Intravoxel Incoherent Motion Diffusion Weighted MR Imaging at 3.0 T: Assessment of Steatohepatitis and Fibrosis Compared with Liver Biopsy in Type 2 Diabetic Patients

Parente, Daniella Braz; Paiva, Fernando Fernandes; Neto, Jaime Araújo Oliveira; Machado-Silva, Lilian; Figueiredo, Fábio P.; Lanzoni, Valéria Pereira; Campos, Carlos Frederico Ferreira; Brasil, Pedro Emmanuel Alvarenga Americano do; Gomes, Marília de Brito; Perez, Renata de Mello; Rodrigues, Rosana Souza

doi:10.1371/journal.pone.0125653

Cited by 36 publications

(19 citation statements)

References 44 publications

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“…We observed that pure D decreased with increasing grades of steatosis, similar with previous reports [24,27,34,35]. Steatosis decrease water molecules movement due to the enlarged hepatocytes, overloaded with macrovesicles of fat, restricting both intracellular and extracellular diffusion [24].…”

Section: Discussionsupporting

confidence: 91%

“…The IVIM model allows separating the liver signal intensity changes due to true molecular diffusion from those related to perfusion within the tissue. Recently, it has been proposed that the IVIM model, and particularly the perfusion-related parameters D* and f, would be more advantageous to evaluate liver fibrosis than conventional ADC measurements [5,[13][14][15][16][17][18][33][34][35]. However, the influence of liver inflammation, steatosis and siderosis on liver values has to be considered in this analysis.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel incoherent motion diffusion-weighted MR imaging

et al. 2016

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Purpose: The purpose of the study was to evaluate the role of intravoxel incoherent motion (IVIM) diffusion model for the assessment of liver fibrosis and inflammation in diffuse liver disorders, also considering the presence of liver steatosis and iron deposits. Methods: Seventy-four patients were included, with liver biopsy and a 3 Tesla abdominal magnetic resonance imaging examination, with an IVIM diffusion-weighted sequence (single-shot spin-echo echo-planar sequence, with gradient reversal fat suppression; 6 b-values: 0, 50, 200, 400, 600, and 800 s/mm 2 ). Histological evaluation comprised the Ishak modified scale, for grading inflammation and fibrosis, plus steatosis and iron loading classification. The liver apparent diffusion coefficient (ADC) and IVIM parameters (D, D*, f) were calculated from the IVIM images. The relationship between IVIM parameters and histopathological scores were evaluated by ANOVA and Spearman correlation tests. A testretest experiment assessed reproducibility and repeatability in 10 healthy volunteers and 10 randomly selected patient studies. Results: ADC and f values were lower with higher fibrosis stages (p = 0.009, p = 0.006, respectively) and also with higher necro-inflammatory activity grades (p = 0.02, p = 0.017, respectively). Considered together, only fibrosis presented a significant effect on ADC and f measurements (p < 0.05), whereas inflammation had no significant effect (p > 0.05). A mild correlation was found between ADC and f with fibrosis (R S = -0.32 and R S = -0.38; p < 0.05) and inflammation (R S = -0.31 and R S = -0.32, p < 0.05; respectively). The AUROC for ADC and f measurements with the different dichotomizations between fibrosis or inflammation grades were only fair (0.670 to 0.749, p < 0.05). Neither D nor D* values were significantly different between liver fibrosis or inflammation grades. D measurements were significantly different across histologic grades of steatosis (p < 0.001) and iron overload (p < 0.001), whereas f measurements showed significant differences across histologic steatosis grades (p = 0.005).

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel incoherent motion diffusion-weighted MR imaging

et al. 2016

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“…FNH contains bile ducts; therefore, after taking up a hepatocyte-specific contrast agent, delayed biliary excretion is possible. Lastly, the background for state of the organ, such as the liver fat content, fibrotic tissue fraction, and even chronic disease such as pancreatitis, could have considerable influences on the measurement of parameters (7,38,39).…”

Section: Discussionmentioning

confidence: 99%

“…Both diffusion and perfusion can be quantified or estimated separately by multi-b values according to a bi-exponential model, including D, f, and D*, which represent the pure diffusion coefficient, perfusion fraction, and pseudodiffusion coefficient, respectively. Recently, IVIM has become popular and has been applied routinely in the human body, mostly to evaluate therapeutic response (5,6), in chronic disease assessment (7,8), and for lesion detection and characterization (9,10). One of the most conspicuous advantages of IVIM is that it does not require contrast medium injection.…”

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confidence: 99%

Intravoxel incoherent motion: application in differentiation of hepatocellular carcinoma and focal nodular hyperplasia

Luo

Jiang²,

Zhang³

2017

Diagn Interv Radiol

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A mong primary malignant hepatic tumors, hepatocellular carcinoma (HCC) is the most common disease and is highly associated with chronic hepatitis B and cirrhosis. Focal nodular hyperplasia (FNH) is the second most common benign focal liver lesion (1), and although it displays gentle biological behavior generally, it can cause abdominal pain or right upper quadrant discomfort occasionally. In terms of the extent of vascular supply during contrast enhancement, HCC and FNH both show a hyperarterialization pattern. HCC is characterized by rapid washout in portal and delayed phase compared with adjacent liver tissue, while FNH displays isointensity or mild hyperintensity in the venous phase because of its slower washout. Liver-specific contrast agents, such as gadoxetic acid, can provide unique information to diagnose these conditions more precisely; however, such agents increase the cost and time-consumption of diagnosis. Occasionally, HCC and FNH show confounding or atypical appearances on imaging, especially for high-or middle-grade differentiated HCC, leading to confusion, misdiagnosis ( Fig. 1), and even unnecessary interventions. Since the treatment of these two lesions is completely different, avoiding unnecessary invasive treatment or tests, such as biopsy, surgery, or interventional therapy, is vital for the prognosis and quality of life of the patient. Therefore, it is crucial to diagnose these conditions noninvasively and accurately before surgery.Diffusion-weighted imaging (DWI) is a functional technology to detect diffusion of water molecules and permits to capture more detailed disease information. For lesion detection, the signal intensity on diffusion-weighted image depends on several factors, particularly cell density. A B D O M I N A L I MAG I N G O R I G I N A L A R T I C L E PURPOSEWe aimed to explore whether intravoxel incoherent motion (IVIM)-related parameters of hepatocellular carcinoma (HCC) and focal nodular hyperplasia (FNH) demonstrate differences that could be used to differentiate and improve diagnostic efficiency. METHODSA total of 27 patients, including 22 with HCC and 5 with FNH, underwent liver 3.0 T magnetic resonance imaging for routine sequences. They were concurrently examined by IVIM diffusion-weighted imaging (DWI) scanning with 11 different b values (0-800 s/mm 2 ). IVIM-derived parameters, such as pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f ), and apparent diffusion coefficient (ADC total ), were quantified automatically by post-processing software and compared between HCC and FNH groups. A receiver operating characteristic (ROC) curve was then created to predict their diagnostic value. RESULTS

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“…For cT1 as well, an optimal cut‐off (875 ms) has been suggested, but to distinguish between low‐ and high‐risk (NASH or fibrosis > 1) patients, with sensitivity/specificity of 97%/50%. Other MRI approaches include quantitative susceptibility imaging, intravoxel incoherent motion (IVIM) diffusion‐weighted MRI, and morphological evaluation such as liver volume and preperitoneal fat area, all evaluated in one single study, with AUROCs ranging from 0.61/0.68/0.74 for different IVIM parameters to 0.91 for susceptibility, the last one tested in a small sample of 32 patients. Moreover, a score based on MRI optical analysis estimators produced an AUROC of 0.83 with sensitivity/specificity of 87%/60% .…”

Section: Resultsmentioning

confidence: 99%

Accuracy of imaging methods for steatohepatitis diagnosis in non‐alcoholic fatty liver disease patients: A systematic review

Besutti

Valenti

Ligabue

et al. 2019

Liver International

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Abbreviations: ARFI, acoustic radiation force impulse; AUROC, area under the receiving operating characteristic curve; MRE, magnetic resonance elastography; MRS, magnetic resonance spectroscopy; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; PDFF, proton density fat fraction; QUADAS-2, Quality Assessment of Diagnostic Accuracy Studies-2; SPIO/USPIO, superparamagnetic iron oxide/ultrasmall superparamagnetic iron oxide; TE, transient elastography. AbstractBackground & Aims: Non-invasive tests to diagnose non-alcoholic steatohepatitis (NASH) are urgently needed. This systematic review aims to evaluate imaging accuracy in diagnosing NASH among non-alcoholic fatty liver disease (NAFLD) patients, using liver biopsy as reference.Methods: Eligible studies were systematic reviews and cross-sectional/cohort studies of NAFLD patients comparing imaging with histology, considering accuracy and/ or associations. MEDLINE, Scopus, EMBASE and Cochrane Library databases were searched up to April 2018. Studies were screened on title/abstract, then assessed for eligibility on full-text. Data were extracted using a predesigned form. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results:Of the 641 studies screened, 61 were included in scoping review, 30 of which (with accuracy results) in data synthesis. Imaging techniques included: elastography (transient elastography-TE, acoustic radiation force impulse-ARFI, magnetic resonance elastography-MRE), ultrasound (US), magnetic resonance (MR), computed tomography and scintigraphy. Histological NASH definition was heterogeneous. In 28/30 studies, no prespecified threshold was used (high risk of bias). AUROCs were up to 0.82 for TE, 0.90 for ARFI, 0.93 for MRE and 0.82 for US scores. MR techniques with higher accuracy were spectroscopy (AUROC = 1 for alanine), susceptibility-weighted imaging (AUROC = 0.91), multiparametric MR (AUROC = 0.80), optical analysis (AUROC = 0.83), gadoxetic acid-enhanced MR (AUROCs = 0.85) and superparamagnetic iron oxide-enhanced MR (AUROC = 0.87). Results derived mostly from single studies without independent prospective validation. Conclusions:There is currently insufficient evidence to support the use of imaging to diagnose NASH. More studies are needed on US and MR elastography and non-elastographic techniques, to date the most promising methods. K E Y W O R D Smagnetic resonance, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, ultrasonography

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Intravoxel Incoherent Motion Diffusion Weighted MR Imaging at 3.0 T: Assessment of Steatohepatitis and Fibrosis Compared with Liver Biopsy in Type 2 Diabetic Patients

Cited by 36 publications

References 44 publications

Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel incoherent motion diffusion-weighted MR imaging

Evaluation of fibrosis and inflammation in diffuse liver diseases using intravoxel incoherent motion diffusion-weighted MR imaging

Intravoxel incoherent motion: application in differentiation of hepatocellular carcinoma and focal nodular hyperplasia

Accuracy of imaging methods for steatohepatitis diagnosis in non‐alcoholic fatty liver disease patients: A systematic review

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