Evaluation of hepatic fibrosis: a review from the society of abdominal radiology disease focus panel

Abstract

Hepatic fibrosis is potentially reversible, however early diagnosis is necessary for treatment in order to halt progression to cirrhosis and development of complications including portal hypertension and hepatocellular carcinoma. Morphologic signs of cirrhosis on ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) alone are unreliable and are seen with more advanced disease. Newer imaging techniques to diagnose liver fibrosis are reliable and accurate, and include magnetic resonance elastography and US elastography (1 dimensional transient elastography and point shear wave elastography or acoustic radiation force impulse imaging). Research is ongoing with multiple other techniques for the noninvasive diagnosis of hepatic fibrosis, including MRI with diffusion weighted imaging, hepatobiliary contrast enhancement, and perfusion; CT using perfusion, fractional extracellular space techniques, and dual energy, contrast-enhanced US, texture analysis in multiple modalities, quantitative mapping, and direct molecular imaging probes. Efforts to advance the noninvasive imaging assessment of hepatic fibrosis will facilitate earlier diagnosis and improved patient monitoring with the goal of preventing the progression to cirrhosis and its complications.

Systematic Review: Noninvasive Assessments of Intestinal Failure–Associated Liver Disease in the Adult Population

“…The diagnostic value should, however, be evaluated in larger studies because the currently available studies, all described in this review, were small in size (14–35 patients). Furthermore, other modalities, such as MR–elastography or ultrasound‐based techniques that, besides fibrosis, also evaluate other liver tissue characteristics, should be evaluated in the IF population . Validation of a histological scoring system that is specific for IFALD is urgently awaited.…”

“…Furthermore, other modalities, such as MR-elastography or ultrasound-based techniques that, besides fibrosis, also evaluate other liver tissue characteristics, should be evaluated in the IF population. 65,66 Validation of a histological scoring system that is specific for IFALD is urgently awaited. Such a scoring system might be devised by a retrospective evaluation of liver biopsies, using various histological scoring systems and correlating the histological stage to liver-related outcomes.…”

Pitfalls in liver MRI: Technical approach to avoiding misdiagnosis and improving image quality

“…[89][90][91][92] Effect of Changes in Background Liver on DWI/ADC Liver fibrosis, iron deposition, and steatosis can alter the background signal of the liver on DWI. Liver fibrosis and cirrhosis reduce DWI signal, [93][94][95] possibly due to increased connective tissue. 77,94 Iron deposition in the background liver causes signal decay on the echo planar images used for DWI sequences, reducing SNR and, if severe, may render the DWI nondiagnostic 96,97 or reduce the background liver ADC.…”

Consensus on the diagnosis and treatment of hepatic fibrosis (2019)

“…Conventional CT and MRI, including plain and enhanced scans, can detect morphological changes in the liver and are of great value for detecting cirrhosis and liver tumors. However, they are unable to quantify early‐stage fibrosis …”