Korean J Radiol.  2017 Dec;18(6):898-905. 10.3348/kjr.2017.18.6.898.

Impact of Liver Fibrosis and Fatty Liver on T1rho Measurements: A Prospective Study

• Xie S
• Li Q
• Cheng Y
• Zhang Y
• Zhuo Z
• Zhao G
• Shen W

• KMID: 2427199
• DOI: http://doi.org/10.3348/kjr.2017.18.6.898

Abstract

OBJECTIVE
To investigate the liver T1rho values for detecting fibrosis, and the potential impact of fatty liver on T1rho measurements.
MATERIALS AND METHODS
This study included 18 healthy subjects, 18 patients with fatty liver, and 18 patients with liver fibrosis, who underwent T1rho MRI and mDIXON collections. Liver T1rho, proton density fat fraction (PDFF) and T2* values were measured and compared among the three groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the T1rho values for detecting liver fibrosis. Liver T1rho values were correlated with PDFF, T2* values and clinical data.
RESULTS
Liver T1rho and PDFF values were significantly different (p < 0.001), whereas the T2* (p = 0.766) values were similar, among the three groups. Mean liver T1rho values in the fibrotic group (52.6 ± 6.8 ms) were significantly higher than those of healthy subjects (44.9 ± 2.8 ms, p < 0.001) and fatty liver group (45.0 ± 3.5 ms, p < 0.001). Mean liver T1rho values were similar between healthy subjects and fatty liver group (p = 0.999). PDFF values in the fatty liver group (16.07 ± 10.59%) were significantly higher than those of healthy subjects (1.43 ± 1.36%, p < 0.001) and fibrosis group (1.07 ± 1.06%, p < 0.001). PDFF values were similar in healthy subjects and fibrosis group (p = 0.984). Mean T1rho values performed well to detect fibrosis at a threshold of 49.5 ms (area under the ROC curve, 0.855), had a moderate correlation with liver stiffness (r = 0.671, p = 0.012), and no correlation with PDFF, T2* values, subject age, or body mass index (p > 0.05).
CONCLUSION
T1rho MRI is useful for noninvasive detection of liver fibrosis, and may not be affected with the presence of fatty liver.

Keyword

Magnetic resonance imaging; T1rho; Liver fibrosis; Fatty liver; Liver stiffness; Hepatic steatosis

MeSH Terms

Adult
Aged
Area Under Curve
Body Mass Index
Female
Healthy Volunteers
Humans
Image Processing, Computer-Assisted
Liver Cirrhosis/*diagnosis/diagnostic imaging
*Magnetic Resonance Imaging
Male
Middle Aged
Non-alcoholic Fatty Liver Disease/*diagnosis/diagnostic imaging
Prospective Studies
ROC Curve
Sensitivity and Specificity
Young Adult

Figure

• 

  Fig. 1 Liver T1rho value, liver fat fraction comparison among three groups and ROC curve of T1rho for predicting liver fibrosis.A. T1rho values of group 1 (healthy control subjects) were similar to those of group 2 (patients with simple fatty liver, p = 0.999). T1rho values in group 3 (patients with liver fibrosis) were significantly higher than those of group 1 (p < 0.001) and group 2 (p < 0.001). In group 3, T1rho measurements of 4 patients overlapped with those of group 1 or 2. B. Liver fat fraction of group 1 were similar to those of group 3 (p = 0.984). Liver fat fraction in group 2 were significantly higher than those of group 1 (p < 0.001) and group 3 (p < 0.001). C. According to ROC analysis at threshold of 49.5 ms, sensitivity and specificity of T1rho in predicting liver fibrosis were 77.8% and 100%, respectively. Area under ROC curve was 0.855. ROC = receiver operating characteristic

• 

  Fig. 2 Examples of healthy subject and fibrosis patient T1rho-weighted images and T1rho map.Upper (row 1 and 2) and lower (row 3 and 4) two rows show liver T1rho-weighted images acquired with times of spin lock pulse (TSL) of 1–50 ms, and T1rho map in 61-year-old normal control subject and 21-year-old patient with fibrosis. Fibrosis liver tissue demonstrates higher signal intensity in T1rho-weighted images and T1rho values in T1rho map, than normal liver tissue.

• 

  Fig. 3 Example of T1rho map in fibrosis patients with different liver stiffness measurement (LSM).A. T1rho map in 35-year-old male: mean T1rho value is 50.6 ms, LSM is 7.2 kPa. B. T1rho map in 33-year-old male: mean T1rho value is 54.1 ms, LSM is 10.6 kPa. C. T1rho map in 28-year-old female: mean T1rho value is 62.7 ms, LSM is 17.3 kPa.

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