Advanced Liver Fibrosis: Diagnosis with 3D Whole-Liver Perfusion MR Imaging—Initial Experience

Abstract

Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. The purpose of this study was to prospectively evaluate sensitivity and specificity of various estimated perfusion parameters at three-dimensional (3D) perfusion magnetic resonance (MR) imaging of the liver in the diagnosis of advanced liver fibrosis (stage >or= 3), with histologic analysis, liver function tests, or MR imaging as the reference standard. Whole-liver 3D perfusion MR imaging was performed in 27 patients (17 men, 10 women; mean age, 55 years) after dynamic injection of 8-10 mL of gadopentetate dimeglumine. The following estimated perfusion parameters were measured with a dual-input single-compartment model: absolute arterial blood flow (F(a)), absolute portal venous blood flow (F(p)), absolute total liver blood flow (F(t)) (F(t) = F(a) + F(p)), arterial fraction (ART), portal venous fraction (PV), distribution volume (DV), and mean transit time (MTT) of gadopentetate dimeglumine. Patients were assigned to two groups (those with fibrosis stage <or= 2 and those with fibrosis stage >or= 3), and the nonparametric Mann-Whitney test was used to compare F(a), F(p), F(t), ART, PV, DV, and MTT between groups. Receiver operating characteristic curve analysis was used to assess the utility of perfusion estimates as predictors of advanced liver fibrosis. There were significant differences for all perfusion MR imaging-estimated parameters except F(p) and F(t). There was an increase in F(a), ART, DV, and MTT and a decrease in PV in patients with advanced fibrosis compared with those without advanced fibrosis. DV had the best performance, with an area under the receiver operating characteristic curve of 0.824, a sensitivity of 76.9% (95% confidence interval: 46.2%, 94.7%), and a specificity of 78.5% (95% confidence interval: 49.2%, 95.1%) in the prediction of advanced fibrosis.

Feasibility of histogram analysis of susceptibility-weighted MRI for staging of liver fibrosis

“…Several new methods, such as FibroScan, DWI, perfusion, gadoxetic acid-enhanced MRI, and magnetic resonance elastography (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), are increasingly being used to assess liver fibrosis and have shown potential in predicting the severity of liver fibrosis. A previous multicenter prospective study showed that the diagnostic accuracy of FibroScan was high for cirrhosis but poor for significant fibrosis (F≥2) (11).…”

Timing bolus dynamic contrast‐enhanced (DCE) MRI assessment of hepatic perfusion: Initial experience

“…Several studies have shown that careful kinetic modeling of dynamic contrast-enhanced (DCE) MR images can noninvasively quantify regional and global changes in hepatic perfusion associated with liver cirrhosis and fibrosis (7)(8)(9)(10). For example, Annet et al (7) showed that hepatic flow parameters measured with MRI correlate with the severity of cirrhosis and portal hypertension.…”

“…For example, Annet et al (7) showed that hepatic flow parameters measured with MRI correlate with the severity of cirrhosis and portal hypertension. Another recent study reported the feasibility of using MR liver perfusion parameters as biomarkers for liver fibrosis (10). In these studies, hepatic perfusion was assessed during dedicated prospective research examinations using optimized scan sequences, and the DCE MR studies were obtained with a bolus injection of gadolinium chelate contrast material with amount ranging from 7 to 10 mL.…”

The evaluation of haemodynamics in cirrhotic patients with spectral CT

“…The HPI value in cirrhotic patients measured with CT perfusion scan usually increases in some degree because of the hepatic arterial buffer effect [5,8,20]. The haemodynamics of cirrhosis was relevant to its pathology.…”