title: Accuracy of MR elastography and anatomic MR imaging features in the diagnosis of severe hepatic fibrosis and cirrhosis.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of magnetic resonance imaging elastography (MRE) and anatomic MRI features in the diagnosis of severe hepatic fibrosis and cirrhosis.
  
  
  METHODS
  Three readers independently assessed presence of morphological changes associated with hepatic fibrosis in 72 patients with liver biopsy including: caudate to right lobe ratios, nodularity, portal venous hypertension (PVH) stigmata, posterior hepatic notch, expanded gallbladder fossa, and right hepatic vein caliber. Three readers measured shear stiffness values using quantitative shear stiffness maps (elastograms). Sensitivity, specificity, and diagnostic accuracy of stiffness values and each morphological feature were calculated. Interreader agreement was summarized using weighted kappa statistics. Intraclass correlation coefficient was used to assess interreader reproducibility of stiffness measurements. Binary logistic regression was used to assess interreader variability for dichotomized stiffness values and each morphological feature.
  
  
  RESULTS
  Using 5.9 kPa as a cutoff for differentiating F3-F4 from F0-2 stages, overall sensitivity, specificity, and diagnostic accuracy for MRE were 85.4%, 88.4%, and 87%, respectively. Overall interreader agreement for stiffness values was substantial, with an insignificant difference (P = 0.74) in the frequency of differentiating F3-4 from F0-2 fibrosis. Only hepatic nodularity and PVH stigmata showed moderately high overall accuracy of 69.4% and 72.2%. Interreader agreement was substantial only for PVH stigmata, moderate for C/R m, deep notch, and expanded gallbladder fossa. Only posterior hepatic notch (P = 0.82) showed no significant difference in reader rating.
  
  
  CONCLUSIONS
  MRE is a noninvasive, accurate, and reproducible technique compared with conventional features of detecting severe hepatic fibrosis.
authors.affiliation: Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Department of Radiology, Chicago, Illinois 60611, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Rustogi
authors.forename: Jeanne
authors.initials: J
authors.lastname: Horowitz
authors.forename: Carla
authors.initials: C
authors.lastname: Harmath
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.forename: Hamid
authors.initials: H
authors.lastname: Chalian
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Ganger
authors.forename: Zongming E
authors.initials: ZE
authors.lastname: Chen
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Bolster
authors.forename: Saurabh
authors.initials: S
authors.lastname: Shah
authors.forename: Frank H
authors.initials: FH
authors.lastname: Miller
mesh_terms: D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity