materials and Methods Thirty subjects (16 with noncirrhotic liver, 14 with cirrhosis) were prospectively assessed with IVIM DW-MRI (n = 27) and DCE-MRI (n = 20). IVIM parameters included perfusion fraction (PF), pseudodiffusion coefficient (D*), true diffusion coefficient (D), and apparent diffusion coefficient (ADC). Model-free DCE-MR parameters included time to peak (TTP), upslope, and initial area under the curve at 60 seconds (IAUC60). A dual input single compartmental perfusion model yielded arterial flow (Fa), portal venous flow (Fp), arterial fraction (ART), mean transit time (MTT), and distribution volume (DV). The diagnostic performances for diagnosis of cirrhosis were evaluated for each modality alone and in combination using logistic regression and receiver operating characteristic analyses. IVIM and DCE-MR parameters were compared using a generalized estimating equations model. Results PF, D*, D, and ADC values were significantly lower in cirrhosis (P = 0.0056–0.0377), whereas TTP, DV, and MTT were significantly increased in cirrhosis (P = 0.0006–0.0154). There was no correlation between IVIM- and DCE-MRI parameters. The highest Az (areas under the curves) values were observed for ADC (0.808) and TTP-DV (0.952 for each). The combination of ADC with DV and TTP provided 84.6% sensitivity and 100% specificity for diagnosis of cirrhosis. Conclusion The combination of DW-MRI and DCE-MRI provides an accurate diagnosis of cirrhosis.

Liver intravoxel incoherent motion (IVIM) magnetic resonance imaging: a comprehensive review of published data on normal values and applications for fibrosis and tumor evaluation

“…Various fitting algorithms have been used to determine IVIM parameters, including asymptotic fitting (9)(10)(11)(12)(19)(20)(21)24,41,45,46,48,51,53), nonlinear least square (usually Levenberg-Marquardt) fitting (23,42,47,52,54,55), and Bayesian fitting (15,22,40,43,50). Current review cannot draw conclusion which one is better than others, nor can the mean values be compared (Figure 8).…”

“…Guiu et al (9) reported that Dslow and Dfast were significantly lower in steatotic compared with nonsteatotic livers; however, PF was significantly higher in steatotic compared with nonsteatotic livers. In another study, Patel et al (12) reported that the value of Dslow, PF and Dfast in liver cirrhosis were lower than non-cirrhosis liver; however, no further grading was performed within their liver cirrhosis subjects as only three patients had histopathology data. In a rat model of diethylnitrosamineinduced liver fibrosis, Zhang et al (57) reported that PF values decreased significantly with the increasing fibrosis level; but Dslow was poorly correlated with fibrosis level.…”

“…Previously, the use of IVIM imaging was limited to neuroradiologic applications because the abdominal organs can be subject to respiratory and other motion artifacts. The advent of respiratory gating combined with parallel imaging allows IVIM MRI to be attempted in the evaluation of abdominal organs, such as liver (7)(8)(9)(10)(11)(12). Yamada et al (7) were the first to assess IVIM MRI in abdominal organs, although they used only limited number of b values (30, 300, 900, and 1,100 s/mm 2 ), and did not calculate pseudodiffusion values.…”

Magnetic resonance diffusion-weighted imaging: quantitative evaluation of age-related changes in healthy liver parenchyma

“…(1). Since a simultaneous fit of all these parameters could be difficult, given the high dispersion and the limited sampling of DwI signals at low b value (bb150 s/mm 2 ) [23,24], a twostep fitting procedure was adopted, as described in other papers [25,26].…”

Are we ready to image the incoherent molecular motion in our minds?

“…A further indispensable step is to examine the reproducibility and the repeatability of the method. Such measurements in the brain and abdominal imaging are scarce, mostly due to the demand for sufficiently high-quality images acquisition [18]. The next formal action is to test the sensitivity of the method for quantifying the fluctuation of capillary blood flow during induced vasoconstriction or vasodilatation [19,20].…”