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Liver Fibrosis: Noninvasive Diagnosis with Double Contrast Material–enhanced MR Imaging¹

¹ From the Departments of Radiology (D.A.A., C.B.S.), Pathology (C.A.B.), and Medicine (E.A., T.I.H.), University of California, San Diego Medical Center, 200 W Arbor Dr, San Diego, CA 92103-8756; and Department of Radiology, Fundacion Santa Fe de Bogota, University Hospital, Bogota, Colombia (D.A.A.). Received March 26, 2005; revision requested June 2; revision received June 4; final version accepted July 1. Address correspondence to C.B.S. (e-mail: csirlin{at}ucsd.edu).

Purpose: To retrospectively evaluate the accuracy of double contrast material–enhanced (hereafter double-enhanced) magnetic resonance (MR) imaging depiction of hepatic fibrosis, with histopathologic analysis findings as the reference standard.

Materials and Methods: The institutional review board approved this HIPAA-compliant study and waived the requirement for informed consent. One hundred one patients (58 men, 43 women; mean age ± standard deviation, 52 years ± 10) who underwent double-enhanced MR imaging with superparamagnetic iron oxide (SPIO)-enhanced and double-enhanced spoiled gradient-echo (SPGR) sequences between 2001 and 2004 and had a reliable reference standard for the diagnosis of liver fibrosis were included. Two blinded MR radiologists retrospectively scored qualitative (reticulation, nodularity, and total scores) and quantitative (contrast-to-noise ratio between hyperintense and hypointense liver regions, coefficient of variation, and noise-corrected coefficient of variation) liver texture features on MR images in consensus. The image scores for patients with advanced (METAVIR fibrosis score 3) versus those for patients with mild (METAVIR score 2) fibrosis were compared, and receiver operating characteristic curves were determined. Diagnostic performance values were calculated at the optimal operating point. Mann-Whitney U and unpaired Student t tests were performed.

Results: Qualitative and quantitative image scores were significantly higher for patients with METAVIR fibrosis scores of 3 or higher than for those with scores of 2 or lower (P < .001); on SPIO-enhanced SPGR images, differences increased with increasing echo time. Diagnostic performance for detection of grade 3 or more severe fibrosis was better with the double-enhanced sequence than with the SPIO-enhanced sequences, and qualitative scores had higher diagnostic performance than quantitative scores. The sensitivity, specificity, and accuracy of qualitative scores on double-enhanced SPGR images were higher than 90%.

Conclusion: Advanced hepatic fibrosis can be detected by using double-enhanced MR imaging. Although diagnostic performance depended on the sequence and scoring system used, sensitivity, specificity, and accuracy values higher than 90% were achievable.

© RSNA, 2006

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