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Noninvasive evaluation of liver fibrosis: comparison of the stretched exponential diffusion-weighted model to other diffusion-weighted MRI models and transient elastography

 Jae Hyon Park  ;  Nieun Seo  ;  Yong Eun Chung  ;  Seung Up Kim  ;  Yung Nyun Park  ;  Jin-Young Choi  ;  Mi-Suk Park  ;  Myeong-Jin Kim 
 EUROPEAN RADIOLOGY, Vol.31(7) : 4813-4823, 2021-07 
Journal Title
Issue Date
Diffusion Magnetic Resonance Imaging ; Elasticity Imaging Techniques* ; Fatty Liver* ; Humans ; Liver Cirrhosis / diagnostic imaging ; Retrospective Studies
Diffusion magnetic resonance imaging ; Elasticity imaging techniques ; Fibrosis ; Liver
Objectives: To compare the diagnostic performance of the stretched exponential model to those of other DWI models and transient elastography (TE) and to evaluate the influence of confounding factors on the staging of liver fibrosis.

Methods: This retrospective study included 78 consecutive patients who underwent both DWI and TE. The distributed diffusion coefficient (DDC) and intravoxel heterogeneity index (α) from the stretched exponential model, apparent diffusion coefficient (ADC), perfusion fraction (f), pseudodiffusion coefficient (Dp), true diffusion coefficient (Dt), and TE were obtained. Associations between imaging parameters and pathological fibrosis, inflammation, and steatosis were evaluated using Spearman's correlation and multiple regression analysis. Diagnostic accuracy of parameters for fibrosis staging was assessed via the Obuchowski measures.

Results: DDC was the only parameter to differ between F0-1 and F2-3 (p < 0.001) and between F2-3 and F4 (p = 0.013). DDC showed significant correlation with fibrosis (p < 0.001) and inflammation (p = 0.001), but not with steatosis (p = 0.619), and was independently associated with only fibrosis in multiple regression analysis (β = - 0.114, p < 0.001). ADC, Dp, and Dt showed a significant correlation with steatosis (ps ≤ 0.038). DDC showed the highest diagnostic performance for liver fibrosis (0.717; 95% confidence interval, 0.653-0.765) followed by TE (0.681, 0.623-0.733) without a significant difference between DDC and TE (p > 0.999).

Conclusions: DDC from the stretched exponential model is the most accurate DWI parameter with no confounding effect from steatosis and with overall similar diagnostic performance to TE.

Key points: • The distributed diffusion coefficient (DDC) from the stretched exponential model is the most accurate DWI parameter for staging liver fibrosis. • DDC and transient elastography have similar good diagnostic performance for evaluating liver fibrosis. • The stretched exponential DWI model has no confounding effect by steatosis, unlike other DWI models.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myeong Jin(김명진) ORCID logo https://orcid.org/0000-0001-7949-5402
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Park, Mi-Suk(박미숙) ORCID logo https://orcid.org/0000-0001-5817-2444
Park, Young Nyun(박영년) ORCID logo https://orcid.org/0000-0003-0357-7967
Seo, Nieun(서니은) ORCID logo https://orcid.org/0000-0001-8745-6454
Chung, Yong Eun(정용은) ORCID logo https://orcid.org/0000-0003-0811-9578
Choi, Jin Young(최진영) ORCID logo https://orcid.org/0000-0002-9025-6274
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