Magnetic resonance elastography for the evaluation of liver fibrosis in chronic Hepatitis B and C by using both gradient-recalled echo and spin-echo echo planar imaging: A prospective study

Yu Shi, Fei Xia, Qiu Ju Li, Jia Hui Li, Bing Yu, Yue Li, He An, Kevin J. Glaser, Shengzhen Tao, Richard Lorne Ehman, Qi Yong Guo

Research output: Contribution to journalArticle

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Abstract

Objectives: Magnetic resonance elastography (MRE) with three-dimensional spin-echo echo planar imaging (3D-SE-EPI) is a newly emerging noninvasive method for assessing liver fibrosis. We hypothesized that 3D-SE-EPI might have better diagnostic accuracy than conventional two-dimensional gradient-recalled echo (2D-GRE). METHODS: We prospectively included 179 consecutive patients with chronic hepatitis B (CHB) or C (CHC) who underwent both MRE and liver biopsy. Liver stiffness was measured by both 3D-SE-EPI and 2D-GRE for staging biopsy-proven liver fibrosis (using METAVIR scores). A receiver-operating characteristic analysis using the area under the receiver-operating characteristic curve (AUC) was used to compare the diagnostic performance in predicting liver fibrosis between these two techniques, and compared them to serum markers of fibrosis. Results: The technical failure rate of 3D-SE-EPI (2.2%, n=4/179) was lower compared with 2D-GRE (8.3%, n=15/179). The stiffness measured by 3D-SE-EPI was slightly lower compared with 2D-GRE, with the mean difference of 0.57 kPa (Bland and Altman plot, 95% limits of agreement: -0.32 and 1.45 kPa). AUCs for the characterization of ≥F1, ≥F2, ≥F3, and F4 were 0.957 (95% confidence interval (CI): 0.913-0.983), 0.971 (0.932-0.991), 0.991 (0.961-0.999), and 0.979 (0.942-0.995) for 3D-SE-EPI, which was slightly higher compared with the AUCs for 2D-GRE at each fibrosis stage (0.948 (0.901-0.977), 0.959 (0.915-0.981), 0.979 (0.943-0.995), and 0.976 (0.938-0.994), respectively), although none reached statistical significance (P=0.160-0.585). In an "intention-to-diagnose" analysis, the diagnostic accuracy (the proportion of well-classified patients) by EPI (86.7-91.3%, n=169) was higher compared with GRE (80.9-82.1%, n=158) after applying optimal cutoffs. Both 3D-SE-EPI and 2D-GRE performed better than serum fibrosis markers. Conclusions: With respect to 2D-GRE, 3D-SE-EPI has the advantage of lower failure rate with equivalent high diagnostic performance for staging liver fibrosis in CHB/CHC patients, and thus more helpful for those challenging cases in 2D-GRE.

Original languageEnglish (US)
Pages (from-to)823-833
Number of pages11
JournalAmerican Journal of Gastroenterology
Volume111
Issue number6
DOIs
StatePublished - Jun 1 2016

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Echo-Planar Imaging
Elasticity Imaging Techniques
Chronic Hepatitis B
Chronic Hepatitis C
Liver Cirrhosis
Prospective Studies
Area Under Curve
Fibrosis
ROC Curve
Biomarkers
Biopsy
Liver
Confidence Intervals

ASJC Scopus subject areas

  • Gastroenterology

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Magnetic resonance elastography for the evaluation of liver fibrosis in chronic Hepatitis B and C by using both gradient-recalled echo and spin-echo echo planar imaging : A prospective study. / Shi, Yu; Xia, Fei; Li, Qiu Ju; Li, Jia Hui; Yu, Bing; Li, Yue; An, He; Glaser, Kevin J.; Tao, Shengzhen; Ehman, Richard Lorne; Guo, Qi Yong.

In: American Journal of Gastroenterology, Vol. 111, No. 6, 01.06.2016, p. 823-833.

Research output: Contribution to journalArticle

Shi, Yu ; Xia, Fei ; Li, Qiu Ju ; Li, Jia Hui ; Yu, Bing ; Li, Yue ; An, He ; Glaser, Kevin J. ; Tao, Shengzhen ; Ehman, Richard Lorne ; Guo, Qi Yong. / Magnetic resonance elastography for the evaluation of liver fibrosis in chronic Hepatitis B and C by using both gradient-recalled echo and spin-echo echo planar imaging : A prospective study. In: American Journal of Gastroenterology. 2016 ; Vol. 111, No. 6. pp. 823-833.
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title = "Magnetic resonance elastography for the evaluation of liver fibrosis in chronic Hepatitis B and C by using both gradient-recalled echo and spin-echo echo planar imaging: A prospective study",
abstract = "Objectives: Magnetic resonance elastography (MRE) with three-dimensional spin-echo echo planar imaging (3D-SE-EPI) is a newly emerging noninvasive method for assessing liver fibrosis. We hypothesized that 3D-SE-EPI might have better diagnostic accuracy than conventional two-dimensional gradient-recalled echo (2D-GRE). METHODS: We prospectively included 179 consecutive patients with chronic hepatitis B (CHB) or C (CHC) who underwent both MRE and liver biopsy. Liver stiffness was measured by both 3D-SE-EPI and 2D-GRE for staging biopsy-proven liver fibrosis (using METAVIR scores). A receiver-operating characteristic analysis using the area under the receiver-operating characteristic curve (AUC) was used to compare the diagnostic performance in predicting liver fibrosis between these two techniques, and compared them to serum markers of fibrosis. Results: The technical failure rate of 3D-SE-EPI (2.2{\%}, n=4/179) was lower compared with 2D-GRE (8.3{\%}, n=15/179). The stiffness measured by 3D-SE-EPI was slightly lower compared with 2D-GRE, with the mean difference of 0.57 kPa (Bland and Altman plot, 95{\%} limits of agreement: -0.32 and 1.45 kPa). AUCs for the characterization of ≥F1, ≥F2, ≥F3, and F4 were 0.957 (95{\%} confidence interval (CI): 0.913-0.983), 0.971 (0.932-0.991), 0.991 (0.961-0.999), and 0.979 (0.942-0.995) for 3D-SE-EPI, which was slightly higher compared with the AUCs for 2D-GRE at each fibrosis stage (0.948 (0.901-0.977), 0.959 (0.915-0.981), 0.979 (0.943-0.995), and 0.976 (0.938-0.994), respectively), although none reached statistical significance (P=0.160-0.585). In an {"}intention-to-diagnose{"} analysis, the diagnostic accuracy (the proportion of well-classified patients) by EPI (86.7-91.3{\%}, n=169) was higher compared with GRE (80.9-82.1{\%}, n=158) after applying optimal cutoffs. Both 3D-SE-EPI and 2D-GRE performed better than serum fibrosis markers. Conclusions: With respect to 2D-GRE, 3D-SE-EPI has the advantage of lower failure rate with equivalent high diagnostic performance for staging liver fibrosis in CHB/CHC patients, and thus more helpful for those challenging cases in 2D-GRE.",
author = "Yu Shi and Fei Xia and Li, {Qiu Ju} and Li, {Jia Hui} and Bing Yu and Yue Li and He An and Glaser, {Kevin J.} and Shengzhen Tao and Ehman, {Richard Lorne} and Guo, {Qi Yong}",
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TY - JOUR

T1 - Magnetic resonance elastography for the evaluation of liver fibrosis in chronic Hepatitis B and C by using both gradient-recalled echo and spin-echo echo planar imaging

T2 - A prospective study

AU - Shi, Yu

AU - Xia, Fei

AU - Li, Qiu Ju

AU - Li, Jia Hui

AU - Yu, Bing

AU - Li, Yue

AU - An, He

AU - Glaser, Kevin J.

AU - Tao, Shengzhen

AU - Ehman, Richard Lorne

AU - Guo, Qi Yong

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Objectives: Magnetic resonance elastography (MRE) with three-dimensional spin-echo echo planar imaging (3D-SE-EPI) is a newly emerging noninvasive method for assessing liver fibrosis. We hypothesized that 3D-SE-EPI might have better diagnostic accuracy than conventional two-dimensional gradient-recalled echo (2D-GRE). METHODS: We prospectively included 179 consecutive patients with chronic hepatitis B (CHB) or C (CHC) who underwent both MRE and liver biopsy. Liver stiffness was measured by both 3D-SE-EPI and 2D-GRE for staging biopsy-proven liver fibrosis (using METAVIR scores). A receiver-operating characteristic analysis using the area under the receiver-operating characteristic curve (AUC) was used to compare the diagnostic performance in predicting liver fibrosis between these two techniques, and compared them to serum markers of fibrosis. Results: The technical failure rate of 3D-SE-EPI (2.2%, n=4/179) was lower compared with 2D-GRE (8.3%, n=15/179). The stiffness measured by 3D-SE-EPI was slightly lower compared with 2D-GRE, with the mean difference of 0.57 kPa (Bland and Altman plot, 95% limits of agreement: -0.32 and 1.45 kPa). AUCs for the characterization of ≥F1, ≥F2, ≥F3, and F4 were 0.957 (95% confidence interval (CI): 0.913-0.983), 0.971 (0.932-0.991), 0.991 (0.961-0.999), and 0.979 (0.942-0.995) for 3D-SE-EPI, which was slightly higher compared with the AUCs for 2D-GRE at each fibrosis stage (0.948 (0.901-0.977), 0.959 (0.915-0.981), 0.979 (0.943-0.995), and 0.976 (0.938-0.994), respectively), although none reached statistical significance (P=0.160-0.585). In an "intention-to-diagnose" analysis, the diagnostic accuracy (the proportion of well-classified patients) by EPI (86.7-91.3%, n=169) was higher compared with GRE (80.9-82.1%, n=158) after applying optimal cutoffs. Both 3D-SE-EPI and 2D-GRE performed better than serum fibrosis markers. Conclusions: With respect to 2D-GRE, 3D-SE-EPI has the advantage of lower failure rate with equivalent high diagnostic performance for staging liver fibrosis in CHB/CHC patients, and thus more helpful for those challenging cases in 2D-GRE.

AB - Objectives: Magnetic resonance elastography (MRE) with three-dimensional spin-echo echo planar imaging (3D-SE-EPI) is a newly emerging noninvasive method for assessing liver fibrosis. We hypothesized that 3D-SE-EPI might have better diagnostic accuracy than conventional two-dimensional gradient-recalled echo (2D-GRE). METHODS: We prospectively included 179 consecutive patients with chronic hepatitis B (CHB) or C (CHC) who underwent both MRE and liver biopsy. Liver stiffness was measured by both 3D-SE-EPI and 2D-GRE for staging biopsy-proven liver fibrosis (using METAVIR scores). A receiver-operating characteristic analysis using the area under the receiver-operating characteristic curve (AUC) was used to compare the diagnostic performance in predicting liver fibrosis between these two techniques, and compared them to serum markers of fibrosis. Results: The technical failure rate of 3D-SE-EPI (2.2%, n=4/179) was lower compared with 2D-GRE (8.3%, n=15/179). The stiffness measured by 3D-SE-EPI was slightly lower compared with 2D-GRE, with the mean difference of 0.57 kPa (Bland and Altman plot, 95% limits of agreement: -0.32 and 1.45 kPa). AUCs for the characterization of ≥F1, ≥F2, ≥F3, and F4 were 0.957 (95% confidence interval (CI): 0.913-0.983), 0.971 (0.932-0.991), 0.991 (0.961-0.999), and 0.979 (0.942-0.995) for 3D-SE-EPI, which was slightly higher compared with the AUCs for 2D-GRE at each fibrosis stage (0.948 (0.901-0.977), 0.959 (0.915-0.981), 0.979 (0.943-0.995), and 0.976 (0.938-0.994), respectively), although none reached statistical significance (P=0.160-0.585). In an "intention-to-diagnose" analysis, the diagnostic accuracy (the proportion of well-classified patients) by EPI (86.7-91.3%, n=169) was higher compared with GRE (80.9-82.1%, n=158) after applying optimal cutoffs. Both 3D-SE-EPI and 2D-GRE performed better than serum fibrosis markers. Conclusions: With respect to 2D-GRE, 3D-SE-EPI has the advantage of lower failure rate with equivalent high diagnostic performance for staging liver fibrosis in CHB/CHC patients, and thus more helpful for those challenging cases in 2D-GRE.

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