Assessment of chronic hepatitis and fibrosis: comparison of MR elastography and diffusion-weighted imaging

Abstract

Objective: The purpose of our study was to compare the utility of MR elastography (MRE) and diffusion-weighted imaging (DWI) in characterizing fibrosis and chronic hepatitis in patients with chronic liver diseases.

Subjects and methods: Seventy-six patients with chronic liver disease underwent abdominal MRI, MRE, and DWI. Severities of liver fibrosis and chronic hepatitis were graded by histopathologic analysis according to standard disease-specific classifications. The overall predictive ability of MRE and DWI in assessment of fibrosis was compared by constructing a receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC) on the basis of histopathologic analysis.

Results: Using ROC analysis, MRE showed greater capability than DWI in discriminating stage 2 or greater (≥ F2), stage 3 or greater (≥ F3), and cirrhosis (≥ F4), shown as significant differences in AUC (p = 0.003, p = 0.001, and p = 0.001, respectively). Higher sensitivity and specificity were shown by MRE in predicting fibrosis scores ≥ F2 (91% and 97%), scores ≥ F3 (92% and 95%), and scores F4 (95% and 87%) compared with DWI (84% and 82%, 88% and 76%, and 85% and 68%, respectively). Although MRE had higher ability in identification of liver with fibrosis scores ≥ F1 than DWI, a significant difference was not seen (p = 0.398). Stiffness values on MRE increased in relation to increasing severity of fibrosis confirmed by histopathology scores; however, a consistent relationship between apparent diffusion coefficient (ADC) values and stage of fibrosis was not shown. In addition, liver tissue with chronic hepatitis preceding fibrosis may account for mild elevation of liver stiffness.

Conclusion: MRE had greater predictive ability in distinguishing the stages of liver fibrosis than DWI.

Figures

Fig. 1

20-year-old woman with history of cystic fibrosis. Stage 1 hepatic fibrosis and grade 1 necroinflammatory activity seen at histopathologic analysis following liver biopsy. A, MR elastogram shows shear stiffness value of 3.45kPa. B, DWI with b50 sec/mm2 image had calculated ADC value of 0.99×10−3mm2/sec.

Fig. 1

20-year-old woman with history of cystic fibrosis. Stage 1 hepatic fibrosis and grade 1 necroinflammatory activity seen at histopathologic analysis following liver biopsy. A, MR elastogram shows shear stiffness value of 3.45kPa. B, DWI with b50 sec/mm2 image had calculated ADC value of 0.99×10−3mm2/sec.

Fig. 2

47-year-old woman with history of primary sclerosing cholangitis. Stage 2 hepatic fibrosis and grade 2 necroinflammatory activity seen at histopathologic analysis following liver biopsy. A, MR elastogram shows shear stiffness value of 5.55kPa. B, DWI with b50 sec/mm2 image had calculated ADC value of 0.99×10−3mm2/sec.

Fig. 2

47-year-old woman with history of primary sclerosing cholangitis. Stage 2 hepatic fibrosis and grade 2 necroinflammatory activity seen at histopathologic analysis following liver biopsy. A, MR elastogram shows shear stiffness value of 5.55kPa. B, DWI with b50 sec/mm2 image had calculated ADC value of 0.99×10−3mm2/sec.

Fig. 3

56-year-old man with history of heavy alcohol abuse. Stage 3 hepatic fibrosis and grade 1 necroinflammatory activity seen at histopathologic analysis following liver biopsy. A, MR elastogram shows shear stiffness value of 6.69kPa. B, DWI with b50 sec/mm2 image had calculated ADC value of 0.89×10−3mm2/sec.

Fig. 3

56-year-old man with history of heavy alcohol abuse. Stage 3 hepatic fibrosis and grade 1 necroinflammatory activity seen at histopathologic analysis following liver biopsy. A, MR elastogram shows shear stiffness value of 6.69kPa. B, DWI with b50 sec/mm2 image had calculated ADC value of 0.89×10−3mm2/sec.

Fig. 4

57-year-old man with history of chronic hepatitis C combined with alcohol abuse. Stage 4 hepatic fibrosis and grade 1 necroinflammatory activity are observed by histopathologic analysis following liver biopsy. A, MR elastogram shows shear stiffness value on MRE of 11.2kPa. B, DWI with b50 sec/mm2 image had calculated ADC value of 0.90×10−3mm2/sec.

Fig. 4

57-year-old man with history of chronic hepatitis C combined with alcohol abuse. Stage 4 hepatic fibrosis and grade 1 necroinflammatory activity are observed by histopathologic analysis following liver biopsy. A, MR elastogram shows shear stiffness value on MRE of 11.2kPa. B, DWI with b50 sec/mm2 image had calculated ADC value of 0.90×10−3mm2/sec.

Fig. 5

Box plot shows shear stiffness values of various stages of fibrosis. Individual data are presented as circles. The horizontal line through each box represents median value and box represents data from the 25th to the 75th percentile (middle 50% of observations). The whiskers represent data from the minimum to the maximum excluding far out values which are displayed as separate circles (Kruskal-Wallis H test and Mann-Whitney U test).

Fig. 6

Box plot shows ADC value of various stages of fibrosis. Individual data are presented as circles. The horizontal line through each box represents median value and box represents data from the 25th to the 75th percentile (middle 50% of observations). The whiskers represent data from the minimum to the maximum excluding far out values which are displayed as separate circles (Kruskal-Wallis H test and Mann-Whitney U test).

Fig. 7

Receiver operator characteristic curves (ROC) analysis of MRE and DWI in distinguishing each stage of hepatic fibrosis A, ROC analysis for MRE and DWI to distinguish liver tissue with no fibrosis from tissues with fibrosis stage 1 or greater (F1-4). The AUC for MRE is 0.92 (95% CI, 0.84 to 0.97) and for DWI is 0.88 (95% CI, 0.78 to 0.94). The difference in AUC is 0.04 (95% CI, -0.06 to 0.14) (P=0.398). B, ROC analysis for MRE and DWI to distinguish liver tissue with no to mild fibrosis (F0-1) from moderate fibrosis to cirrhosis (F2-4). The AUC for MRE is 0.98 (95% CI, 0.92 to 1.00) and for DWI is 0.86 (95% CI, 0.76 to 0.93). The difference in AUC is 0.12 (95% CI, 0.04 to 0.22) (P=0.003). C, Receiver operator characteristic curves for MRE and DWI to distinguish liver tissue with no to moderate fibrosis (F0-2) from advanced fibrosis to cirrhosis (F3-4). The AUC for MRE is 0.99 (95% CI, 0.93 to 1.00) and for DWI is 0.84 (95% CI, 0.74 to 0.92). The difference in AUC is 0.15 (95% CI, 0.06 to 0.23) (P=0.001). D, Receiver operator characteristic curves for MRE and DWI to distinguish liver tissue with no to moderate fibrosis (F0-3) from advanced fibrosis to cirrhosis (F4). The AUC for MRE is 0.95 (95% CI, 0.87 to 0.99) and for DWI is 0.78 (95% CI, 0.68 to 0.87). The difference in AUC is 0.17 (95% CI, 0.06 to 0.27) (P=0.001).

Fig. 7

Receiver operator characteristic curves (ROC) analysis of MRE and DWI in distinguishing each stage of hepatic fibrosis A, ROC analysis for MRE and DWI to distinguish liver tissue with no fibrosis from tissues with fibrosis stage 1 or greater (F1-4). The AUC for MRE is 0.92 (95% CI, 0.84 to 0.97) and for DWI is 0.88 (95% CI, 0.78 to 0.94). The difference in AUC is 0.04 (95% CI, -0.06 to 0.14) (P=0.398). B, ROC analysis for MRE and DWI to distinguish liver tissue with no to mild fibrosis (F0-1) from moderate fibrosis to cirrhosis (F2-4). The AUC for MRE is 0.98 (95% CI, 0.92 to 1.00) and for DWI is 0.86 (95% CI, 0.76 to 0.93). The difference in AUC is 0.12 (95% CI, 0.04 to 0.22) (P=0.003). C, Receiver operator characteristic curves for MRE and DWI to distinguish liver tissue with no to moderate fibrosis (F0-2) from advanced fibrosis to cirrhosis (F3-4). The AUC for MRE is 0.99 (95% CI, 0.93 to 1.00) and for DWI is 0.84 (95% CI, 0.74 to 0.92). The difference in AUC is 0.15 (95% CI, 0.06 to 0.23) (P=0.001). D, Receiver operator characteristic curves for MRE and DWI to distinguish liver tissue with no to moderate fibrosis (F0-3) from advanced fibrosis to cirrhosis (F4). The AUC for MRE is 0.95 (95% CI, 0.87 to 0.99) and for DWI is 0.78 (95% CI, 0.68 to 0.87). The difference in AUC is 0.17 (95% CI, 0.06 to 0.27) (P=0.001).

Fig. 7

Receiver operator characteristic curves (ROC) analysis of MRE and DWI in distinguishing each stage of hepatic fibrosis A, ROC analysis for MRE and DWI to distinguish liver tissue with no fibrosis from tissues with fibrosis stage 1 or greater (F1-4). The AUC for MRE is 0.92 (95% CI, 0.84 to 0.97) and for DWI is 0.88 (95% CI, 0.78 to 0.94). The difference in AUC is 0.04 (95% CI, -0.06 to 0.14) (P=0.398). B, ROC analysis for MRE and DWI to distinguish liver tissue with no to mild fibrosis (F0-1) from moderate fibrosis to cirrhosis (F2-4). The AUC for MRE is 0.98 (95% CI, 0.92 to 1.00) and for DWI is 0.86 (95% CI, 0.76 to 0.93). The difference in AUC is 0.12 (95% CI, 0.04 to 0.22) (P=0.003). C, Receiver operator characteristic curves for MRE and DWI to distinguish liver tissue with no to moderate fibrosis (F0-2) from advanced fibrosis to cirrhosis (F3-4). The AUC for MRE is 0.99 (95% CI, 0.93 to 1.00) and for DWI is 0.84 (95% CI, 0.74 to 0.92). The difference in AUC is 0.15 (95% CI, 0.06 to 0.23) (P=0.001). D, Receiver operator characteristic curves for MRE and DWI to distinguish liver tissue with no to moderate fibrosis (F0-3) from advanced fibrosis to cirrhosis (F4). The AUC for MRE is 0.95 (95% CI, 0.87 to 0.99) and for DWI is 0.78 (95% CI, 0.68 to 0.87). The difference in AUC is 0.17 (95% CI, 0.06 to 0.27) (P=0.001).

Fig. 7

Receiver operator characteristic curves (ROC) analysis of MRE and DWI in distinguishing each stage of hepatic fibrosis A, ROC analysis for MRE and DWI to distinguish liver tissue with no fibrosis from tissues with fibrosis stage 1 or greater (F1-4). The AUC for MRE is 0.92 (95% CI, 0.84 to 0.97) and for DWI is 0.88 (95% CI, 0.78 to 0.94). The difference in AUC is 0.04 (95% CI, -0.06 to 0.14) (P=0.398). B, ROC analysis for MRE and DWI to distinguish liver tissue with no to mild fibrosis (F0-1) from moderate fibrosis to cirrhosis (F2-4). The AUC for MRE is 0.98 (95% CI, 0.92 to 1.00) and for DWI is 0.86 (95% CI, 0.76 to 0.93). The difference in AUC is 0.12 (95% CI, 0.04 to 0.22) (P=0.003). C, Receiver operator characteristic curves for MRE and DWI to distinguish liver tissue with no to moderate fibrosis (F0-2) from advanced fibrosis to cirrhosis (F3-4). The AUC for MRE is 0.99 (95% CI, 0.93 to 1.00) and for DWI is 0.84 (95% CI, 0.74 to 0.92). The difference in AUC is 0.15 (95% CI, 0.06 to 0.23) (P=0.001). D, Receiver operator characteristic curves for MRE and DWI to distinguish liver tissue with no to moderate fibrosis (F0-3) from advanced fibrosis to cirrhosis (F4). The AUC for MRE is 0.95 (95% CI, 0.87 to 0.99) and for DWI is 0.78 (95% CI, 0.68 to 0.87). The difference in AUC is 0.17 (95% CI, 0.06 to 0.27) (P=0.001).