Does intravoxel incoherent motion reliably stage hepatic fibrosis, steatosis, and inflammation?

Kumar Sandrasegaran, Paul Territo, Reem M. Elkady, Yuning Lin, Pauley Gasparis, Gitasree Borthakur, Chen Lin

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: To investigate the usefulness of intravoxel incoherent motion (IVIM) in determining the severity of hepatic fibrosis, steatosis, and inflammation in patients with chronic liver disease. Methods: Forty-nine patients who had liver MRI with IVIM sequence and liver biopsy within three months of MRI were enrolled. A reviewer, blinded to histology, placed regions of interest of 1–2 cm2 in the right liver lobe. In addition, the first twenty patients were assessed with a second reviewer. Perfusion fraction (f), pseudodiffusion coefficient (Dfast), true diffusion coefficient (Dslow), and apparent diffusion coefficient (ADC) were calculated from normalized signal intensities that were fitted into a biexponential model. Errors in the model were minimized with global stochastic optimization using Simulated Annealing. ANOVA with post hoc Tukey–Kramer test and multivariate generalized linear model analysis were performed, using histological findings as the gold standard. Results: The most common etiologies for liver disease were hepatitis C and alcohol, accounting together for 76% (37/49) of patients. Low-grade fibrosis (F0, F1), hepatic steatosis, and inflammation were seen in 24% (12/49), 31% (15/49), and 29% (14/49) of patients, respectively. The interobserver correlation was poor for Dfast and Dslow (0.105, 0.173) and moderate for f and ADC (0.461, 0.418). ANOVA showed a strong inverse association between Dfast and liver fibrosis grade (p = 0.001). A weak inverse association was seen between ADC and hepatic steatosis (p = 0.059). Multivariate general linear model revealed that the only significant association between IVIM parameters and pathological features was between Dfast and fibrosis. On ROC curve analysis, Dfast < 23.4 × 10−3 mm2/s had a sensitivity of 82.8% and a specificity of 64.3% in predicting high-grade fibrosis. Conclusion: Dfast has the strongest association with hepatic fibrosis but has weak interobserver correlation. IVIM parameters were not significantly associated with hepatic inflammation or steatosis.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalAbdominal Radiology
DOIs
StateAccepted/In press - Aug 21 2017

Fingerprint

Fibrosis
Inflammation
Liver
ROC Curve
Liver Diseases
Linear Models
Analysis of Variance
Hepatitis C
Liver Cirrhosis
Histology
Chronic Disease
Perfusion
Alcohols
Biopsy

Keywords

  • Hepatic fibrosis
  • Hepatic steatosis
  • Hepatitis
  • IVIM
  • MRI

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology
  • Radiological and Ultrasound Technology

Cite this

Does intravoxel incoherent motion reliably stage hepatic fibrosis, steatosis, and inflammation? / Sandrasegaran, Kumar; Territo, Paul; Elkady, Reem M.; Lin, Yuning; Gasparis, Pauley; Borthakur, Gitasree; Lin, Chen.

In: Abdominal Radiology, 21.08.2017, p. 1-7.

Research output: Contribution to journalArticle

Sandrasegaran, Kumar ; Territo, Paul ; Elkady, Reem M. ; Lin, Yuning ; Gasparis, Pauley ; Borthakur, Gitasree ; Lin, Chen. / Does intravoxel incoherent motion reliably stage hepatic fibrosis, steatosis, and inflammation?. In: Abdominal Radiology. 2017 ; pp. 1-7.
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abstract = "Objective: To investigate the usefulness of intravoxel incoherent motion (IVIM) in determining the severity of hepatic fibrosis, steatosis, and inflammation in patients with chronic liver disease. Methods: Forty-nine patients who had liver MRI with IVIM sequence and liver biopsy within three months of MRI were enrolled. A reviewer, blinded to histology, placed regions of interest of 1–2 cm2 in the right liver lobe. In addition, the first twenty patients were assessed with a second reviewer. Perfusion fraction (f), pseudodiffusion coefficient (Dfast), true diffusion coefficient (Dslow), and apparent diffusion coefficient (ADC) were calculated from normalized signal intensities that were fitted into a biexponential model. Errors in the model were minimized with global stochastic optimization using Simulated Annealing. ANOVA with post hoc Tukey–Kramer test and multivariate generalized linear model analysis were performed, using histological findings as the gold standard. Results: The most common etiologies for liver disease were hepatitis C and alcohol, accounting together for 76{\%} (37/49) of patients. Low-grade fibrosis (F0, F1), hepatic steatosis, and inflammation were seen in 24{\%} (12/49), 31{\%} (15/49), and 29{\%} (14/49) of patients, respectively. The interobserver correlation was poor for Dfast and Dslow (0.105, 0.173) and moderate for f and ADC (0.461, 0.418). ANOVA showed a strong inverse association between Dfast and liver fibrosis grade (p = 0.001). A weak inverse association was seen between ADC and hepatic steatosis (p = 0.059). Multivariate general linear model revealed that the only significant association between IVIM parameters and pathological features was between Dfast and fibrosis. On ROC curve analysis, Dfast < 23.4 × 10−3 mm2/s had a sensitivity of 82.8{\%} and a specificity of 64.3{\%} in predicting high-grade fibrosis. Conclusion: Dfast has the strongest association with hepatic fibrosis but has weak interobserver correlation. IVIM parameters were not significantly associated with hepatic inflammation or steatosis.",
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T1 - Does intravoxel incoherent motion reliably stage hepatic fibrosis, steatosis, and inflammation?

AU - Sandrasegaran, Kumar

AU - Territo, Paul

AU - Elkady, Reem M.

AU - Lin, Yuning

AU - Gasparis, Pauley

AU - Borthakur, Gitasree

AU - Lin, Chen

PY - 2017/8/21

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N2 - Objective: To investigate the usefulness of intravoxel incoherent motion (IVIM) in determining the severity of hepatic fibrosis, steatosis, and inflammation in patients with chronic liver disease. Methods: Forty-nine patients who had liver MRI with IVIM sequence and liver biopsy within three months of MRI were enrolled. A reviewer, blinded to histology, placed regions of interest of 1–2 cm2 in the right liver lobe. In addition, the first twenty patients were assessed with a second reviewer. Perfusion fraction (f), pseudodiffusion coefficient (Dfast), true diffusion coefficient (Dslow), and apparent diffusion coefficient (ADC) were calculated from normalized signal intensities that were fitted into a biexponential model. Errors in the model were minimized with global stochastic optimization using Simulated Annealing. ANOVA with post hoc Tukey–Kramer test and multivariate generalized linear model analysis were performed, using histological findings as the gold standard. Results: The most common etiologies for liver disease were hepatitis C and alcohol, accounting together for 76% (37/49) of patients. Low-grade fibrosis (F0, F1), hepatic steatosis, and inflammation were seen in 24% (12/49), 31% (15/49), and 29% (14/49) of patients, respectively. The interobserver correlation was poor for Dfast and Dslow (0.105, 0.173) and moderate for f and ADC (0.461, 0.418). ANOVA showed a strong inverse association between Dfast and liver fibrosis grade (p = 0.001). A weak inverse association was seen between ADC and hepatic steatosis (p = 0.059). Multivariate general linear model revealed that the only significant association between IVIM parameters and pathological features was between Dfast and fibrosis. On ROC curve analysis, Dfast < 23.4 × 10−3 mm2/s had a sensitivity of 82.8% and a specificity of 64.3% in predicting high-grade fibrosis. Conclusion: Dfast has the strongest association with hepatic fibrosis but has weak interobserver correlation. IVIM parameters were not significantly associated with hepatic inflammation or steatosis.

AB - Objective: To investigate the usefulness of intravoxel incoherent motion (IVIM) in determining the severity of hepatic fibrosis, steatosis, and inflammation in patients with chronic liver disease. Methods: Forty-nine patients who had liver MRI with IVIM sequence and liver biopsy within three months of MRI were enrolled. A reviewer, blinded to histology, placed regions of interest of 1–2 cm2 in the right liver lobe. In addition, the first twenty patients were assessed with a second reviewer. Perfusion fraction (f), pseudodiffusion coefficient (Dfast), true diffusion coefficient (Dslow), and apparent diffusion coefficient (ADC) were calculated from normalized signal intensities that were fitted into a biexponential model. Errors in the model were minimized with global stochastic optimization using Simulated Annealing. ANOVA with post hoc Tukey–Kramer test and multivariate generalized linear model analysis were performed, using histological findings as the gold standard. Results: The most common etiologies for liver disease were hepatitis C and alcohol, accounting together for 76% (37/49) of patients. Low-grade fibrosis (F0, F1), hepatic steatosis, and inflammation were seen in 24% (12/49), 31% (15/49), and 29% (14/49) of patients, respectively. The interobserver correlation was poor for Dfast and Dslow (0.105, 0.173) and moderate for f and ADC (0.461, 0.418). ANOVA showed a strong inverse association between Dfast and liver fibrosis grade (p = 0.001). A weak inverse association was seen between ADC and hepatic steatosis (p = 0.059). Multivariate general linear model revealed that the only significant association between IVIM parameters and pathological features was between Dfast and fibrosis. On ROC curve analysis, Dfast < 23.4 × 10−3 mm2/s had a sensitivity of 82.8% and a specificity of 64.3% in predicting high-grade fibrosis. Conclusion: Dfast has the strongest association with hepatic fibrosis but has weak interobserver correlation. IVIM parameters were not significantly associated with hepatic inflammation or steatosis.

KW - Hepatic fibrosis

KW - Hepatic steatosis

KW - Hepatitis

KW - IVIM

KW - MRI

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