Value of intravoxel incoherent motion in detecting and staging liver fibrosis: A meta-analysis

Abstract

BACKGROUND Liver fibrosis (LF) is a common pathological feature of all chronic liver diseases. With the accumulation of extracellular matrix in the fibrotic liver, true molecular water diffusion and perfusion-related diffusion are restricted. Intravoxel incoherent motion (IVIM) can capture the information on tissue diffusivity and microcapillary perfusion separately and reflect the fibrotic severity with diffusion coefficients. AIM To investigate the diagnostic performance of IVIM in detecting and staging LF with histology as a reference standard. METHODS A comprehensive literature search was conducted to identify studies on the diagnostic accuracy of IVIM for assessment of histologically proven LF. The stages of LF were classified as F0 (no fibrosis), F1 (portal fibrosis without septa), F2 (periportal fibrosis with few septa), F3 (septal fibrosis), and F4 (cirrhosis) according to histopathological findings. Data were extracted to calculate the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio, as well as the area under the summary receiver operating characteristic curve (AUC) in each group. RESULTS A total of 12 studies with 923 subjects were included in this meta-analysis with 5 studies ( n = 465) for LF ≥ F1, 9 studies ( n = 757) for LF ≥ F2, 4 studies ( n = 413) for LF ≥ F3, and 6 studies ( n = 562) for LF = F4. The pooled sensitivity and specificity were estimated to be 0.78 (95% confidence interval: 0.73-0.82) and 0.81 (0.74-0.86) for LF ≥ F1 detection with IVIM; 0.82 (0.79-0.86) and 0.80 (0.75-0.84) for staging F2 fibrosis; 0.85 (0.79-0.90) and 0.83 (0.77-0.87) for staging F3 fibrosis, and 0.90 (0.84-0.94) and 0.75 (0.70-0.79) for detecting F4 cirrhosis, respectively. The AUCs for LF ≥ F1, F2, F3, F4 detection were 0.862 (0.811-0.914), 0.883 (0.856-0.909), 0.886 (0.865-0.907), and 0.899 (0.866-0.932), respectively. Moderate to substantial heterogeneity was observed with inconsistency index ( I 2 ) ranging from 0% to 77.9%. No publication bias was detected. CONCLUSION IVIM is a noninvasive tool with good diagnostic performance in detecting and staging LF. Optimized and standardized IVIM protocols are needed to further improve its diagnostic accuracy in clinical practice.

Value of IVIM in Differential Diagnoses between Benign and Malignant Solitary Lung Nodules and Masses: A Meta-analysis

“…The increased D * value may result from the angiogenesis of immature vessels in lung cancer, leading to larger blood flow velocity and capillary segment length in lung cancer ( 20 ). Since increasing angiogenesis is also a characteristic of benign lesions, higher D * may also be seen in benign lesions ( 37 ). The f value primarily reflects the proportion of blood perfusion in the whole diffusion movement of the tumor and could represent the percentage of capillary capacity in the voxel range to the whole tissue volume ( 38 ).…”

Multiparameter magnetic resonance imaging of liver fibrosis in a bile duct ligation mouse model

“…First, because of the limited number of mice, it was difficult to avoid selection bias and carry out a subgroup analysis. Second, many advanced sequences such as MRE[ 15 ] and intravoxel incoherent motion imaging[ 16 ] could not be used in our study because of technological limitations in clinical MRI. Third, it is difficult to use the breath-holding technique in mice, and the subsequent respiratory movement in the abdomen might have degraded image quality and caused bias in measurements.…”

Clinical Significance of Liver MR Imaging

“…109,110 The pooled sensitivity and specificity were 0.63-0.82 and 0.78-0.86, respectively, with an AUROC of 0.79-0.88 for the staging of significant fibrosis (F ≥ 2), 0.71-0.88 and 0.68-0.84, respectively, with an AUROC of 0.81-0.89 for the staging of severe fibrosis (F ≥ 3), and 0.80-0.96 and 0.69-0.77, respectively, with an AUROC of 0.80-0.90 for the staging of cirrhosis (F4) in DWI and IVIM. 109,[111][112][113][114] Elastography Cirrhosis is the most important risk factor for HCC; therefore, it is important to accurately assess advanced fibrosis. For many patients, fibrosis stages are monitored using noninvasive tests, including elastography.…”