Accuracy of MR elastography and anatomic MR imaging features in the diagnosis of severe hepatic fibrosis and cirrhosis

Abstract

Purpose To compare the diagnostic accuracy of MR elastography and anatomic MR imaging features in the diagnosis of severe hepatic fibrosis and cirrhosis. Materials and Methods Three readers independently assessed presence of morphological changes associated with hepatic fibrosis in 72 patients with liver biopsy including: caudate to right lobe ratios, nodularity, portal venous hypertension (PVH) stigmata, posterior hepatic notch, expanded gallbladder fossa and right hepatic vein caliber. Three readers measured shear stiffness values using quantitative shear stiffness maps (elastograms). Sensitivity, specificity and diagnostic accuracy of stiffness values and each morphological feature were calculated. Inter-reader agreement was summarized using weighted kappa statistics. Intra-class correlation coefficient was used to assess inter-reader reproducibility of stiffness measurements. Binary logistic regression was used to assess inter-reader variability for dichotomized stiffness values and each morphological feature. Results Using 5.9 kPa as a cut-off for differentiating F3–F4 from F0–2 stages, overall sensitivity, specificity and diagnostic accuracy for MR elastography were 85.4%, 88.4 % and 87% respectively. Overall inter-reader agreement for stiffness values was substantial, with insignificant difference (p=0.74) in the frequency of differentiating F3–4 from F0–2 fibrosis. Only hepatic nodularity and PVH stigmata showed moderately high overall accuracy of 69.4% and 72.2%. Inter-reader agreement was substantial only for PVH stigmata, moderate for C/R m, deep notch and expanded gallbladder fossa. Only posterior hepatic notch (p=0.82) showed no significant difference in reader rating. Conclusion MR elastography is a non-invasive, accurate and reproducible technique compared with conventional features of detecting severe hepatic fibrosis.

Radiologic Assessment of Liver Fibrosis – Present and Future

“…As reported by Rustogi et al [105] stiffness measurements are repeatable with high overall inter-reader agreement (P=0.74); thus, MRE shows potential for longitudinal monitoring of patients. Furthermore, Yin et al found that this technique has a high negative predictive value (97%) for excluding the presence of fibrosis, suggesting that MRE could have a role for improving the ability to risk-stratify patients for liver biopsy [102].…”

Elastography in Chronic Liver Disease: Modalities, Techniques, Limitations, and Future Directions

“…lobe-to-right lobe width ratio has only moderate overall interreader agreement, with a k value of 0.53 (22). Signs of portal hypertension are indirect markers for cirrhosis.…”

“…Investigators have demonstrated that MR elastographic values are better than morphologic features on MR images for the prediction of advanced fibrosis and cirrhosis (22,26).…”

Prediction of liver cirrhosis, using diagnostic imaging tools

“…Wang et al [73] 2012 Meta-analysis 1. Rustogi et al [54] 2012 Retrospective 1. to-noise limitations; (2) a longer examination time than SSI; (3) the need for dedicated installation equipment; and (4) a lack of comparable studies between 1.5 Tesla and 3.0 Tesla MRI machines and among other company products (Table 2). Therefore, an absolute cut-off value for diagnosis and grading of hepatic fibrosis has not been established.…”

“…This study also showed that MRE could discriminate patients with moderate and severe fibrosis (grades 24) from those with mild fibrosis (sensitivity, 86%; specificity, 85%). Several studies show that MRE is more reliable for staging hepatic fibrosis compared to DWI and conventional MRI, with a powerful combination of sensitivity, specificity, likelihood ratios, diagnostic odds ratio, and area under the summary receiver operating characteristic curve values [51,[53][54][55] (Table 2). MRE can be easily added to standard abdominal MRI protocols, promising value added in staging liver cirrhosis.…”