diffuse liver disease

DIFFUSE LIVER DISEASE DIFFUSE LIVER DISEASE

BN 20111207

Dr. Bengt NorénDr. Bengt Norén

M. D, Med Lic.M. D, Med Lic.Dep. of Radiology and CMIVDep. of Radiology and CMIV

University Hospital LinköpingUniversity Hospital Linköping

BN 20111207

BN 20111207

Conventional Biopsy

• Inflammation

• Fibrosis/cirrhosis

• Steatosis

• Fe

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Fibrosis grading – Biopsy

F0- F4 (Batts and Ludwig)

Grouped into :F0 – F2F3 – F4

Non Invasive Liver Biopsy ”NILB”

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1. 31 P MRS

2. DCE-MRI

Fibrosis/cirrhosis ; 31 P MRS

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ConcmM

PME Pi ATPb PDE

Fibrosis/cirrhosis ; 31 P MRS I

Anabolic charge (AC) :[PME] / ([PME] + [PDE])

Patients had a significant larger AC than the control subjects, 0.29 vs 0.16 (p 0.005).

BN 20111207Noren et al European Radiology, 2005, 15(1), 148-157.

BN 20111207

Fibrosis/cirrhosis ; 31 P MRS II

AC

Group BN 20111207

Fibrosis/cirrhosis ; 31 P MRS II

Degree of fibrosis predicted from AC

P = 0.0097. Fisher’s exact test

Fibrosis grade

0-2

Fibrosis grade

3-4

AC 0.27 6 15 21

AC 0.27 7 1 8

13 16 29

AC cut-off value of 0.27 showed a sensitivity of 93% and a specificity of 54 %.

BN 20111207Noren et al European Journal of Radiology, 2008, 66(2), 313-320

Fibrosis/cirrhosis ; 31 P MRS II

Can we identify and separate different stages of fibrosis by quantitatively measure the uptake of Gd-EOB-DTPA (Primovist) using DCE-MRI ?

BN 20111207

Fibrosis/cirrhosis; DCE-MRI

Prospective study.

• 38 patients ( 21 men, 17 women)

• Pathological liver function tests

• Liver biopsy

BN 20111207

Fibrosis/cirrhosis; DCE-MRI

•1.5 T MR (Achieva, Philips Medical Systems )

• T1-weighted 3D GRE (native, arterial and venous portal phase; 3, 10, 20 and 30 min)

BN 20111207

Fibrosis/cirrhosis; DCE-MRI

KHep – contrast uptake rate

LSC_N10 and LSC_N20

LSC10 and LSC20

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  F0-2 F3-4 AUROC p-value† 

KHep 0.436±0.255a 0.293±0.254c 0,71 0.050*

LSC_N10 1.405±0.120a 1.243±0.138c 0,8 0.004**

LSC_N20 1.555±0.160b 1.382±0.161d 0,78 0.010*

LSC10 1.652±0.196a 1.504±0.252c 0,68 0,09

LSC20 1.823±0.265b 1.663±0.291d 0,64 0,223

Fibrosis/cirrhosis; DCE-MRI

NILB ”Multi parameter Q - MR approach”

• Inflammation

• Fibrosis/cirrhosis

• Steatosis

• Fe

Biopsy MR techniques;

• MRS - 31P• MRS - 1 H• DCE- MRI• MRE• T2/T2*• Diffusion

BN 20111207

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BN 20100906