Document Detail

Diffusion-weighted magnetic resonance imaging for staging liver fibrosis is less reliable in the presence of fat and iron.
MedLine Citation:
PMID:  23138385     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To investigate the reliability of diffusion-weighted magnetic resonance imaging (DW-MRI) for staging liver fibrosis in the presence of fat and iron.
METHODS: Ninety-five patients, including 48 men and 47 women, aged 57.0 ± 14.2 years, underwent liver biopsy. Ninety-six samples were histologically staged for liver fibrosis (0-Ishak score 0; 1-Ishak score 1-4; 2-Ishak score 5-6) and semiquantitatively graded for hepatic iron (0, no; 1, low; 2, moderate; 3, high iron) and for hepatic steatosis. Within 72 h after biopsy, navigator-triggered DW-MRI using b-values of 50/400/800 s/mm(2) was performed in a 1.5-T system, and apparent diffusion coefficients (ADC) were analysed. ADCs were correlated with fibrosis stage, steatosis grade, and iron grade using linear regression.
RESULTS: ADC did not correlate with fibrosis stages in either the overall group (n = 96; R (2) = 0.38; P = 0.17) or in the subgroup without liver iron and steatosis (n = 40; R (2) = 0.01; P = 0.75). ADC decreased significantly with steatosis grade in cases without iron and fibrosis (n = 42; R (2) = 0.28; ß = -5.3; P < 0.001). Liver iron was modestly correlated with ADC in patients without fibrosis and steatosis (n = 33; R (2) = 0.29; P = 0.04), whereas high iron concentrations were associated with low ADC values (group 3: β = -489; P = 0.005; reference:group 0) but intermediate levels were not (group 1/group 2: P = 0.93/P = 0.54; reference group: 0).
CONCLUSIONS: ADC values are confounded by fat and iron. However, even in patients without fat or iron, DW-MRI does not adequately discriminate the stage of fibrosis.
KEY POINTS: • Diffusion-weighted magnetic resonance imaging (DW-MRI) is increasingly used to evaluate liver disease. • DWI using b-values of 50/400/800 s/mm (2) does not adequately quantify fibrosis. • Assessment of the apparent diffusion coefficient (ADC) is confounded by fat and iron. • Fat may influence ADCs by altering water diffusion. • Iron may influence ADCs by signal decay and noise floor effects.
Robin Bülow; Birger Mensel; Peter Meffert; Diego Hernando; Matthias Evert; Jens-Peter Kühn
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2012-11-09
Journal Detail:
Title:  European radiology     Volume:  23     ISSN:  1432-1084     ISO Abbreviation:  Eur Radiol     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-11     Completed Date:  2013-09-30     Revised Date:  2014-01-15    
Medline Journal Info:
Nlm Unique ID:  9114774     Medline TA:  Eur Radiol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1281-7     Citation Subset:  IM    
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MeSH Terms
Adipose Tissue / pathology*
Diffusion Magnetic Resonance Imaging / methods*
Fatty Liver / metabolism*,  pathology*
Iron / analysis*
Liver Cirrhosis / metabolism*,  pathology*
Middle Aged
Reproducibility of Results
Sensitivity and Specificity
Reg. No./Substance:
Comment In:
Rofo. 2013 Dec;185(12):1134

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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