Apparent Diffusion Coefficient Is a Novel Imaging Biomarker of Myopathic Changes in Liver Cirrhosis

Abstract

Diffusion weighted imaging can provide information regarding tissue composition and can quantitatively characterize different pathological changes by means of apparent diffusion coefficient (ADC). The study comprised of 114 patients with liver cirrhosis—22 women and 92 men with a mean age of 56.5 ± 9.0 years. In all patients, the Model for End Stage-Liver Disease (MELD) score was calculated. Furthermore, 12 healthy persons (5 women, 7 men), mean age, 42.1 ± 16.2 years, were investigated as a control group. In all cases, magnetic resonance imaging of the liver/trunk was performed using different 3T scanners and diffusion weighted images were obtained with a multi-shot SE-EPI sequence. In all cases, polygonal regions of interest were manually drawn on the ADC maps along the contours of the iliopsoas and paravertebral muscles. The comparison of ADC values in groups was performed by Mann-Whitney-U tests. The association between ADC and MELD score was calculated by Spearman’s rank correlation coefficient. ADC values of the skeletal musculature were statistically much higher in comparison to those in the control group: 1.85 ± 0.46 × 10−3 mm2 s−1 vs. 1.23 ± 0.12 × 10−3 mm2 s−1, p = 0.001. ADC values showed statistically significant correlation with the MELD score (r = 0.473, p = 0.0001). Furthermore, ADC values differed between the subgroups with different values of the MELD score. ADC values correlated slightly with lactate dehydrogenase (LDH) (r = 0.381, p = 0.0001) and tended to correlate with C-reactive protein (CRP) (r = 0.171, p = 0.07) and alanine aminotransferase (ALAT) (r = −0.167, p = 0.076). ADC can reflect muscle changes in liver cirrhosis and shows statistically significant correlation with the MELD score. Therefore, ADC can be used as an imaging biomarker of myopathic changes in liver cirrhosis.

Assessment of Malnutrition, Sarcopenia and Frailty in Patients with Cirrhosis: Which Tools Should We Use in Clinical Practice?

“…FFMA was independently associated with mortality. Surov et al [104] recently described higher apparent diffusion coefficient (ADC) values in cirrhosis compared to healthy people. ADC values significantly correlated with the severity of cirrhosis assessed by MELD score.…”

Muscular abnormalities in liver cirrhosis

“…The study does not offer a direct proposal for the clinical use of the proposed indices in the assessment of sarcopenia. In the multivariate analysis, the authors also used only the MELD score[ 53 ].…”

Established paths and new avenues: a review of the main radiological techniques for investigating sarcopenia

“…Regarding the application of DWI for sarcopenia, Surov et al found a significant correlation between the model for end stage-liver disease and muscle changes in patients with cirrhosis, and even proposed the apparent diffusion coefficient (ADC) as new biomarker (74). Similarly, McPherson and colleagues identified significant differences in ADC values of the lower limb muscles between patients with spinal cord injury and healthy controls (75) (Figure 5).…”

“…Aside from brain imaging, DWI's main field of application is oncological imaging (69)(70)(71). However, it can be also reliably used for musculoskeletal diseases including myositis and sarcopenia (46,(72)(73)(74). Indeed, in muscles, extra-, intra-, and transcellular water diffusion as well as capillary perfusion occur and the signal attenuation on DWI images is mainly due to the extracellular component and to microvascular perfusion (75).…”