Assessment of liver fibrosis with gadoxetic acid-enhanced MRI: comparisons with transient elastography, ElastPQ, and serologic fibrosis markers

Abstract

ObjectivesTo compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI), ultrasonography (US)based elastography, and serologic fibrosis markers in assessing the stage of liver fibrosis.Materials and methodsThis retrospective study included 67 patients (55 male and 12 female; mean age 62.5years) who underwent gadoxetic acid-enhanced MRI and liver stiffness measurements before liver biopsy or surgery between January 2014 and January 2018. Measurements were performed using transient elastography (TE), ultrasound shear wave elastography point quantification (ElastPQ), and blood tests. The following MRI-based fibrosis markers were assessed: contrast enhancement index (CEI), liver-spleen contrast ratio (LSC), liver-portal vein contrast ratio (LPC), and signal intensity ratio (SIR). The diagnostic performances of fibrosis markers were compared using the area under the receiver operating characteristic curve (AUC), with histopathologic fibrosis stage as the reference standard.ResultsThe fibrosis stages were F0-F1 (n=17), F2 (n=7), F3 (n=20), and F4 (n=23). MRI-based fibrosis markers negatively correlated with histologic stage: CEI (r=-0.786); LSC (r=-0.718); LPC (r=-0.448); and SIR (r=-0.617; all P<0.001). For diagnosis of either significant liver fibrosis (F2) or cirrhosis (F4), the CEI provided better diagnostic accuracy (AUC=0.898 and 0.881) than the aspartate aminotransferase-to-platelet ratio index (APRI) (AUC=0.699 and 0.715; all P<0.05). The CEI displayed similar diagnostic accuracy forF2 or F4 when using TE (AUC=0.866 and 0.884, both P>0.05) or ElastPQ [AUC=0.751 (P=0.021) and AUC=0.786 (P=0.234)].ConclusionsThe CEI measured by gadoxetic acid-enhanced MRI allows the staging of liver fibrosis, with a diagnostic accuracy comparable to that of TE and superior to that of ElastPQ or APRI.