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European Radiology
Published in: European Radiology 5/2013

01-05-2013 | Hepatobiliary-Pancreas

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

Authors: Robin Bülow, Birger Mensel, Peter Meffert, Diego Hernando, Matthias Evert, Jens-Peter Kühn

Published in: European Radiology | Issue 5/2013

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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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Metadata
Title
Diffusion-weighted magnetic resonance imaging for staging liver fibrosis is less reliable in the presence of fat and iron
Authors
Robin Bülow
Birger Mensel
Peter Meffert
Diego Hernando
Matthias Evert
Jens-Peter Kühn
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
European Radiology / Issue 5/2013
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-012-2700-2

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