Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Diagnostic Performance of Spin-Echo Echo-Planar Imaging Magnetic Resonance Elastography in 3T System for Noninvasive Assessment of Hepatic Fibrosis

  • Se Woo Kim (Department of Radiology, Seoul National University Hospital) ;
  • Jeong Min Lee (Department of Radiology, Seoul National University Hospital) ;
  • Sungeun Park (Department of Radiology, Konkuk University Medical Center) ;
  • Ijin Joo (Department of Radiology, Seoul National University Hospital) ;
  • Jeong Hee Yoon (Department of Radiology, Seoul National University Hospital) ;
  • Won Chang (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Haeryoung Kim (Department of Pathology, Seoul National University Hospital)
  • Received : 2021.02.18
  • Accepted : 2021.08.09
  • Published : 2022.02.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: To validate the performance of 3T spin-echo echo-planar imaging (SE-EPI) magnetic resonance elastography (MRE) for staging hepatic fibrosis in a large population, using surgical specimens as the reference standard. Materials and Methods: This retrospective study initially included 310 adults (155 undergoing hepatic resection and 155 undergoing donor hepatectomy) with histopathologic results from surgical liver specimens. They underwent 3T SE-EPI MRE ≤ 3 months prior to surgery. Demographic findings, underlying liver disease, and hepatic fibrosis pathologic stage according to METAVIR were recorded. Liver stiffness (LS) was measured by two radiologists, and inter-reader reproducibility was evaluated using the intraclass correlation coefficient (ICC). The mean LS of each fibrosis stage (F0-F4) was calculated in total and for each etiologic subgroup. Comparisons among subgroups were performed using the Kruskal-Wallis test and Conover post-hoc test. The cutoff values for fibrosis staging were estimated using receiver operating characteristic (ROC) curve analysis. Results: Inter-reader reproducibility was excellent (ICC, 0.98; 95% confidence interval, 0.97-0.99). The mean LS values were 1.91, 2.41, 3.24, and 5.41 kPa in F0-F1 (n = 171), F2 (n = 26), F3 (n = 38), and F4 (n = 72), respectively. The discriminating cutoff values for diagnosing ≥ F2, ≥ F3, and F4 were 2.18, 2.71, and 3.15 kPa, respectively, with the ROC curve areas of 0.97-0.98 (sensitivity 91.2%-95.9%, specificity 90.7%-99.0%). The mean LS was significantly higher in patients with cirrhosis (F4) of nonviral causes, such as primary biliary cirrhosis (9.56 kPa) and alcoholic liver disease (7.17 kPa) than in those with hepatitis B or C cirrhosis (4.28 and 4.92 kPa, respectively). There were no statistically significant differences in LS among the different etiologic subgroups in the F0-F3 stages. Conclusion: The 3T SE-EPI MRE demonstrated high interobserver reproducibility, and our criteria for staging hepatic fibrosis showed high diagnostic performance. LS was significantly higher in patients with non-viral cirrhosis than in those with viral cirrhosis.

Keywords

Acknowledgement

We appreciate the statistical consultation provided by the Medical Research Collaborating Center at the Seoul National University Hospital.

References

  1. Hoodeshenas S, Yin M, Venkatesh SK. Magnetic resonance elastography of liver: current update. Top Magn Reson Imaging 2018;27:319-333
  2. Tacke F, Weiskirchen R. An update on the recent advances in antifibrotic therapy. Expert Rev Gastroenterol Hepatol 2018;12:1143-1152
  3. Zoubek ME, Trautwein C, Strnad P. Reversal of liver fibrosis: from fiction to reality. Best Pract Res Clin Gastroenterol 2017;31:129-141
  4. Pinzani M, Rombouts K, Colagrande S. Fibrosis in chronic liver diseases: diagnosis and management. J Hepatol 2005;42:S22-S36
  5. Afdhal NH, Nunes D. Evaluation of liver fibrosis: a concise review. Am J Gastroenterol 2004;99:1160-1174
  6. Horowitz JM, Venkatesh SK, Ehman RL, Jhaveri K, Kamath P, Ohliger MA, et al. Evaluation of hepatic fibrosis: a review from the society of abdominal radiology disease focus panel. Abdom Radiol (NY) 2017;42:2037-2053
  7. Lee DH, Lee JM, Han JK, Choi BI. MR elastography of healthy liver parenchyma: normal value and reliability of the liver stiffness value measurement. J Magn Reson Imaging 2013;38:1215-1223
  8. Guo Y, Parthasarathy S, Goyal P, McCarthy RJ, Larson AC, Miller FH. Magnetic resonance elastography and acoustic radiation force impulse for staging hepatic fibrosis: a meta-analysis. Abdom Imaging 2015;40:818-834
  9. Singh S, Venkatesh SK, Wang Z, Miller FH, Motosugi U, Low RN, et al. Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data. Clin Gastroenterol Hepatol 2015;13:440-451.e6
  10. Chang W, Lee JM, Yoon JH, Han JK, Choi BI, Yoon JH, et al. Liver fibrosis staging with MR elastography: comparison of diagnostic performance between patients with chronic hepatitis B and those with other etiologic causes. Radiology 2016;280:88-97
  11. Wagner M, Corcuera-Solano I, Lo G, Esses S, Liao J, Besa C, et al. Technical failure of MR elastography examinations of the liver: experience from a large single-center study. Radiology 2017;284:401-412
  12. Goodman ZD. Grading and staging systems for inflammation and fibrosis in chronic liver diseases. J Hepatol 2007;47:598-607
  13. Yu E. Histologic grading and staging of chronic hepatitis: on the basis of standardized guideline proposed by the Korean Study Group for the Pathology of Digestive Diseases. Korean J Hepatol 2003;9:42-46
  14. Lambert J, Halfon P, Penaranda G, Bedossa P, Cacoub P, Carrat F. How to measure the diagnostic accuracy of noninvasive liver fibrosis indices: the area under the ROC curve revisited. Clin Chem 2008;54:1372-1378
  15. Obuchowski NA. Estimating and comparing diagnostic tests' accuracy when the gold standard is not binary. Acad Radiol 2005;12:1198-1204
  16. Chou CT, Chen RC, Wu WP, Lin PY, Chen YL. Prospective comparison of the diagnostic performance of magnetic resonance elastography with acoustic radiation force impulse elastography for pre-operative staging of hepatic fibrosis in patients with hepatocellular carcinoma. Ultrasound Med Biol 2017;43:2783-2790
  17. Batheja M, Vargas H, Silva AM, Walker F, Chang YH, De Petris G, et al. Magnetic resonance elastography (MRE) in assessing hepatic fibrosis: performance in a cohort of patients with histological data. Abdom Imaging 2015;40:760-765
  18. Morisaka H, Motosugi U, Glaser KJ, Ichikawa S, Ehman RL, Sano K, et al. Comparison of diagnostic accuracies of two-and three-dimensional MR elastography of the liver. J Magn Reson Imaging 2017;45:1163-1170
  19. Obara N, Ueno Y, Fukushima K, Nakagome Y, Kakazu E, Kimura O, et al. Transient elastography for measurement of liver stiffness measurement can detect early significant hepatic fibrosis in Japanese patients with viral and nonviral liver diseases. J Gastroenterol 2008;43:720-728
  20. Behairy Bel-S, Sira MM, Zalata KR, Salama el-SE, Abd-Allah MA. Transient elastography compared to liver biopsy and morphometry for predicting fibrosis in pediatric chronic liver disease: does etiology matter? World J Gastroenterol 2016;22:4238-4249
  21. Venkatesh SK, Xu S, Tai D, Yu H, Wee A. Correlation of MR elastography with morphometric quantification of liver fibrosis (Fibro-C-Index) in chronic hepatitis B. Magn Reson Med 2014;72:1123-1129
  22. Wong VW, Chan HL. Transient elastography. J Gastroenterol Hepatol 2010;25:1726-1731
  23. Besa C, Wagner M, Lo G, Gordic S, Chatterji M, Kennedy P, et al. Detection of liver fibrosis using qualitative and quantitative MR elastography compared to liver surface nodularity measurement, gadoxetic acid uptake, and serum markers. J Magn Reson Imaging 2018;47:1552-1561
  24. Wagner M, Besa C, Bou Ayache J, Yasar TK, Bane O, Fung M, et al. Magnetic resonance elastography of the liver: qualitative and quantitative comparison of gradient echo and spin echo echoplanar imaging sequences. Invest Radiol 2016;51:575-581
  25. Kim DW, Kim SY, Yoon HM, Kim KW, Byun JH. Comparison of technical failure of MR elastography for measuring liver stiffness between gradient-recalled echo and spin-echo echoplanar imaging: a systematic review and meta-analysis. J Magn Reson Imaging 2020;51:1086-1102
  26. Yin M, Glaser KJ, Talwalkar JA, Chen J, Manduca A, Ehman RL. Hepatic MR elastography: clinical performance in a series of 1377 consecutive examinations. Radiology 2016;278:114-124
  27. Trout AT, Serai S, Mahley AD, Wang H, Zhang Y, Zhang B, et al. Liver stiffness measurements with MR elastography: agreement and repeatability across imaging systems, field strengths, and pulse sequences. Radiology 2016;281:793-804