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. 2020 Mar;81(2):365-378.
doi: 10.3348/jksr.2020.81.2.365. Epub 2020 Feb 18.

Quantitative Evaluation of Liver Fibrosis on T1 Relaxometry in Comparison with Fibroscan

Byeong Hak Sim, Suk Hee Heo, Sang Soo Shin, Seong Beom Cho, Yong Yeon Jeong

Quantitative Evaluation of Liver Fibrosis on T1 Relaxometry in Comparison with Fibroscan

Byeong Hak Sim et al. Taehan Yongsang Uihakhoe Chi. 2020 Mar.

Abstract
in English, Korean

Purpose: This study was performed to determine whether the T1 relaxation time of gadoxetic acid-enhanced liver MR imaging is useful for detecting and staging liver fibrosis in patients with chronic liver disease.

Materials and methods: One hundred and three patients with suspected focal liver lesion underwent MR imaging and Fibroscan. Fibroscan was chosen as the reference standard for classifying liver fibrosis. T1 relaxation times were acquired before (preT1), 20 minutes after (postT1) contrast administration, and reduction rate of T1 relaxation time (rrT1) on transverse 3D VIBE (volumetric interpolated breath-hold examination) sequence using 3T MR imaging. The optimal cut-off values for the fibrosis staging were determined with ROC analysis.

Results: PreT1 and postT1 increased and rrT1 decreased constantly with increasing severity of liver fibrosis according to the METAVIR score (F0-F4). There were statistically significant differences between F2 and F3 in preT1 (F2, 836.0 ± 74.7 ms; F3, 888.6 ± 77.5 ms, p < 0.05) and between F3 and F4 in postT1 (F3, 309.0 ± 80.2 ms; F4, 406.6 ± 147.7 ms, p < 0.05) and rrT1 (F3, 65.4 ± 7.7%; F4, 57.3 ± 11.4%, p < 0.05). ROC analysis revealed that combination test (preT1 + postT1) was the best test for predicting liver fibrosis.

Conclusion: PreT1 and postT1 increased constantly with increasing severity of liver fibrosis. T1 mapping in gadoxetic acid-enhanced liver MR imaging could be a helpful complementary sequence to determine the liver fibrosis stage.

목적: 본 연구는 gadoxetic acid 조영증강 간 자기공명영상에서 T1 이완시간이 만성간질환을 가진 환자에서 간섬유화의 발견과 병기설정에 유용한지 알아보고자 한다.

대상과 방법: 국소간병변이 의심되는 103명 환자들이 간 자기공명영상과 Fibroscan을 시행하였다. Fibroscan은 간섬유화의 정도를 분류하는 참조표준검사로 사용되었다. T1 이완시간은 조영제 주입 전(preT1)과 주입 20분 후(postT1), 그리고 이들 간의 T1 이완시간 감소율(rrT1)을 3 테슬라 자기공명영상의 횡단 3D VIBE 시퀀스 하에 측정하였다. Receiver operating characteristic (이하 ROC) 분석을 통해 간섬유화 병기설정을 위한 최적의 cut-off 값이 결정되었다.

결과: METAVIR score (F0–F4)에 따른 간섬유화 병기가 증가함에 따라, preT1과 postT1은 증가하였고, rrT1은 감소하였다. PreT1의 F2와 F3 사이(F2, 836.0 ± 74.7 ms; F3, 888.6 ± 77.5 ms, p < 0.05), postT1의 F3와 F4 사이(F3, 309.0 ± 80.2 ms; F4, 406.6 ± 147.7 ms, p < 0.05), 그리고 rrT1의 F3와 F4사이(F3, 65.4 ± 7.7%; F4 57.3 ± 11.4%, p < 0.05)에서 통계적 유의미한 차이를 보였다. ROC 분석은 preT1과 postT1의 병용검사가 간섬유화 병기설정에 있어 가장 유용한 검사라는 것을 보여준다.

결론: preT1과 postT1은 간섬유화 병기가 증가함에 따라 증가하며, T1 mapping이 gadoxetic acid 조영증강 간 자기공명영상에서 간섬유화 병기설정에 있어 유용한 보조적 시퀀스로 사용될 수 있다.

Keywords: Gadolinium DTPA; Humans; Liver; Liver Cirrhosis; Magnetic Resonance Imaging.

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Conflict of interest statement

Conflicts of Interest: The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Flow chart of selection of the research population.
HCC = hepatocellular carcinoma, RFA = radiofrequency ablation, TACE = transarterial chemoembolization
Fig. 2
Fig. 2. Boxplots of pre-contrast T1 based on the METAVIR score on Fibroscan. PreT1 indicates the T1 relaxation time before gadoxetic acid administration in patients. Data are expressed as mean preT1 ± standard deviation.
* p-values < 0.05 are significant.
Fig. 3
Fig. 3. Boxplots of post-contrast T1 based on the METAVIR score on Fibroscan. PostT1 indicates T1 relaxation time 20 minutes after gadoxetic acid administration in patients. Data are expressed as mean postT1 ± standard deviation.
* p-values < 0.05 are significant.
Fig. 4
Fig. 4. Boxplots of the rrT1 based on the METAVIR score on Fibroscan. rrT1 indicates rrT1 from pre- to post-contrast T1. Data are expressed as mean rrT1 ± standard deviation.
* p-values < 0.05 are significant. rrT1 = the reduction rate of the T1 relaxation time
Fig. 5
Fig. 5. ROC curves showing diagnostic performances for liver fibrosis staging of pre- and post-contrast T1 and the combination test (pre-contrast T1 + post-contrast T1).
A–C. ROC curves with a threshold of F2 (A), F3 (B), and F4 (C) are shown. ROC = receiver operating characteristic
Fig. 6
Fig. 6. ROC curves showing diagnostic performances for liver fibrosis staging of the reduction rate of T1.
A. ROC curve with a threshold of F2 is shown (≥ F2, p = 0.06). B. ROC curve with a threshold of F3 is shown (≥ F3; cut-off: 66.3%, AUC: 0.64, p = 0.013). C. ROC curve with a threshold of F4 is shown (F4; cut-off: 59.9%, AUC: 0.73, p < 0.001). AUC = area under the curve, CI = confidence interval, ROC = receiver operating characteristic
See this image and copyright information in PMC

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