Diffusion-weighted magnetic resonance imaging for the assessment of fibrosis in chronic hepatitis C

✍ Scribed by Maïté Lewin; Armelle Poujol-Robert; Pierre-Yves Boëlle; Dominique Wendum; Elisabeth Lasnier; Magalie Viallon; Jérôme Guéchot; Christine Hoeffel; Lionel Arrivé; Jean-Michel Tubiana; Raoul Poupon

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 320 KB
• Volume: 46
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.21747

✦ Synopsis

Liver biopsy is the gold standard for assessing fibrosis but has several limitations. We evaluated a noninvasive method, so-called diffusion-weighted magnetic resonance imaging (DWMRI), which measures the apparent diffusion coefficient (ADC) of water, for the diagnosis of liver fibrosis in patients with chronic hepatitis C virus (HCV). We analyzed 20 healthy volunteers and 54 patients with chronic HCV (METAVIR: F0, n ‫؍‬ 1; F1, n ‫؍‬ 30; F2, n ‫؍‬ 8; F3, n ‫؍‬ 5; and F4, n ‫؍‬ 10) prospectively included. Patients with moderate-to-severe fibrosis (F2-F3-F4) had hepatic ADC values lower than those without or with mild fibrosis (F0-F1; mean: 1.10 ؎ 0.11 versus 1.30 ؎ 0.12 ؋ 10 ؊3 mm 2 /s) and healthy volunteers (mean: 1.44 ؎ 0.02 ؋ 10 ؊3 mm 2 /s). In discriminating patients staged F3-F4, the areas under the receiving operating characteristic curves (AUCs) were 0.92 (؎0.04) for magnetic resonance imaging (MRI), 0.92 (؎0.05) for elastography, 0.79 (؎0.08) for FibroTest, 0.87 (؎0.06) for the aspartate aminotransferase to platelets ratio index (APRI), 0.86 (؎0.06) for the Forns index, and 0.87 (؎0.06) for hyaluronate. In these patients, the sensitivity, specificity, positive predictive value, and negative predictive value were 87%, 87%, 72%, and 94%, respectively, with an ADC cutoff level of 1.21 ؋ 10 ؊3 mm 2 /s. In discriminating patients staged F2-F3-F4, the AUC values were 0.79 (؎0.07) for MRI, 0.87 (؎0.05) for elastography, 0.68 (؎0.09) for FibroTest, 0.81 (؎0.06) for APRI, 0.72 (؎0.08) for the Forns index, and 0.77 (؎0.06) for hyaluronate. Conclusion: This preliminary study suggests that DWMRI compares favorably with other noninvasive tests for the presence of significant liver fibrosis.