Comparison of the efficacy of Gd-EOB-DTPA-enhanced magnetic resonance imaging and magnetic resonance elastography in the detection and staging of hepatic fibrosis

Abstract

The present study compared the efficacy of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and magnetic resonance elastography (MRE) in the estimation of hepatic fibrosis stages with histopathologic correlation.This retrospective study included 104 patients (87 men and 17 women; mean age, 60.6 ± 10.6 years) with chronic liver disease who underwent both Gd-EOB-DTPA-enhanced MRI and MRE. The relative enhancement (RE) ratio of the liver parenchyma and the contrast enhancement index (CEI) were calculated as (SIpostliver - SIpreliver)/SIpreliver and SIpost/SIpre, respectively, where SIpost and SIpre were the liver-to-muscle signal intensity ratios on the hepatobiliary phase images and noncontrast-enhanced images, respectively. The liver stiffness values were measured using MRE stiffness maps. The diagnostic performance of MRE, RE ratios, and CEI values for hepatic fibrosis staging were compared.The distribution of fibrosis stages was as follows: F0, n = 3 (2.9%); F1, n = 12 (11.5%); F2, n = 17 (16.3%); F3, n = 26 (25.0%); and F4, n = 46 (44.2%). MRE, RE ratios, and CEI values correlated significantly with hepatic fibrosis (rs = .79, -.35, -.25, respectively, P < .05). MRE showed a significantly higher diagnostic performance than did RE ratios and CEI values for each fibrosis stage, except while distinguishing the F1 fibrosis stage (CEI, P = .15). A cutoff value of RE ratio = 0.89 can be used to identify patients with significant hepatic fibrosis, with positive predictive value, sensitivity, specificity, and negative predictive value of 93.2%, 61.8%, 73.3%, and 24.4%, respectively.Gd-EOB-DTPA-enhanced MRI can potentially predict significant hepatic fibrosis. However, the diagnostic performance of MRE for hepatic fibrosis staging was superior to that of Gd-EOB-DTPA-enhanced MRI.

Figure 1

A 65-y-old man with chronic liver disease and F2 hepatic fibrosis (confirmed through pathologic analysis) underwent gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and MR elastography (MRE): (A) precontrast phase and (B) hepatobiliary phase of the T1-weighted image; the region of interests (ROIs) in the liver parenchyma (solid line) and paraspinal muscle (dotted line) at the precontrast and hepatobiliary phases. (c) MR elastogram and (d) liver stiffness value was determined at the confidence area (dotted line). The mean liver stiffness value, contrast enhancement index (CEI), and relative enhancement (RE) ratio measured through MRE were 3.43, 1.67, and 0.89 kPa, respectively.

Figure 2

Scatterplots for (A) relative enhancement (RE) ratio, (B) contrast enhancement index (CEI), and (C) liver stiffness values measured through magnetic resonance elastography (MRE) at different hepatic fibrosis stages. Spearman correlation demonstrated the relationships between the hepatic fibrosis stages and RE ratios (r_s = −0.35; P < .001), CEI values (r_s = −0.25; P = .01), and liver stiffness values (r_s = 0.79; P < .001).

Figure 3

Receiver operating characteristic (ROC) curve analysis for F ≥1 (A), F ≥2 (B), F ≥3 (C), F ≥4 (D) of magnetic resonance elastography (MRE), relative enhancement ratio (RE), and contrast enhancement index (CEI) of liver parenchyma on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) images.