Liver intravoxel incoherent motion diffusion-weighted imaging for the assessment of hepatic steatosis and fibrosis in children

doi:10.3748/wjg.v24.i27.3013

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Jul 21, 2018; 24(27): 3013-3020
Published online Jul 21, 2018. doi: 10.3748/wjg.v24.i27.3013

Table 1 Liver magnetic resonance imaging parameters

	SSFSE T2 weighted image	*IDEAL-IQ for PDFF and R2 (1/T2) map*	MRE	IVIM
Acquisition plane	Axial	Axial	Axial	Axial
Acquisition scheme	Breath hold	Breath hold	Breath hold	Free breathing
TR (millisecond)	540	5.9	1000	6000
TE (millisecond)	80	2.6	62	74
Acquisition matrix	320 × 256	128 × 128	64 × 64	128 × 128
Field of view (cm)	40	42	38	38
Slice/internal thickness (mm)	8	8	8	4
Gap (mm)	10	8	2	5
Flip angle (°)	90	3	90	90
Number of signal averages	0.64	0.69	2	2 → 1
Notes		Six gradient echoes (from 0.9 to 4.4 millisecond)	60 Hz MEG (20% driver power reduction)	Eight b-values (15, 27.3, 49.8, 90.7, 165.3, 301.2, 548.8, 1000)
Scan time (min)	0:12	0:16	0:24 (or 0:12 × 2 times)	4:30

SSFSE: Single shot fast spine echo; PDFF: MR proton density fat fraction; MRE: MR elastography; IVIM: Intravoxel incoherent motion; TR: Repetition time; TE: Echo time; MEG: Motion encoding gradient.

Table 2 Comparison of clinical and magnetic resonance imaging findings between the three groups

		Normal (n = 8)¹	FAT (n = 93)¹	FIB (n = 22)¹	P-value²	P-value³	P-value⁴	P-value⁵
Clinical findings	Age (yr)	11 (9.25-13.75)	12 (10-15.5)	10 (8.75-11)	< 0.001^a	0.611	0.855	< 0.001^a
	Gender (M:F)	4:04	70:23:00	9:13	0.005^a	0.615	1.000	0.012^a
	Weight (kg)	36.5 (28.5-49.5)	65 (51.9-76.5)	33 (28.3-44)	< 0.001^a	0.001^a	1.000	< 0.001^a
	Height (cm)	145 (137-162)	158 (145-164)	136.3 (131.8-148.1)	< 0.001^a	0.543	0.563	< 0.001^a
	AST (IU/L)	22.5 (18.3-24.8)	52.0 (27.0-80.5)	33.0 (22.8-68.0)	0.007^a	0.008^a	0.167	0.541
	ALT (IU/L)	11.0 (9.0-12.0)	87.0 (44.5-138.5)	28.0 (16.0-55.3)	< 0.001^a	< 0.001^a	0.533	< 0.001^a
MRI findings	PDFF (%)	2.65 (2.4-3.1)	22 (14.1-34)	2.6 (2.0-4.1)	< 0.001^a	< 0.001^a	1.000	< 0.001^a
	T2* (millisecond)	25.8 (22.0-27.3)	18 (16.1-20.75)	23.4 (21-26.6)	< 0.001^a	0.007^a	1.000	< 0.001^a
	MRE (kPa)⁶	2.0 (1.6-2.5)	2.6 (2.2-3.1)	3.2 (2.8-4.6)	< 0.001^a	0.058	< 0.001^a	0.001^a
	D (× 10^-3 mm²/s)	1.06 (1.03, 1.1)	1.07 (0.94, 1.35)	0.93 (0.81, 1.2)	0.158
	D* (× 10^-3 mm²/s)	70.2 (44.3, 139.7)	61 (39.5, 81.2)	36.5 (19.2, 52.5)	0.001^a	0.937	0.015^a	0.003^a
	f (%)	28.5 (18.6, 34.8)	31.5 (27.9, 39.3)	19.3 (14.0, 33.2)	0.001^a	0.542	1.000	< 0.001^a
	ADC (× 10^-3 mm²/s)	1.08 (0.97, 1.2)	1.05 (0.9, 1.21)	0.97 (0.89, 1.15)	0.575

^aP < 0.05;

¹All values: Median (Q1-Q3);

²Overall P-value from Kruskal-Wallis test or Fisher’s exact test, after testing with Dunn’s method for multiple comparisons;

³Normal vs FAT groups;

⁴Normal vs FIB groups;

⁵FAT vs FIB groups;

⁶n = 7, 77, 19 for the normal, FAT, and FIB groups, respectively. FAT: Fatty liver; FIB: Fibrotic liver; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; PDFF: MR proton density fat fraction; MRE: MR elastography; ADC: Apparent diffusion coefficient.

Table 3 Univariate linear regression analysis for intravoxel incoherent motion parameters in all groups

	D (× 10^-3 mm²/s)			*D (× 10^-3 mm²/s)**			f (%)			ADC (× 10^-3 mm²/s)
	β	SE	P value	β	SE	P value	β	SE	P value	β	SE	P value
AST (IU/L)	-1.389	0.588	0.020^a	-0.145	0. 072	0.047^a	-0.238	0.266	0.372	-1.146	0.551	0.040^a
ALT (IU/L)	-0.304	0.316	0.339	-0.030	0.039	0.445	0.096	0.141	0.496	-0.446	0.294	0.132
PDFF (%)	1.785	1.949	0.362	0.255	0.237	0.284	4.289	0.775	< 0.001^a	-0.263	1.826	0.886
T2* (millisecond)	-8.400	4.042	0.040^a	0.818	0.495	0.101	-5.002	1.767	0.005^a	-4.978	3.814	0.194
MRE (kPa) (n = 103)	-58.819	22.493	0.010^a	-8.582	2.672	0.002^a	-27.982	7.408	< 0.001^a	-33.675	20.407	0.102

^aP < 0.05; IVIM: Intravoxel incoherent motion; ADC: Apparent diffusion coefficient; β: Coefficient; SE: Standard error of the estimated coefficient; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; PDFF: MR proton density fat fraction; MRE: MR elastography.

Table 4 Multivariate linear regression analysis for intravoxel incoherent motion parameters in all groups

	D (× 10^-3 mm²/s)			*D (× 10^-3 mm²/s)**			f (%)			ADC (× 10^-3 mm²/s)
	β	SE	P value	β	SE	P value	β	SE	P value	β	SE	P value
AST (IU/L)	-2.222	1.337	0.100	-0.063	0.161	0.697	-0.485	0.408	0.238	-1.343	1.227	0.277
ALT (IU/L)	0.718	0.673	0.289	0.013	0.081	0.877	0.116	0.206	0.574	0.419	0.618	0.499
PDFF (%)	-1.228	2.622	0.640	0.381	0.315	0.230	3.194	0.801	< 0.001^a	-3.663	2.407	0.131
T2* (millisecond)	-11.189	4.697	0.019^a	1.316	0.565	0.022^a	-0.847	1.435	0.557	-8.473	4.313	0.052
MRE (kPa) (n = 103)	-37.042	26.853	0.171	-7.031	3.231	0.032^a	-11.667	8.206	0.158	-29.679	24.658	0.232

Citation: Shin HJ, Yoon H, Kim MJ, Han SJ, Koh H, Kim S, Lee MJ. Liver intravoxel incoherent motion diffusion-weighted imaging for the assessment of hepatic steatosis and fibrosis in children. World J Gastroenterol 2018; 24(27): 3013-3020
URL: https://www.wjgnet.com/1007-9327/full/v24/i27/3013.htm
DOI: https://dx.doi.org/10.3748/wjg.v24.i27.3013