Non-invasive detection of liver fibrosis: Is superparamagnetic iron oxide particle-enhanced MR imaging a contributive technique?

Abstract

The purpose of our study was to evaluate the ability of superparamagnetic iron oxide (SPIO)-enhanced MR imaging to detect liver fibrosis in patients with chronic liver disease and to compare the findings with histopathological data. Sixty-seven patients with chronic hepatitis ( n=58) or focal nodular hyperplasia (FNH; n=9) were studied using a 1.5-T MR system. The protocol included proton density-weighted, T2-weighted spin-echo (SE) and fast SE (FSE) sequences before and after SPIO administration and T2*-weighted gradient-recalled-echo (GRE) sequences after SPIO. Pre- and post-contrast T2-weighted and T2*-weighted sequences were retrospectively evaluated by three independent observers for evidence of non-tumor hypersignal intensities. Three liver patterns were considered: thick reticulations; thin reticulations; and/or multiple areas of hypersignal intensities. Unenhanced or enhanced patterns were compared with histopathological specimens, which had been obtained by percutaneous biopsy of the right lobe within a maximum of 12 months of MR examination. Liver fibrosis was histologically graded using a five-level scale (F0-F4), according to the METAVIR classification. Histopathology demonstrated significant fibrosis (F2-F4) in 57 patients, non-significant fibrosis in 1 patient (F1), and normal liver surrounding FNH in 9 patients (F0). After SPIO administration, at least one pattern of non-tumor hypersignal intensities was seen in 43 (76%) of the 57 patients with F>/=2 with good agreement (kappa=0.68) compared with 2 (20%) of the 10 F0/1 patients ( p<0.01). Attenuated non-homogeneous liver-signal intensities with persistent thick reticulations, thin reticulations, or multiple areas of hypersignals were observed in, respectively, 30, 52, and 56% of patients with F>/=2 with moderate agreement (kappa=0.51). Before SPIO, MR images were positive in 21 of 57 (37%) F>/=2 and zero F0/1 patients. Post-contrast proton-density-weighted and T2*-weighted GRE were the most sensitive sequences for detecting non-tumor hypersignal intensities. In patients with chronic liver diseases, SPIO-enhanced MR imaging exhibits non-tumor hypersignal intensities indicative of liver fibrosis by decreasing the signal from the non-fibrotic areas where Kupffer cells are present.

Can preoperative diffusion-weighted MRI predict postoperative hepatic insufficiency after curative resection of HBV-related hepatocellular carcinoma? A pilot study

“…Accordingly, although DW-MRI is potentially useful when other noninvasive tools have failed to assess liver fibrosis in patients with hepatitis C virus infection (which makes mostly micronodular structures in the liver) [14], it seems that DW-MRI with our current setting of 3-T MRI system is not applicable to patients with CHB. However, because the intra-and interobserver reliability of DW-MRI were proved to be significantly high in this study and various techniques are under investigation to improve the image quality [36][37][38][39][40], the usefulness of DW-MRI can be investigated again in the future for patients with CHB, especially for obese patients in whom LSM is often inadequate.…”

Evaluation of the uptake function of liver in rats with obstructive jaundice before and after relief from obstruction by superparamagnetic iron oxide-enhanced magnetic resonance imaging

“…Previously, SPIO was mainly used to differentiate hepatocellular carcinoma from benign focal lesions. Recently, some investigators have assessed the application of SPIO in certain diffuse diseases, such as non-alcoholic fatty liver disease, liver cirrhosis or fibrosis (13)(14)(15). These studies showed that following the administration of SPIO, the signal in the model group exhibited a significantly lower reduction compared to the normal group.…”

Magnetic resonance imaging of hepatic fibrosis: Emerging clinical applications

“…45 For patients with varying degrees of involvement with chronic hepatitis, an increasing PME/PDE ratio was found to correlate with necroinflammatory and fibrosis scores on liver histology compared with healthy volunteers. [52][53][54][55] Although differences between means for each group were 31 P, labeled phosphorus; ISIS, image selected in vivo spectroscopy; TR, repetition time; NA, number of acquisitions; PBC, primary biliary cirrhosis; CSI, chemical shift imaging; PME, phosphomonoester; Pi, inorganic phosphate; Glx, glutamate; Glu, glucose; GPE, glycerophosphorylethanolamine; GPC, glycerylphosphorylcholine; PE, phosphoethanolamine; PC, phosphocholine; PDE, phosphodiester; ATP, adenosine triphosphate; P, inorganic phosphorus; n/a, not available; CTP, Child-Turcotte-Pugh; HA, hyaluronic acid; MRE, magnetic resonance elastography. statistically significant, there was some overlap between the patient groups.…”

“…27,28 In turn, a number of studies have described changes in hepatic parenchyma texture after contrast-enhanced imaging by MRI (Table 1). [27][28][29][30][31][32][33][34][35] Early patchy enhancement may correlate with increased numbers of macrophages and necroinflammation on liver histology. In contrast, a delayed, heterogeneous enhancement pattern is associated with bright-appearing reticulations suggestive of hepatic fibrosis.…”

“…28 In contrast, the administration of superparamagnetic iron oxide (SPIO) contrast agents creates hypointensity within liver parenchyma based on its accumulation in reticuloendothelial cells. [30][31][32]34,35 Recently, the sequential administration of gadolinium followed by SPIO contrast media was done to determine whether improved detection of liver fibrosis architecture could be observed (Fig. 1).…”