Korean J Radiol.  2017 Jun;18(3):444-451. 10.3348/kjr.2017.18.3.444.

Quantitative Measurement of Hepatic Fibrosis with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Chronic Hepatitis B Infection: A Comparative Study on Aspartate Aminotransferase to Platelet Ratio Index and Fibrosis-4 Index

• Lee GM
• Kim YR
• Ryu JH
• Kim TH
• Cho EY
• Lee YH
• Yoon KH

• KMID: 2427299
• DOI: http://doi.org/10.3348/kjr.2017.18.3.444

Abstract

OBJECTIVE
To quantitatively measure hepatic fibrosis on gadoxetic acid-enhanced magnetic resonance (MR) in chronic hepatitis B (CHB) patients and identify the correlations with aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) values.
MATERIALS AND METHODS
This study on gadoxetic acid-enhanced 3T MR imaging included 81 patients with CHB infection. To quantitatively measure hepatic fibrosis, MR images were analyzed with an aim to identify inhomogeneous signal intensities calculated from a coefficient of variation (CV) map in the liver parenchyma. We also carried out a comparative analysis between APRI and FIB-4 based on metaregression results. The diagnostic performance of the CV map was evaluated using a receiver-operating characteristic (ROC) curve.
RESULTS
In the MR images, the mean CV values in control, groups I, II, and III based on APRI were 4.08 ± 0.92, 4.24 ± 0.80, 5.64 ± 1.11, and 5.73 ± 1.28, respectively (p < 0.001). In CHB patients grouped by FIB-4, the mean CV values of groups A, B, and C were 4.22 ± 0.95, 5.40 ± 1.19, and 5.71 ± 1.17, respectively (p < 0.001). The mean CV values correlated well with APRI (r = 0.392, p < 0.001) and FIB-4 (r = 0.294, p < 0.001). In significant fibrosis group, ROC curve analysis yielded an area under the curve of 0.875 using APRI and 0.831 using FIB-4 in HB, respectively.
CONCLUSION
Gadoxetic acid-enhanced MR imaging for calculating a CV map showed moderate correlation with APRI and FIB-4 values and could be employed to quantitatively measure hepatic fibrosis in patients with CHB.

Keyword

Liver; Magnetic resonance imaging; Chronic hepatitis B; Fibrosis; Gadoxetic acid; Gd-EOB-DTPA

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Area Under Curve
Aspartate Aminotransferases/*analysis
Blood Platelets/*cytology
Case-Control Studies
Female
Gadolinium DTPA/*chemistry
Hepatitis B, Chronic/complications/*diagnosis
Humans
Liver Cirrhosis/complications/*diagnostic imaging/pathology
*Magnetic Resonance Imaging
Male
Middle Aged
Platelet Count
ROC Curve
Severity of Illness Index
Young Adult
Aspartate Aminotransferases
Gadolinium DTPA

Figure

• 

  Fig. 1 Workflow for calculation of coefficients of variation (CV) in control subject (A) and in patient with chronic hepatitis B (B) in hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI.To measure hepatic fibrosis quantitatively, MATLAB-based software was used to calculate CV map. After acquisition of MR images, bias correction and segmentation of liver parenchyma were performed, and then mean value of CV map on region of interest at anterior segment of right lobe of liver was calculated. Gd-EOB-DTPA = gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid or gadoxetic acid, MRI = magnetic resonance imaging

• 

  Fig. 2 Images show representative CV maps on control and patients with chronic hepatitis B of group I, II, and III on HB phases of Gd-EOB-DTPA-enhanced MRI.CV values are 3.54, 3.58, 5.58, and 6.7 in HB phase, respectively. CV = coefficients of variation, Gd-EOB-DTPA = gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid or gadoxetic acid, HB = hepatobiliary, MRI = magnetic resonance imaging

• 

  Fig. 3 Correlation of CV with APRI and FIB-4.A. Shows correlation between aspartate aminotransferase-to-platelet ratio and coefficient of variation (CV) (r = 0.392, p < 0.001). B. Shows correlation between FIB-4 and CV values (r = 0.294, p < 0.001) in HB phases of Gd-EOB-DTPA-enhanced MRI. FIB-4 = fibrosis-4, Gd-EOB-DTPA = gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid or gadoxetic acid, HB = hepatobiliary, MRI = magnetic resonance imaging

• 

  Fig. 4 Receiver operating characteristic curves of coefficient of variation used for diagnosis in patient with significant fibrosis (aspartate aminotransferase-to-platelet ratio > 0.5 and FIB-4 score > 1.45).AUC was 0.875 in APRI version with optimal cut-off values of 4.1866 (red line). AUC was 0.831 in FIB-4 version with optimal cut-off values of 4.5642 (blue line). APRI = aspartate aminotransferase to platelet ratio index, AUC = area under the curve, FIB-4 = fibrosis-4

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