Staging liver fibrosis with DWI: is there an added value for diffusion
Received: 25 October 2017 / Revised: 29 November 2017 / Accepted: 5 December 2017 / Published online: 30 January 2018
European Society of Radiology 2017
Objectives To assess liver fibrosis in patients with chronic liver disease using diffusion kurtosis imaging (DKI) in comparison
with conventional diffusion-weighted imaging, with histology as reference standard.
Methods This prospective study included 81 patients and DKI with b-values of 0, 200, 500, 1,000, 1,500, 2,000 s/mm
performed. Mean diffusivity (MD), mean kurtosis (MK) and apparent diffusion coefficient (ADC) maps were calculated. The
diagnostic efficacy of MD, MK and ADC for predicting stage 2 fibrosis or greater, and stage 3 fibrosis or greater were compared.
Results The MD (rho=-0.491, p<0.001), MK (rho=0.537, p<0.001) and ADC (rho=-0.496, p<0.001) correlated significantly
with fibrosis stages, and ADC exhibited a strong negative correlation with MK (rho=-0.968; p<0.001) and a moderate association
with MD (rho=0.601, p<0.001). Areas under the curves (AUCs) for predicting stage 2 fibrosis or greater were not significantly
different (p>0.05) between MK (0.809) and ADC (0.797) as well as between MD (0.715) and ADC. AUCs were also similar for
MD (0.710), MK (0.768) and ADC (0.747) for predicting stage 3 fibrosis or greater.
Conclusion Although DKI is feasible for predicting liver fibrosis in patients with chronic liver disease, MD and MK offer similar
diagnostic performance to ADC values.
• Diffusion kurtosis imaging is feasible for staging liver fibrosis.
• Diffusion kurtosis and monoexponential model are highly correlated.
• The kurtosis model offers no added value to the conventional, monoexponential model
Keywords Liver disease
Magnetic resonance imaging
ADC Apparent diffusion coefficient
DWI Diffusion-weighted imaging
ECM Extracellular matrix
MD Mean diffusivity
MK Mean kurtosis
Liver fibrosis is an evolving wound-healing response to
sustained chronic liver inflammation due to various causes
such as viral hepatitis and alcohol- and non-alcohol- caused
steatohepatitis. Typical fibrosis features involve excessive de-
position of extracellular matrix (ECM) [1, 2], and progression
of ECM accumulation leads ultimately to liver cirrhosis and
related life-threatening complications. Accurate early staging
of liver fibrosis ensures important decision-making on anti-
fibrosis treatment and better prognostic values for patients. It
has been strongly suggested that anti-fibrosis therapy
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00330-017-5245-6) contains supplementary
material, which is available to authorized users.
* Mengsu Zeng
Department of Radiology, Shanghai Institute of Medical Imaging,
Zhongshan Hospital, Fudan University, Shanghai, People’sRepublic
MR Applications Predevelopment, Siemens Healthcare,
MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China
Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
European Radiology (2018) 28:3041–3049