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Diffusion-weighted magnetic resonance imaging for staging liver fibrosis is less reliable in the presence of fat and iron

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Abstract

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/mm2 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.

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Acknowledgments

Robin Bülow and Jens-Peter Kühn contributed equally to this work.

Some of subjects were prospectively enrolled in another study: “Kühn JP, Evert M, Friedrich N, et al. (2011) Noninvasive quantification of hepatic fat content using three-echo dixon magnetic resonance imaging with correction for T2* relaxation effects. Invest Radiol 46:783-9. PubMed PMID: 21808200”. In this prospective study, we investigated a chemical shift-encoded MRI for liver fat quantification compared to histology. In the present study, retrospective data evaluation was performed to assess liver fibrosis using diffusion-weighted MR imaging.

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Authors and Affiliations

  1. Department of Radiology and Neuroradiology, Ernst Moritz Arndt University of Greifswald, Ferdinand-Sauerbruch-Straße NK, Greifswald, 17475, Germany

    Robin Bülow, Birger Mensel & Jens-Peter Kühn

  2. Community Medicine, Ernst Moritz Arndt University of Greifswald, Walther-Rathenau-Straße 46, Greifswald, 17475, Germany

    Peter Meffert

  3. Departments of Medical Physics, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705, USA

    Diego Hernando

  4. Department of Pathology, Ernst Moritz Arndt University of Greifswald, Friedrich Loeffler-Strasse 23, Greifswald, 17475, Germany

    Matthias Evert

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  1. Robin Bülow
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  4. Diego Hernando
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Correspondence to Robin Bülow.

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Bülow, R., Mensel, B., Meffert, P. et al. Diffusion-weighted magnetic resonance imaging for staging liver fibrosis is less reliable in the presence of fat and iron. Eur Radiol 23, 1281–1287 (2013). https://doi.org/10.1007/s00330-012-2700-2

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  • DOI: https://doi.org/10.1007/s00330-012-2700-2

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