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. 2010 Mar;31(3):589-600.
doi: 10.1002/jmri.22081.

Diagnosis of cirrhosis with intravoxel incoherent motion diffusion MRI and dynamic contrast-enhanced MRI alone and in combination: preliminary experience

Jignesh Patel  1 , Eric E Sigmund, Henry Rusinek, Marcel Oei, James S Babb, Bachir Taouli
Affiliations

Diagnosis of cirrhosis with intravoxel incoherent motion diffusion MRI and dynamic contrast-enhanced MRI alone and in combination: preliminary experience

Jignesh Patel et al. J Magn Reson Imaging. 2010 Mar.

Abstract

Purpose: To report our preliminary experience with the use of intravoxel incoherent motion (IVIM) diffusion-weighted magnetic resonance imaging (DW-MRI) and dynamic contrast-enhanced (DCE)-MRI alone and in combination for the diagnosis of liver cirrhosis.

Materials and methods: Thirty subjects (16 with noncirrhotic liver, 14 with cirrhosis) were prospectively assessed with IVIM DW-MRI (n = 27) and DCE-MRI (n = 20). IVIM parameters included perfusion fraction (PF), pseudodiffusion coefficient (D*), true diffusion coefficient (D), and apparent diffusion coefficient (ADC). Model-free DCE-MR parameters included time to peak (TTP), upslope, and initial area under the curve at 60 seconds (IAUC60). A dual input single compartmental perfusion model yielded arterial flow (Fa), portal venous flow (Fp), arterial fraction (ART), mean transit time (MTT), and distribution volume (DV). The diagnostic performances for diagnosis of cirrhosis were evaluated for each modality alone and in combination using logistic regression and receiver operating characteristic analyses. IVIM and DCE-MR parameters were compared using a generalized estimating equations model.

Results: PF, D*, D, and ADC values were significantly lower in cirrhosis (P = 0.0056-0.0377), whereas TTP, DV, and MTT were significantly increased in cirrhosis (P = 0.0006-0.0154). There was no correlation between IVIM- and DCE-MRI parameters. The highest Az (areas under the curves) values were observed for ADC (0.808) and TTP-DV (0.952 for each). The combination of ADC with DV and TTP provided 84.6% sensitivity and 100% specificity for diagnosis of cirrhosis.

Conclusion: The combination of DW-MRI and DCE-MRI provides an accurate diagnosis of cirrhosis.

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Figures

Figure 1
Figure 1
ROI placement for signal intensity measurement used to quantify IVIM diffusion parameters in a 43-year-old male volunteer. Three consecutive coronal SS EPI images centered on the portal vein for b = 50 s/mm2 are shown. ROIs are copied into the remaining images with different b-values.
Figure 2
Figure 2
IVIM diffusion decay curves shown in a 70-year-old female patient with normal liver (circles) and a 71-year-old female patient with cirrhosis related to chronic hepatitis C (squares). The same patients are shown also in Figs. 3 and 5. Y-axis: ratio of SI after application of diffusion gradient to baseline SI (in log scale) measured in liver parenchyma, x-axis: b-values (multiple b-values, 0-50-100-150-200-300-500-700-1000 s/mm2 are used for sampling). The perfusion (or pseudodiffusion) effect is seen as an early drop in SI observed with b-values lower than 200 s/mm2. Perfusion fraction (PF) is measured as the difference between SI for b = 0 s/mm2 and the intercept of the high b-value monoexponential fit. D* (pseudodiffusion coefficient) measures the curvature of the initial curve. D (true diffusion coefficient) is measured with b-values higher than 200 s/mm2. ADC was measured using all b-values with a monoexponential fit. PF (%), D* (× 10−3 mm2/s), D (× 10−3 mm2/s), and ADC (× 10−3 mm2/s) were all decreased in the cirrhotic patient (23.52, 24.02, 0.93, 1.22 in cirrhosis vs. 36.80, 29.78, 1.28, 2.05 in normal liver, respectively). [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.]
Figure 3
Figure 3
Time activity curves obtained with DCE-MRI in the same patients as in Fig. 2 (curves for aorta, portal vein, and liver parenchyma are shown). TTP (sec), ART (%), DV (%), MTT (sec), and Fa (mL/100g/min) were increased in the cirrhotic liver (88.22, 44.35, 35.67, 27.22, and 34.90) compared to normal liver (42.86, 10.19, 29.16, 7.78, and 22.50). Fp (mL/100g/min), Fa + Fp (mL/100g/min) and upslope were decreased in the cirrhotic liver (43.90, 78.80, and 0.36) versus normal liver (205.80, 228.30, and 0.69). [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.]
Figure 4
Figure 4
Boxplot distribution of IVIM parameters in cirrhotic and noncirrhotic patients (n = 27). ADC showed the best discrimination. Top and bottom of boxes: 25%–75% percentiles of data, line in box: median value, *outliers. PF: perfusion fraction (%), D*: pseudodiffusion coefficient (× 10−3 mm2/s), D: true diffusion coefficient (× 10−3 mm2/s), ADC: apparent diffusion coefficient (×10−3 mm2/s). [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.]
Figure 5
Figure 5
Coronal voxel-based parametric maps of IVIM diffusion parameters in the same patients as in Fig. 2. The SS EPI image for b = 0 is shown for reference. ADC, D, PF, and D* maps demonstrate qualitative differences between normal and cirrhotic liver, with lower values in cirrhosis. Quantitative values for both patients are listed in Figs. 2 and 3.
Figure 6
Figure 6
Boxplot distribution of DCE-MRI parameters in cirrhotic and noncirrhotic patients (n = 20). DV (distribution volume) and TTP (time to peak) showed the best discrimination between noncirrhotic and cirrhotic patients. Top and bottom of boxes: 25%–75% percentiles of data, line in box: median value, *outliers. ART: arterial fraction (%), IAUC60: integrated area under the time activity curve over 60 s (mM.s), DV: distribution volume (%), Fa: arterial liver blood flow (ml/100g/min), Fp: portal liver blood flow (ml/100g/min), (Fa + Fp): total liver blood flow (ml/100g/min), MTT: mean transit time (sec), TTP: time to peak (sec) [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.]
Figure 7
Figure 7
Matrix plot distribution of ADC vs. TTP and DV values in 17 patients who underwent both IVIM DW- and DCE-MRI. The dashed lines indicate the threshold values calculated with logistic regression and ROC analyses (ADC ≤ 1.50 × 10−3 mm2/s, TTP ≥57.14 sec, DV ≥30.20%). All four noncirrhotic patients had decreased TTP and DV, and 11 cirrhotic patients had decreased ADC and increased TTP or increased DV. The combination of ADC with TTP and DV provided 84.6% sensitivity (11/13), 100% specificity (4/4), 100% positive predictive value (11/11), 66.6% negative predictive value (4/6), and 88.2% (15/17) accuracy for diagnosing cirrhosis. [Color figure can be viewed in the online issue, which is available at www.interscience.wiley.com.]
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References

    1. Afdhal NH, Nunes D. Evaluation of liver fibrosis: a concise review. Am J Gastroenterol. 2004;99:1160–1174. - PubMed
    1. NIH Consensus Statement on Management of Hepatitis C: 2002. NIH Consens State Sci Statements. 2002;19:1–46. - PubMed
    1. Kim AI, Saab S. Treatment of hepatitis C. Am J Med. 2005;118:808–815. - PubMed
    1. Namimoto T, Yamashita Y, Sumi S, Tang Y, Takahashi M. Focal liver masses: characterization with diffusion-weighted echo-planar MR imaging. Radiology. 1997;204:739–744. - PubMed
    1. Ichikawa T, Haradome H, Hachiya J, Nitatori T, Araki T. Diffusion-weighted MR imaging with a single-shot echoplanar sequence: detection and characterization of focal hepatic lesions. AJR Am J Roentgenol. 1998;170:397–402. - PubMed

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