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

Authors

  • Maïté Lewin,

    Corresponding author
    1. Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Pierre et Marie Curie Paris 6 University, Paris, France
    • Service de Radiologie, Hôpital Saint Antoine, 184 Rue du Faubourg Saint Antoine, 75012 Paris, France
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    • fax: (33) 1 49 28 22 59

  • Armelle Poujol-Robert,

    1. Department of Hepatology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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  • Pierre-Yves Boëlle,

    1. Department of Public Health, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Pierre et Marie Curie Paris 6 University, Paris, France
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  • Dominique Wendum,

    1. Department of Pathology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Pierre et Marie Curie Paris 6 University, Paris, France
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  • Elisabeth Lasnier,

    1. Department of Biochemistry, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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  • Magalie Viallon,

    1. Siemens Medical Department, Saint Denis, France
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  • Jérôme Guéchot,

    1. Department of Biochemistry, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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  • Christine Hoeffel,

    1. Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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  • Lionel Arrivé,

    1. Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Pierre et Marie Curie Paris 6 University, Paris, France
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  • Jean-Michel Tubiana,

    1. Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Pierre et Marie Curie Paris 6 University, Paris, France
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  • Raoul Poupon

    1. Department of Hepatology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
    2. Pierre et Marie Curie Paris 6 University, Paris, France
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  • Potential conflict of interest: Nothing to report.

Abstract

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 mm2/s) and healthy volunteers (mean: 1.44 ± 0.02 × 10−3 mm2/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 mm2/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. (HEPATOLOGY 2007.)

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