Diagnostic performance of conventional diffusion weighted imaging and diffusion tensor imaging for the liver fibrosis and inflammation

Tosun, Mesude; İnan, Nagihan; Sarisoy, Hasan Tahsin; Akansel, Gür; Gümüştaş, Sevtap; Gürbüz, Yeşim; Demırcı, Ali

doi:10.1016/j.ejrad.2012.09.009

Cited by 52 publications

(60 citation statements)

References 17 publications

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“…It has been reported that ADC and f values decreased not only with fibrosis stage [4-9, 13, 17, 20-22, 31-33] but also with the severity of necroinflammatory activity [6,7,9,[20][21][22]. However, in our series, only fibrosis was the main explicative variable for the ADC and perfusion-related f decrements.…”

Section: Discussioncontrasting

confidence: 52%

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Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel incoherent motion diffusion-weighted MR imaging

et al. 2016

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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/mm 2 ). 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 testretest 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).

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Section: Discussioncontrasting

confidence: 52%

“…Liver inflammation is characterized by different grades of hepatocytes' swelling and necrosis, inflammatory cells migration through liver sinusoids and increased regional blood flow [19]. Inflammatory responses may also influence ADC measurements [6,7,9,[20][21][22] and both diffusion and perfusion IVIM parameters.…”

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confidence: 99%

Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel incoherent motion diffusion-weighted MR imaging

et al. 2016

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“…This anisotropic behaviour "can be detected by observing differences in diffusivity by using diffusion gradients in at least six directions". Diffusion tensor imaging has been used predominantly for brain imaging [37,38] with limited data for body imaging of liver [39,40] , kidneys [41][42][43] , breast [44] and prostate [45] .…”

Section: Dw Imaging In Biological Tissuementioning

confidence: 99%

Diffusion-weighted magnetic resonance imaging in cancer: Reported apparent diffusion coefficients,in-vitroandin-vivoreproducibility

Jafar

Parsaï

Miquel

2016

WJR

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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 extracranial 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) 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. Core tip: Diffusion-weighted magnetic resonance imaging was highlighted as a potential cancer imaging biomarker by a team of experts in a report published in 2009. We review the variability of published diffusion values in the major extra-cranial organs and focus on the validation literature, both in vivo and in vitro . A total of 115 studies were selected including for liver parenchyma, kidney, pancreatic body, spleen, gallbladder, prostate, uterus (endometrium, myometrium, cervix) and breast. We also look in detail at the published repeatability and reproducibility studies, both in vivo and in phantoms. A series of recommendations based on our findings are given at the end of this review.Jafar MM, Parsai A, Miquel ME. Diffusion-weighted magnetic resonance imaging in cancer: Reported apparent diffusion coefficients, in vitro and in vivo reproducibility.

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“…Chronic HCV infection leads to an increase in the extracellular matrix, particularly collagen fibers. Diffusion may be restricted by the presence of excess collagen, consequently decreasing the ADCs in fibrotic parenchyma (19).…”

Section: Discussionmentioning

confidence: 99%

Liver Apparent Diffusion Coefficient Changes during Telaprevir-Based Therapy for Chronic Hepatitis C

et al. 2016

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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 echoplanar 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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Diagnostic performance of conventional diffusion weighted imaging and diffusion tensor imaging for the liver fibrosis and inflammation

Cited by 52 publications

References 17 publications

Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel incoherent motion diffusion-weighted MR imaging

Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel incoherent motion diffusion-weighted MR imaging

Diffusion-weighted magnetic resonance imaging in cancer: Reported apparent diffusion coefficients,in-vitroandin-vivoreproducibility

Liver Apparent Diffusion Coefficient Changes during Telaprevir-Based Therapy for Chronic Hepatitis C

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