Comparison of the Efficiency of Conventional Diffusion, Diffusion Tensor Imaging, and Dynamic Susceptibility Contrast-Enhanced Magnetic Resonance Perfusion Imaging in the Evaluation of Liver Fibrosis

Yıl 2021, Cilt: 7 Sayı: 3, 250 - 255, 01.11.2021

Neriman Zengin Fıstıkçıoğlu , Nagihan İnan Gürcan , Mesude Tosun , Hande Uslu

https://doi.org/10.30934/kusbed.936876

Öz

Objective: Liver fibrosis is a dynamic, reversible process that can result in liver failure. There has been considerable interest in developing noninvasive methods for diagnosis and staging. To investigate the diffusion and perfusion changes of the fibrotic liver parenchyma with conventional diffusion-weighted imaging (CDI), diffusion tensor imaging (DTI), and T2*weighted dynamic susceptibility contrast-magnetic resonance perfusion imaging (DSC-MRPI) at 3Tesla MR scanner.
Methods: Twenty-seven patients with chronic viral hepatitis and 24 volunteers were evaluated, prospectively. The standard MRI protocols of the abdomen, CDI, and DTI were performed. Apparent diffusion coefficient (ADC) maps were obtained, D and FA values were calculated for DTI. Signal Intensity(SI)-time curves were obtained and “blood volume”(BV), “blood flow” (BF), “time to peak”(TTP), “mean transit time”(MTT) were measured. All patients with hepatitis underwent liver biopsy. The efficacy of diffusion and perfusion parameters used in the diagnosis of fibrosis was analyzed with the receiver operating characteristic curve (ROC).
Results: Patients had significantly lower liver ADC when compared to the control group, either with CDI and DTI. D values obtained from DTI were lower in patients than those of the normal volunteers, and the difference was statistically significant. On DSC-MRPI; BF, BV, MTT, and TTP of the liver were lower than those of the control group but only BV and MTT values showed statistical significance. Liver ADC, D, and BV values had a negative correlation with fibrosis.
Conclusion: The results showed that the D values obtained from DTI, BV, and MTT values obtained from DSC-MRPI can be an efficient diagnostic tool for liver fibrosis in patients with chronic hepatitis.

Anahtar Kelimeler

Liver fibrosis, chronic hepatitits, conventional diffusion imaging, diffusion tensor imaging, dynamic susceptibility contrast magnetic resonance perfusion imaging.

Karaciğer Fibrozisinin Değerlendirilmesinde Konvansiyonel Difüzyon, Difüzyon Tensör Görüntüleme ve Dinamik Duyarlılık Kontrastlı Manyetik Rezonans Perfüzyon Görüntülemenin Etkinliğinin Karşılaştırılması

Öz

Amaç: Karaciğer fibrozu, karaciğer yetmezliğine neden olabilen dinamik, geri dönüşümlü bir süreçtir. Teşhis ve evreleme için noninvaziv yöntemlerin geliştirilmesine büyük ilgi vardır. 3Tesla MR'da konvansiyonel difüzyon ağırlıklı görüntüleme (DAG), difüzyon tensör görüntüleme (DTG) ve T2* ağırlıklı dinamik duyarlılık kontrastlı manyetik rezonans perfüzyon görüntüleme (DDK-MRPG) ile fibrotik karaciğer parankiminin difüzyon ve perfüzyon değişikliklerini araştırmayı amaçladık.
Yöntem: Kronik viral hepatiti olan 27 hasta ve 24 gönüllü prospektif olarak değerlendirildi. Rutin batın MR protokolüne ek olarak DAG ve DTG uygulandı. Görünür difüzyon katsayısı (ADC) haritaları elde edildi, DTG için D ve FA değerleri hesaplandı. Sinyal Yoğunluğu (SI)-zaman eğrisi elde edildi ve “kan volümü” (KV), “kan akımı” (KA), “pik zamanı” (PZ), “ortalama geçiş zamanı” (OGZ) ölçüldü. Hepatitli tüm hastalara karaciğer biyopsisi yapıldı. Fibrozis tanısında kullanılan difüzyon ve perfüzyon parametrelerinin etkinliği, ROC eğrisi ile analiz edildi.
Bulgular: Hastalar, DAG ve DTG de kontrol grubuna kıyasla önemli ölçüde daha düşük karaciğer ADC'sine sahipti, DTG’den elde edilen D değerleri hastalarda, sağlıklı gönüllülere göre düşük olup fark istatistiksel olarak anlamlıydı. DDK-MRPG hakkında; Karaciğerin KA, KV, OGZ ve PZ’nı kontrol grubuna göre daha düşüktü ancak sadece KV ve OGZ değerleri istatistiksel anlamlılık gösterdi. Karaciğer ADC, D ve KV değerleri fibrozis ile negatif korelasyona sahipti.
Sonuç: DDK-MRPG'den elde edilen KV ve OGZ, DTG’den elde edilen D değerlerinin kronik hepatitli hastalarda karaciğer fibrozisi için etkili bir tanı aracı olabileceğini gösterdi.

Anahtar Kelimeler

Karaciğer fibrozisi, kronik hepatit, konvansiyonel difüzyon görüntüleme, difüzyon tensör görüntüleme, dinamik duyarlılık kontrast manyetik rezonans perfüzyon görüntüleme.

Kaynakça

• Bozza C, Cinausero M, Iacono D, Puglisi F. Hepatitis B and cancer: A practical guide for the oncologist. Crit Rev Oncol Hematol . 2016;98:137-146.
• Polasek M, Fuchs BC, Uppal R, et al. Molecular MR imaging of liver fibrosis: a feasibility study using rat and mouse models. J Hepatol. 2012;57:549–555.
• Peng CY, Chien RN, Liaw YF. Hepatitis B virus-related decompensated liver cirrhosis: Benefits of antiviral therapy. J Hepatol .2012;57:442-450.
• Pan S, Wang XQ, Guo QY. Quantitative assessment of hepatic fibrosis in chronic hepatitis B and C: T1 mapping on Gd-EOB-DTPA-enhanced liver magnetic resonance imaging. World J Gastroenterol.2018; 24:2024–2035.
• Yoon JH, Lee JM, Baek JH, et al. Evaluation of Hepatic Fibrosis Using Intravoxel Incoherent Motion in Diffusion-Weighted Liver MRI. J Comput Assist Tomogr. 2014;38:110-116.
• Bedossa P, Darg`ere D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology. 2003; 38:1449-1457.
• Sharma S, Khalili K, Nguyen GC. Non-invasive diagnosis of advanced fibrosis and cirrhosis. World J Gastroenterol. 2014;20:16820-16830.
• Venkatesh SK, Wang G, Lim SG, Wee A. Magnetic resonance elastography for the detection and staging of liver fibrosis in chronic hepatitis B. Eur Radiol. 2014:24;70-78
• Tosun M, Onal T, Uslu H, Alparslan B, Çetin Akhan S. Intravoxel incoherent motion imaging for diagnosing and staging the liver fibrosis and inflammation. Abdom Radiol.2020:45;15-23 https://doi.org/10.1007/s00261-019-02300-z
• Liao YS, Lee LW, Yang PH, et al. Assessment of liver cirrhosis for patients with Child's A classification before hepatectomy using dynamic contrast-enhanced MRI. Clin Radiol. 2019;74:407.e11-407.e17.
• Chan JH, Tsui EY, Luk SH, et al. Detection of hepatic tumor perfusion following transcatheter arterial chemoembolization with dynamic susceptibility contrast-enhanced echoplanar imaging. Clin Imaging. 1999;23:190-194.
• Ichikawa T, Haradome, Hachiya J, Nitatori T, Araki T. Characterization of hepatic lesions by perfusion-weighted MR imaging with echoplanar sequence. AJR, Am J Roentgenol. 1998;170:1029-1034.
• Tsui EY, Chan JH, Cheung YK, et al. Evaluation of therapeutic effectiveness of transarterial chemoembolization for hepatocellular carcinoma: correlation of dynamic susceptibility contrast-enhanced echoplanar imaging and hepatic angiography. Clin Imaging. 2000;24:210-216.
• 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;1:431-435.
• Taouli B, Tolia AJ, Losada M, et al. Diffusion-weighted MRI for quantification of Liver fibrosis: preliminary experience. Am J Roentgenol. 2007;189:799–806.
• Koinuma M, Ohashi I, Hanafusa K, Shibuya H. Apparent diffusion coefficient measurements with diffusion-weighted magnetic resonance imaging for evaluation of hepatic fibrosis. J Magn Reson Imaging. 2005;22:80-85.
• Girometti R, Esposito G, Bagatto D, Avellini C, Bazzocchi M, Zuiani C. Is water diffusion isotropic in the cirrhotic liver? a study with diffusion-weighted imaging at 3.0 Tesla. Acad Radiol. 2012;19:55-61.
• Palmucci S, Cappello G, Attinà G, et al. Diffusion-weighted MRI for the assessment of liver fibrosis: principles and applications. Biomed Res Int. 2015;874201.
• Thoeny HC, De Keyzer F, Oyen RH, Peeters RR. Diffusion-weighted MR imaging of kidneys in healthy volunteers and patients with parenchymal diseases: initial experience. Radiology. 2005;235: 911-917.
• Taouli B, Chouli M, Martin AJ,Qayyum A, Coakley FV, VilgrainV. Chronic hepatitis: role of diffusion-weighted imaging and diffusion tensor imaging for the diagnosis of liver fibrosis and inflammation. J Magn Reson Imaging. 2008;28:89-95.
• Scharf J, Zapletal C, Hess T, et al. Assessment of hepatic perfusion in pigs by pharmacokinetic analysis of dynamic MR images.J Magn Reson Imaging.1999;9:568-572.
• Annet L, Materne R, Danse E, Jamart J, Horsmans Y, Van Beers BE. Hepatic flow parameters measured with MR imaging and Doppler US: correlations with degree of cirrhosis and portal hypertension. Radiology. 2003;229:409-414.
• Hagiwara M, Rusinek H, Lee VS, et al. Advanced liver fibrosis: diagnosis with 3D whole-liver perfusion MR imaging initial experience. Radiology. 2008;246: 926-934.
• Chen BB, Hsu CY, Yu CW, et al. Dynamic contrast-enhanced magnetic resonance imaging with Gd-EOB-DTPA for the evaluation of liver fibrosis in chronic hepatitis patients. Eur Radiol.2012;22:171-180.
• Chen F, De Keyzer F, Ni Y. Cancer models-multiparametric applications of clinical MRI in rodent hepatic tumor model.Methods Mol Biol. 2011;771;489-507.
• Chen F, Sun X, De Keyzer F, et al. Liver tumor model with implanted rhabdomyosarcoma in rats: MR imaging, microangiography, and histopathologic analysis. Radiology. 2006;239:554-562.