Non-invasive assessment of hepatic fibrosis: comparison of MR elastography to transient elastography and intravoxel incoherent motion diffusion-weighted MRI

Objective To compare the ability of MR elastography (MRE) with transient elastography (TE) and intravoxel incoherent motion (IVIM) diffusion-weighted MRI in staging hepatic fibrosis (HF). Materials and methods 100 patients with chronic liver disease and 25 healthy volunteers underwent preoperative MRE, IVIM on a 3T MRI unit, and ultrasound-based TE. Liver stiffness measurement from MRE (LSM-MRE) and liver stiffness measurement from TE (LSM-TE) were measured; four diffusion parameters including the true diffusion coefficient ( D t ), pseudo-diffusion coefficient, perfusion fraction ( f ), and apparent diffusion coefficient (ADC) were calculated. Receiver operating characteristic (ROC) curves were performed for significant parameters to compare the diagnosis performance for detecting HF. Results LSM-MRE and LSM-TE values showed positive correlation with the fibrosis stage ( r = 0.910 and 0.813, P < 0.001). D t , f , and ADC values showed negative correlation with the fibrosis stage ( r = − 0.727, − 0.503, and − 0.601, all P < 0.001). The area under the ROC curve (AUC) of LSM-MRE (AUC = 0.965, 0.957, 0.983) was significantly higher than that of LSM-TE (AUC = 0.906, 0.913, 0.931) and D t (AUC = 0.875, 0.879, 0.861) in discriminating significant HF (≥ F2), advanced HF (≥ F3), or cirrhosis (F4) (all P < 0.05). Although LSM-TE showed higher AUCs than D t in detecting fibrosis stages, there were no significant differences between LSM-TE and D t ( P > 0.05) except for detecting F4 ( P < 0.05). Conclusion MRE shows excellent diagnostic performance for predicting significant fibrosis, advanced fibrosis compared with TE and IVIM, while TE and IVIM have comparable diagnostic performance.