Spatial heterogeneity of hepatic fibrosis in primary sclerosing cholangitis vs. viral hepatitis assessed by MR elastography

Abstract

Spatial heterogeneity of hepatic fibrosis in primary sclerosing cholangitis (PSC) in comparison to viral hepatitis was assessed as a potential new biomarker using MR elastography (MRE). In this proof-of-concept study, we hypothesized a rather increased heterogeneity in PSC and a rather homogeneous distribution in viral hepatitis. Forty-six consecutive subjects (PSC: n = 20, viral hepatitis: n = 26) were prospectively enrolled between July 2014 and April 2017. Subjects underwent multifrequency MRE (1.5 T) using drive frequencies of 35–60 Hz and generating shear-wave speed (SWS in m/s) maps as a surrogate of stiffness. The coefficient of variation (CV in %) was determined to quantify fibrosis heterogeneity. Mean SWS and CV were 1.70 m/s and 21% for PSC, and 1.84 m/s and 18% for viral hepatitis. Fibrosis heterogeneity was significantly increased for PSC (P = 0.04) while no difference was found for SWS of PSC and viral hepatitis (P = 0.17). Global hepatic stiffness was similar in PSC and viral hepatitis groups, but spatial heterogeneity may reveal spatial patterns of stiffness changes towards enhanced biophysics-based diagnosis by MRI.

Inhomogeneous liver fibrosis distribution revealed by macromolecular proton fraction quantification based on spin-lock MRI

“…Dhall et al ( 12 ) found a quarter of patients with congestive hepatopathy secondary to heart failure had heterogeneous liver biopsy results. Reiter et al ( 13 ) demonstrated heterogeneous distribution of fibrosis in patients with primary sclerosing cholangitis using magnetic resonance elastography. While the stiffness map may highlight focal liver lesions ( 14 ), liver stiffness measurement sometimes may be confounded by acute inflammation, biliary obstruction, and congestion.…”

Noninvasive evaluation of fibrosis in adult biliary diseases

“…Liver stiffness distribution is often heterogeneous in PSC and the differentiation between artefacts and true variations in liver fibrosis in PSC may be challenging. In order to improve accuracy, two recent articles propose using multifrequency MRE providing full-field-ofview elastograms of the entire liver with improved detail resolution, or drawing free-hand ROIs that include all the valid regions of liver parenchyma to avoid selection bias [26,27]. They argue that focal areas of increased liver stiffness should be assessed by correlation with anatomic and wave images, as they may reflect the patchy disease pattern; they should not be excluded automatically from the analysis as artefacts.…”

Biomécanique du foie : caractérisations, modélisations et applications cliniques

“…Dès lors que les fréquences utilisées sont suffisamment voisines, on peut raisonnablement négliger les effets de dispersion, et intégrer les champs de déplacement obtenus aux différentes fréquences dans une reconstruction unique. Ce principe est utilisé dans la reconstruction "MDEV" (Streitberger et al, 2014) et sa version dérivée kMDEV, qui ont été utilisées avec succès dans la détermination des propriétés mécaniques du foie chez les patients (Dittmann et al, 2017;Reiter et al, 2018Reiter et al, , 2021Hudert et al, 2021).…”