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Staging liver fibrosis with DWI: is there an added value for diffusion kurtosis imaging?

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Abstract

Objectives

To assess liver fibrosis in patients with chronic liver disease using diffusion kurtosis imaging (DKI) in comparison with conventional diffusion-weighted imaging, with histology as reference standard.

Methods

This prospective study included 81 patients and DKI with b-values of 0, 200, 500, 1,000, 1,500, 2,000 s/mm2 were performed. Mean diffusivity (MD), mean kurtosis (MK) and apparent diffusion coefficient (ADC) maps were calculated. The diagnostic efficacy of MD, MK and ADC for predicting stage 2 fibrosis or greater, and stage 3 fibrosis or greater were compared.

Results

The MD (rho=-0.491, p<0.001), MK (rho=0.537, p<0.001) and ADC (rho=-0.496, p<0.001) correlated significantly with fibrosis stages, and ADC exhibited a strong negative correlation with MK (rho=-0.968; p<0.001) and a moderate association with MD (rho=0.601, p<0.001). Areas under the curves (AUCs) for predicting stage 2 fibrosis or greater were not significantly different (p>0.05) between MK (0.809) and ADC (0.797) as well as between MD (0.715) and ADC. AUCs were also similar for MD (0.710), MK (0.768) and ADC (0.747) for predicting stage 3 fibrosis or greater.

Conclusion

Although DKI is feasible for predicting liver fibrosis in patients with chronic liver disease, MD and MK offer similar diagnostic performance to ADC values.

Key Points

Diffusion kurtosis imaging is feasible for staging liver fibrosis.

Diffusion kurtosis and monoexponential model are highly correlated.

The kurtosis model offers no added value to the conventional, monoexponential model

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Abbreviations

ADC:

Apparent diffusion coefficient

DWI:

Diffusion-weighted imaging

D:

Diffusivity

ECM:

Extracellular matrix

K:

Kurtosis

MD:

Mean diffusivity

MK:

Mean kurtosis

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Acknowledgements

We thank Xiaofei Xu from Erasmus Medical Center Cancer Institute in the Netherlands, who helped with proofreading the paper.

Funding

This study has received funding by National Natural Science Foundation of China; contract grant number: 81571661

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Corresponding author

Correspondence to Mengsu Zeng.

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Guarantor

The scientific guarantor of this publication is Mengsu Zeng.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Cross-sectional study

• diagnostic study

• performed at one institution

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Yang, L., Rao, S., Wang, W. et al. Staging liver fibrosis with DWI: is there an added value for diffusion kurtosis imaging?. Eur Radiol 28, 3041–3049 (2018). https://doi.org/10.1007/s00330-017-5245-6

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  • DOI: https://doi.org/10.1007/s00330-017-5245-6

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