The diagnostic efficacy of quantitative liver MR imaging with diffusion-weighted, SWI, and hepato-specific contrast-enhanced sequences in staging liver fibrosis—a multiparametric approach

Purpose To assess the diagnostic efficacy of multiparametric MRI using quantitative measurements of the apparent diffusion coefficient (ADC) of the liver parenchyma on diffusion-weighted imaging (DWI), signal intensity (SI) on susceptibility-weighted imaging (SWI), and gadoxetic acid-enhanced T1-weighted imaging during the hepatobiliary phase for the staging of liver fibrosis. Materials and Methods Seventy-seven patients underwent a 3T MRI examination, including DWI/SWI sequences and gadoxetic acid-enhanced T1-weighted MRI. Liver fibrosis according to liver biopsy was staged using the Metavir fibrosis score: F0 ( n = 21, 27.3 %); F1 ( n = 7, 9.1 %); F2 ( n = 8, 10.4 %); F3 ( n = 12, 15.6 %); and F4 ( n = 29, 37.7 %). SI of the liver was defined using region-of-interest measurements to calculate the ADC values, the relative enhancement (RE) in the hepatobiliary phase, and the liver-to-muscle ratio (LMR) measurements for SWI. Results The values of RE, LMR, and ADC measurements were statistically significantly different among the five fibrosis stages ( p < 0.004). Combining the three parameters in a multiparametric approach, the AUC for detecting F1 stage or greater (≥ F1) was 94 %, for F2 or greater (≥F2) was 95 %, for F3 or greater (≥F3) was 90 %, and for stage F4 was 93 %. Conclusions Multiparametric MRI is an efficient non-invasive diagnostic tool for the staging of liver fibrosis. Key Points • Multiparametric MRI has high accuracy in predicting moderate or greater liver fibrosis. • Relative enhancement post- gadoxetic acid is an independent predictor of liver fibrosis. • Liver SWI signal intensity and ADC values enhance the diagnostic ability.