Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2024; 30(9): 1164-1176
Published online Mar 7, 2024. doi: 10.3748/wjg.v30.i9.1164
Staging liver fibrosis with various diffusion-weighted magnetic resonance imaging models
Yan-Li Jiang, Juan Li, Peng-Fei Zhang, Feng-Xian Fan, Jie Zou, Pin Yang, Peng-Fei Wang, Shao-Yu Wang, Jing Zhang
Yan-Li Jiang, Peng-Fei Zhang, Feng-Xian Fan, Jie Zou, Pin Yang, Peng-Fei Wang, Jing Zhang, Department of Magnetic Resonance Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
Yan-Li Jiang, Peng-Fei Zhang, Second Clinical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
Yan-Li Jiang, Feng-Xian Fan, Jie Zou, Pin Yang, Peng-Fei Wang, Jing Zhang, Gansu Province Clinical Research Center for Functional and Molecular Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
Juan Li, Department of Hepatology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730030, Gansu Province, China
Shao-Yu Wang, MR Scientific Marketing, Siemens Healthineers, Xi’an 710065, Shaanxi Province, China
Co-first authors: Yan-Li Jiang and Juan Li.
Author contributions: Jiang YL, Li J, Wang SY, and Zhang J conceived, designed and refined the study protocol; Zou and Wang PF were involved in the data collection; Zhang PF, Yang P, and Wang SY analyzed the data; Jiang YL, Li J, and Fan FX drafted the manuscript; All authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. Jiang YL and Li J contributed equally to this work as co-first author. The reasons for designating Jiang YL and Li J as co-first authors are threefold. First, the research was performed as a collaborative effort, and the designation of co-first authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-first authors best reflects this diversity. This also promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching readers’ understanding by offering various expert perspectives. Third, Jiang YL and Li J contributed efforts of equal substance throughout the research process. The choice of these researchers as co-first authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Jiang YL and Li J as co-first authors is fitting for our manuscript as it accurately reflects our team’s collaborative spirit, equal contributions, and diversity.
Supported by the Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital, NO. CY2021-QN-B09; the Science and Technology Project of Gansu Province, NO. 21JR11RA122; Department of Education of Gansu Province: Innovation Fund Project, NO. 2022B-056; and Gansu Province Clinical Research Center for Functional and Molecular Imaging, NO. 21JR7RA438.
Institutional review board statement: The ethics committee of Lanzhou University Second Hospital approved this prospective study (2021A-423).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: Availability of data and materials all data generated and analyzed during the current study will be available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Zhang, Doctor, MD, PhD, Researcher, Department of Magnetic Resonance Imaging, The Second Hospital & Clinical Medical School, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou 730030, Gansu Province, China. ery_zhangjing@lzu.edu.cn
Received: October 22, 2023
Peer-review started: October 22, 2023
First decision: January 5, 2024
Revised: January 15, 2024
Accepted: February 7, 2024
Article in press: February 7, 2024
Published online: March 7, 2024
Abstract
BACKGROUND

Diffusion-weighted imaging (DWI) has been developed to stage liver fibrosis. However, its diagnostic performance is inconsistent among studies. Therefore, it is worth studying the diagnostic value of various diffusion models for liver fibrosis in one cohort.

AIM

To evaluate the clinical potential of six diffusion-weighted models in liver fibrosis staging and compare their diagnostic performances.

METHODS

This prospective study enrolled 59 patients suspected of liver disease and scheduled for liver biopsy and 17 healthy participants. All participants underwent multi-b value DWI. The main DWI-derived parameters included Mono-apparent diffusion coefficient (ADC) from mono-exponential DWI, intravoxel incoherent motion model-derived true diffusion coefficient (IVIM-D), diffusion kurtosis imaging-derived apparent diffusivity (DKI-MD), stretched exponential model-derived distributed diffusion coefficient (SEM-DDC), fractional order calculus (FROC) model-derived diffusion coefficient (FROC-D) and FROC model-derived microstructural quantity (FROC-μ), and continuous-time random-walk (CTRW) model-derived anomalous diffusion coefficient (CTRW-D) and CTRW model-derived temporal diffusion heterogeneity index (CTRW-α). The correlations between DWI-derived parameters and fibrosis stages and the parameters’ diagnostic efficacy in detecting significant fibrosis (SF) were assessed and compared.

RESULTS

CTRW-D (r = -0.356), CTRW-α (r = -0.297), DKI-MD (r = -0.297), FROC-D (r = -0.350), FROC-μ (r = -0.321), IVIM-D (r = -0.251), Mono-ADC (r = -0.362), and SEM-DDC (r = -0.263) were significantly correlated with fibrosis stages. The areas under the ROC curves (AUCs) of the combined index of the six models for distinguishing SF (0.697-0.747) were higher than each of the parameters alone (0.524-0.719). The DWI models’ ability to detect SF was similar. The combined index of CTRW model parameters had the highest AUC (0.747).

CONCLUSION

The DWI models were similarly valuable in distinguishing SF in patients with liver disease. The combined index of CTRW parameters had the highest AUC.

Keywords: Liver fibrosis, Magnetic resonance imaging, Diffusion-weighted magnetic resonance, Liver biopsy, Significant fibrosis

Core Tip: Six diffusion-weighted models generate quantitative information that can be used in liver fibrosis staging. The assessed diffusion-weighted models were all suitable for liver fibrosis staging, showing similar diagnostic performance in distinguishing significant fibrosis. The combined index of continuous-time random-walk model parameters, which was a novel diffusion-weighted imaging model, had the highest areas under the ROC curve in detecting significant fibrosis.