title: Diagnosis of cirrhosis with intravoxel incoherent motion diffusion MRI and dynamic contrast-enhanced MRI alone and in combination: preliminary experience.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  The combination of DW-MRI and DCE-MRI provides an accurate diagnosis of cirrhosis.
authors.affiliation: NYU Langone Medical Center, Department of Radiology, New York, New York, USA.
authors.forename: Jignesh
authors.initials: J
authors.lastname: Patel
authors.forename: Eric E
authors.initials: EE
authors.lastname: Sigmund
authors.forename: Henry
authors.initials: H
authors.lastname: Rusinek
authors.forename: Marcel
authors.initials: M
authors.lastname: Oei
authors.forename: James S
authors.initials: JS
authors.lastname: Babb
authors.forename: Bachir
authors.initials: B
authors.lastname: Taouli
mesh_terms: D000465:Algorithms; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives*; D009038:Motion; D009942:Organometallic Compounds; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D055815:Young Adult
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine