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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Diffusion-weighted magnetic resonance imaging and micro-RNA in the diagnosis of hepatic fibrosis in chronic hepatitis C virus
Tarek Besheer, Hatem Elalfy, Mohamed Abd El-Maksoud, Ahmed Abd El-Razek, Saher Taman, Khaled Zalata, Wagdy Elkashef, Hossam Zaghloul, Heba Elshahawy, Doaa Raafat, Wafaa Elemshaty, Eman Elsayed, Abdel-Hady El-Gilany, Mahmoud El-Bendary
Tarek Besheer, Hatem Elalfy, Mohamed Abd El-Maksoud, Mahmoud El-Bendary, Department of Tropical Medicine and Hepatology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
Ahmed Abd El-Razek, Saher Taman, Department of Diagnostic Radiology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
Khaled Zalata, Wagdy Elkashef, Department of Pathology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
Hossam Zaghloul, Heba Elshahawy, Doaa Raafat, Wafaa Elemshaty, Eman Elsayed, Department of Clinical Pathology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
Abdel-Hady El-Gilany, Department of Public Health and Preventive Medicine, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
Author contributions: Besheer T, Elalfy H, and El-Bendary M were involved in study conception and design; Abd El-Razek A and Taman S performed radiological imaging; Zaghloul H, Elshahawy H, Raafat D, Elemshaty W, and Elsayed E performed laboratory techniques; Zalata K and Elkashef W performed pathological diagnosis of the liver biopsies; El-Gilany AH and Abd El-Maksoud M acquired the data and performed analysis and interpretation of data; all authors were involved in the drafting and critical revision of the manuscript; all authors approved the final version of the manuscript.
Supported by Science and Technology Development Foundation (STDF), Project NO. 3457 (TC/4/Health/2010/hep-1.6).
Institutional review board statement: The study protocol was reviewed and approved by the institutional ethics committee of the Mansoura Faculty of Medicine. (R.18.04.139.R1-2018/04/17).
Informed consent statement: Written informed consent was obtained from all eligible patients who were included in the study.
Conflict-of-interest statement: No conflict of interest.
STROBE Statement: The guidelines of the STROBE statement have been adopted.
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 Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mahmoud El-Bendary, MD, Professor, Department of Tropical Medicine and Hepatology, Mansoura Faculty of Medicine - Mansoura University, Elgomhoria Street, Mansoura 35111, Dakahlia, Egypt.
mm_elbendary@mans.edu.eg
Telephone: +20-1002592205 Fax: +20-502267016
Received: November 12, 2018
Peer-review started: November 12, 2018
First decision: December 28, 2018
Revised: January 30, 2019
Accepted: February 15, 2019
Article in press: February 15, 2019
Published online: March 21, 2019
Processing time: 129 Days and 2.5 Hours
BACKGROUND
Diffusion-weighted magnetic resonance imaging has shown promise in the detection and quantification of hepatic fibrosis. In addition, the liver has numerous endogenous micro-RNAs (miRs) that play important roles in the regulation of biological processes such as cell proliferation and hepatic fibrosis.
AIM
To assess diffusion-weighted magnetic resonance imaging and miRs in diagnosing and staging hepatic fibrosis in patients with chronic hepatitis C.
METHODS
This prospective study included 208 patients and 82 age- and sex-matched controls who underwent diffusion-weighted magnetic resonance imaging of the abdomen, miR profiling, and liver biopsy. Pathological scoring was classified according to the METAVIR scoring system. The apparent diffusion coefficient (ADC) and miR were calculated and correlated with pathological scoring.
RESULTS
The ADC value decreased significantly with the progression of fibrosis, from controls (F0) to patients with early fibrosis (F1 and F2) to those with late fibrosis (F3 and F4) (median 1.92, 1.53, and 1.25 × 10-3 mm2/s, respectively) (P = 0.001). The cut-off ADC value used to differentiate patients from controls was 1.83 × 10-3 mm2/s with an area under the curve (AUC) of 0.992. Combining ADC and miR-200b revealed the highest AUC (0.995) for differentiating patients from controls with an accuracy of 96.9%. The cut-off ADC used to differentiate early fibrosis from late fibrosis was 1.54 × 10-3 mm2/s with an AUC of 0.866. The combination of ADC and miR-200b revealed the best AUC (0.925) for differentiating early fibrosis from late fibrosis with an accuracy of 80.2%. The ADC correlated with miR-200b (r = - 0.61, P = 0.001), miR-21 (r = - 0.62, P = 0.001), and miR-29 (r = 0.52, P = 0.001).
CONCLUSION
Combining ADC and miRs offers an alternative surrogate non-invasive diagnostic tool for diagnosing and staging hepatic fibrosis in patients with chronic hepatitis C.
Core tip: We aimed to assess diffusion-weighted magnetic resonance imaging and micro-RNAs in diagnosis and staging of hepatic fibrosis. Patients underwent DWI of the abdomen, micro-RNA profiling, and liver biopsy. The apparent diffusion coefficient (ADC) and miR were calculated and correlated with METAVIR score. We found that ADC value was decreased from controls (F0) to patients with early fibrosis and those with late fibrosis. Combined ADC and miR-200b revealed the best result for differentiating early from late fibrosis and offer an alternative surrogate non-invasive diagnostic tool for diagnosis and staging of hepatic fibrosis in patients with chronic hepatitis C.
