Difüzyon Ağırlıklı MR Kullanarak Karaciğer Fibrozisinin Non-Invaziv Değerlendirilmesi

Year 2024, Volume: 34 Issue: 4, 465 - 471, 31.08.2024

Mehmet Hakan Pıçak , A.hande Yardımcı

https://doi.org/10.54005/geneltip.1438885

Abstract

Amaç: Bu çalışmada, HBV ve HCV'ye bağlı kronik hepatit ve sirozlu hastalarda karaciğer fibrozunun evrelerini karaciğer biyopsisi yerine DWI-MRI ile değerlendirmeyi ve ADC değerlerinin histolojik fibroz evrelemesinin yerine kullanılabilirliğini araştırmayı amaçladık.
Gereç ve Yöntem: Biyopsi ile İshak fibroz skorlama sistemi uygulanmış kronik hepatit tanılı 46 hasta ile radyolojik ve klinik bulgulara göre normal olarak değerlendirilen 11 olgu çalışmaya dahil edildi. Karaciğer fibrozu olan hastaların ve sağlıklı kontrol grubunun ADC değerleri karşılaştırıldı. ADC değeri ile karaciğer fibrozis evreleri arasındaki korelasyon analiz edildi.
Bulgular: ADC değerlerinin fibrozis evresi arttıkça azaldığı gösterildi. Ortalama karaciğer ADC değerleri arasında çok yüksek düzeyde istatistiksel olarak anlamlı fark bulundu (p<0.001). Normalize edilmiş karaciğer ADC değerleri arasında yüksek düzeyde istatistiksel olarak anlamlı fark bulundu (0.001≤p<0.01).
Sonuç: DWI görüntülemesi, birçok görüntüleme merkezinde rutin sekanslar arasında yer almakta, yaygın bir şekilde kullanılmakta ve fibrozis evrelemesinde iyi sonuçlar vermektedir. İleri çalışmalar ile standartlaştırılmış değerlere ulaşılabilir ve daha etkin sonuçlara ulaşmak mümkün olabilir.

Keywords

Difüzyon MR, ADC, Karaciğer, Fibrozis

Non-Invasive Assessment of Liver Fibrosis Using Diffusion-Weighted MRI

Abstract

Background/Aims: In this study, we aimed to evaluate the stage of liver fibrosis in patients with chronic hepatitis and cirrhosis due to HBV and HCV, with DWI-MRI instead of the liver biopsy, and to investigate whether ADC values can practically replace histological fibrosis staging.
Methods: We included 46 cases with diagnosis of confirmed chronic hepatitis whose Ishaac fibrosis scoring were performed and 11 cases were assesed as normal according to radiological and clinical data.The ADC value of liver fibrosis patients and healthy controls was compared. The correlation of ADC value and liver fibrosis staging was analyzed.
Results: The ADC values were demonstrated to be decreased with increasing fibrosis stage.Very high statistical significance was found between the mean liver ADC values (p<0.001). A high level of statistical significance was found between the normalized liver ADC values (0.001≤p<0.01).
Conclusion: DWI images have been among the routine sequences in many imaging centers, are being used extensively, and give good results in the staging of fibrosis. With further studies we can access to standardized values which can lead to more efficient results.

Keywords

liver fibrosis, MRI, DWI, ADC

Ethical Statement

The Institutional Ethics Committee of İstanbul EAH approved this study Year 2017 , number 1114, and informed consent was obtained from all participants.

References

• Friedman SL. Molecular regulation of hepatic fibrosis, an integrated cellular response to tissue injury. Journal of Biological Chemistry. 2000; 275(4):2247-2250.
• Friedman SL. Mechanisms of disease: mechanisms of hepatic fibrosis and therapeutic implications. Nature clinical practice Gastroenterology & hepatology. 2004;1(2):98-105.
• Knodell RG, Ishak KG, Black WC, et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology. 1981;1(5):431-435.
• Ishak K. Histological grading and staging of chronic hepatitis. J hepatol. 1995;22:696-699.
• Dufour J-F, Delellis R, Kaplan MM. Regression of hepatic fibrosis in hepatitis C with long-term interferon treatment. Digestive diseases and sciences. 1998;43:2573-2576.
• Malekzadeh R, Mohamadnejad M, Nasseri-Moghaddam S, et al. Reversibility of cirrhosis in autoimmune hepatitis. The American journal of medicine. 2004;117(2):125-129.
• Wanless IR, Nakashima E, Sherman M. Regression of human cirrhosis: morphologic features and the genesis of incomplete septal cirrhosis. Archives of pathology & laboratory medicine. 2000;124(11):1599-1607.
• Thampanitchawong P, Piratvisuth T. Liver biopsy:complications and risk factors. World J Gastroenterol. Aug 1999;5(4):301-304. doi:10.3748/wjg.v5.i4.301
• Regev A, Berho M, Jeffers LJ, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. The American journal of gastroenterology. 2002;97(10):2614-2618.
• Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. AJR Am J Roentgenol. Jun 2007;188(6):1622-35. doi:10.2214/ajr.06.1403
• Taouli B, Tolia AJ, Losada M, et al. Diffusion-weighted MRI for quantification of liver fibrosis: preliminary experience. American Journal of Roentgenology. 2007;189(4):799-806.
• Papanikolaou N, Gourtsoyianni S, Yarmenitis S, et al. Comparison between two-point and four-point methods for quantification of apparent diffusion coefficient of normal liver parenchyma and focal lesions: value of normalization with spleen. Eur J Radiol 2010; 73:305 –309
• Friedman SL. Hepatic fibrosis—overview. Toxicology. 2008;254(3):120-129.
• Popper H, Udenfriend S. Hepatic fibrosis: correlation of biochemical and morphologic investigations. The American journal of medicine. 1970;49(5):707-721.
• Schaffner F, Klion FM. Chronic hepatitis. Annual Review of Medicine. 1968;19(1):25-38.
• Soyer MT, Ceballos R, Aldrete JS. Reversibility of severe hepatic damage caused by jejunoileal bypass after re-establishment of normal intestinal continuity. Surgery. 1976;79(5):601-604.
• Pinzani M. Liver fibrosis. Springer; 2000:475-490.
• Afdhal NH, Nunes D. Evaluation of liver fibrosis: a concise review. Official journal of the American College of Gastroenterology| ACG. 2004; 99(6):1160-1174.
• Zhao Y-P, Guo D-M, Liu H, Liu W-H , et al. Apparent diffusion coefficient measurements and Gd-DTPA enhanced-imaging in staging hepatic fibrosis in rats. International Journal of Clinical and Experimental Medicine. 2015;8(2):2197.
• Taouli B, Chouli M, Martin AJ, et al. Chronic hepatitis: role of diffusion‐weighted imaging and diffusion tensor imaging for the diagnosis of liver fibrosis and inflammation. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. 2008;28(1):89-95.
• Koinuma M, Ohashi I, Hanafusa K, et al. Apparent diffusion coefficient measurements with diffusion‐weighted magnetic resonance imaging for evaluation of hepatic fibrosis. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. 2005;22(1):80-85.
• Girometti R, Furlan A, Bazzocchi M, et al. Diffusion-weighted MRI in evaluating liver fibrosis: a feasibility study in cirrhotic patients. La radiologia medica. 2007;112(3):394-408.
• Lewin M, Poujol‐Robert A, Boëlle PY, et al. Diffusion‐weighted magnetic resonance imaging for the assessment of fibrosis in chronic hepatitis C. Hepatology. 2007;46(3):658-665.
• Naganawa S, Kawai H, Fukatsu H, et al. Diffusion-weighted imaging of the liver: technical challenges and prospects for the future. Magnetic Resonance in Medical Sciences. 2005;4(4):175-186.
• Do RK, Chandanara H, Felker E, et al. Diagnosis of liver fibrosis and cirrhosis with diffusion-weighted imaging: value of normalized apparent diffusion coefficient using the spleen as reference organ. American Journal of Roentgenology. 2010;195(3):671-676.
• Bonekamp S, Torbenson MS, Kamel IR. Diffusion-weighted magnetic resonance imaging for the staging of liver fibrosis. Journal of clinical gastroenterology. 2011;45(10):885.
• Fujimoto K, Tonan T, Azuma S, et al. Evaluation of the mean and entropy of apparent diffusion coefficient values in chronic hepatitis C: correlation with pathologic fibrosis stage and inflammatory activity grade. Radiology. 2011; 258(3):739-748.
• Kim AI, Saab S. Treatment of hepatitis C. The American journal of medicine. 2005;118(8):808-815.
• Soylu A, Kilickesmez O, Poturoglu S, et al. Utility of diffusion-weighted MRI for assessing liver fibrosis in patients with chronic active hepatitis. Diagn Interv Radiol. 2010;16(3):204-208.
• Charatcharoenwitthaya P, Sukonrut K, Korpraphong P, et al. (2021) Diffusion-weighted magnetic resonance imaging for the assessment of liver fibrosis in chronic viral hepatitis. PLoS ONE 16(3): e0248024.
• Pan Z, Li Z, Meng F, Hu Y, et al. Fat- and iron-corrected ADC to assess liver fibrosis in patients with chronic hepatitis B. Diagn Interv Radiol. 2022;28(1):5-11.
• Jang, W., Jo, S., Song, J.S. et al. Comparison of diffusion-weighted imaging and MR elastography in staging liver fibrosis: a meta-analysis. Abdom Radiol 46, 3889–3907 (2021)
• Jiang Y, Fan F, Zhang P, et al. Staging liver fibrosis by a continuous-time random-walk diffusion model. Magn Reson Imaging. 2024 Jan;105:100-107.
• Kim T, Murakami T, Takahashi S, Hori M, et al. Diffusion-weighted single-shot echoplanar MR imaging for liver disease. AJR American journal of roentgenology. 1999;173(2):393-398.
• Girometti R, Furlan A, Esposito G, et al. Relevance of b‐values in evaluating liver fibrosis: a study in healthy and cirrhotic subjects using two single‐shot spin‐echo echo‐planar diffusion‐weighted sequences. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. 2008;28(2):411-419.
• Zhou M-L, Yan F-H, Xu P-J, et al. Comparative study on clinical and pathological changes of liver fibrosis with diffusion-weighted imaging. Zhonghua yi xue za zhi. 2009; 89(25):1757-1761