Diffusion-weighted MRI in evaluating liver fibrosis: a feasibility study in cirrhotic patients.
OBJECTIVE
This study was designed to establish whether the measurement of apparent diffusion coefficients (ADCs) is clinically accurate in diagnosing liver fibrosis in a selected series of cirrhotic patients.


METHODS
Twenty-eight cirrhotic patients (mean age 58.1 years) with histologically proven liver fibrosis and 29 healthy controls (mean age 43.8 years) underwent liver diffusion-weighted magnetic resonance (MR) using a 1.5-Tesla (T) magnet equipped with a phased-array coil. Diffusion studies with parallel imaging [generalized autocalibrating partially parallel acquisitions (GRAPPA)] were performed within a single breath-hold using a single-shot spin-echo echo-planar sequence (TE 74 ms) using four b values: b=0, 150, 250 and 400 s/mm(2). A unidirectional diffusion gradient was applied. ADCs were measured on ADC maps.


RESULTS
Mean ADC was significantly lower in cirrhotic livers than in controls (1.11+/-0.16 vs. 1.54+/-0.12.10(-3)mm(2)/s) (p<0.0001). Receiver operating characteristic (ROC) analysis showed an area under the curve (AUC) of 0.96 [confidence interval (CI) 95%:(0.87; 0.94)], demonstrating higher sensitivity and specificity (92.9% and 100%, respectively) for an ADC cutoff of 1.31.10(-3)mm(2)/s. Positive predictive value (PPV), negative predictive value (NPV) and overall accuracy were 100%, 99.9% and 96.4%, respectively.


CONCLUSIONS
Diffusion-weighted MRI is an accurate tool in evaluating advanced liver fibrosis if an optimised single-shot spin-echo echo-planar sequence with maximum intermediate b value is used. The ADC threshold for liver fibrosis was 1.31.10(-3)mm(2)/s.
Girometti
R
R
Institute of Radiology, Udine University, Via Colugna 50, I-33100 Udine, Italy. rgirometti@sirm.org
Furlan
A
A
Bazzocchi
M
M
Soldano
F
F
Isola
M
M
Toniutto
P
P
Bitetto
D
D
Zuiani
C
C
D000328:Adult; D000368:Aged; D001706:Biopsy; D016001:Confidence Intervals; D003627:Data Interpretation, Statistical; D038524:Diffusion Magnetic Resonance Imaging; D017352:Echo-Planar Imaging; D005240:Feasibility Studies; D005260:Female; D005355:Fibrosis / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity