Korean J Radiol.  2011 Aug;12(4):431-438. 10.3348/kjr.2011.12.4.431.

Segmental Difference of the Hepatic Fibrosis from Chronic Viral Hepatitis due to Hepatitis B versus C Virus Infection: Comparison Using Dual Contrast Material-Enhanced MRI

• Shim JH
• Yu JS
• Chung JJ
• Kim JH
• Kim KW

• KMID: 1783209
• DOI: http://doi.org/10.3348/kjr.2011.12.4.431

Abstract

OBJECTIVE
We wanted to identify the geographic differences in hepatic fibrosis and their associations with the atrophy-hypertrophy complex in patients with chronic viral hepatitis using the dual-contrast material-enhanced MRI (DC-MRI) with gadopentetate dimeglumine and ferucarbotran.
MATERIALS AND METHODS
Patients with chronic C (n = 22) and B-viral hepatitis (n = 35) were enrolled for determining the subjective grade of fibrosis (the extent and thickness of fibrotic reticulations) in the right lobe (RL), the caudate lobe (CL), the medial segment (MS) and the lateral segment (LS) of the liver, with using a 5-grade scale, on the gradient echo T2*-weighted images of DC-MRI. The fibrosis grades of different segments were compared using the Kruskal-Wallis test followed by post-hoc analysis to establish the segment-by-segment differences. The incidences of two pre-established morphologic signs of cirrhosis were also compared with each other between the two groups of patients.
RESULTS
There were significant intersegmental differences in fibrosis grades of the C-viral group (p = 0.005), and the CL showed lower fibrosis grades as compared with the grades of the RL and MS, whereas all lobes were similarly affected in the B-viral group (p = 0.221). The presence of a right posterior hepatic notch was significantly higher in the patients with intersegmental differences of fibrosis between the RL and the CL (19 out of 25, 76%) than those without such differences (6 out of 32, 19%) (p < 0.001). An expanded gallbladder fossa showed no significant relationship (p = 0.327) with the segmental difference of the fibrosis grades between the LS and the MS.
CONCLUSION
The relative lack of fibrosis in the CL with more advanced fibrosis in the RL can be a distinguishing feature to differentiate chronic C-viral hepatitis from chronic B-viral hepatitis and this is closely related to the presence of a right posterior hepatic notch.

Keyword

Liver cirrhosis; Magnetic resonance imaging; Gadolinium; Iron; Chronic hepatitis B; Chronic hepatitis C

MeSH Terms

Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Contrast Media/*diagnostic use
Dextrans/*diagnostic use
Diagnosis, Differential
Female
Gadolinium DTPA/*diagnostic use
Hepatitis B, Chronic/*diagnosis
Hepatitis C, Chronic/*diagnosis
Humans
Liver Cirrhosis/*diagnosis/*virology
Magnetite Nanoparticles/*diagnostic use
Male
Middle Aged
Retrospective Studies
Statistics, Nonparametric

Figure

• 

  Fig. 1 60-year-old man with C-viral induced cirrhosis. A. Double contrast material-enhanced gradient echo (196/10 msec) T2*-weighted image obtained by 1.5T unit depicts diffuse hyperintense reticulations in entire liver except area of hypertrophic caudate lobe (arrowheads). B. On transverse 3D gradient echo MR images (4.4/2.1 msec) below level of A, right posterior hepatic notch (arrow) is seen between right lobe and caudate lobe. C. Transverse 3D gradient echo MR image (4.4/2.1 msec) demonstrates medial portion of lateral segment (arrowhead) is separated from gallbladder (asterisk) without intervening with medial segment, and this represents expanded gallbladder fossa sign below level of B.

• 

  Fig. 2 61-year-old man with C-viral induced cirrhosis. A. Double contrast material-enhanced gradient echo (140/5.8 msec) images obtained by 3T unit depict diffuse involvement of reticular fibrosis involving entire liver except for small portion of caudate lobe (arrowheads). B. There is no hypertrophy of caudate lobe and 3D gradient echo (4.0/1.0 msec) image shows smooth curvature of right posterior medial margin of liver (arrowheads) without any notch formation.

• 

  Fig. 3 60-year-old woman with B-viral induced cirrhosis. Double contrast material-enhanced gradient echo (196/10 msec) T2*-weighted hepatic MR image obtained by using 1.5T unit depicts homogeneous reticular fibrosis involving entire liver without any evidence of caudate lobe hypertrophy.

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