MR-diffusion imaging in assessing chronic liver diseases: does a clinical role exist?

This study was done to evaluate whether and which of the magnetic resonance diffusion-weighted imaging (MR-DWI) parameters - apparent diffusion coefficient (ADC), diffusion (D) or perfusion fraction (f) - correlates with the degree of chronic liver disease progression.

Twenty-eight patients were evaluated with abdominal MR-DWI from March to November 2010: seven healthy volunteers, seven patients with chronic liver disease F0-F2 (METAVIR score), seven F3-F4 Child-Pugh A, and seven F4 Child-Pugh BC, classified as groups 1-4, respectively. DWI acquisitions were performed during breath-holding (b = 0-150 s/mm(2) and 1,000) and free breathing (multi-b = 0-200-400-600-800-1,000 s/mm(2)). Using a double-blind control procedure, two observers estimated ADC, D, and f by applying a region of interest (ROI) in 4/12 sections in the middle-lower portion of the right hepatic lobe. Statistical analysis was done with analysis of variance (ANOVA).

A reduction in the mean value of f, ADC(150) and, to a lesser extent, ADC(1,000) is shown to progress from healthy volunteers (group 1) to cirrhosis patients (group 4), with wide overlap among groups. There were no statistically significant changes of D.

Our results indicate that stratifying patients with chronic liver disease for clinical purposes cannot be done with DWI. However, there is a tendency among groups for reduced perfusion-related parameters as chronic liver disease progresses.