Diagnosis of Cirrhosis with Intravoxel Incoherent Motion Diffusion MRI and Dynamic Contrast-enhanced MRI Alone and in Combination: Preliminary Experience

Purpose: To report our preliminary experience with the use of intravoxel incoherent motion (IVIM) diffusion-weighted magnetic resonance imaging (DW-MRI) and dynamic contrast-enhanced (DCE)-MRI alone and in combination for the diagnosis of liver cirrhosis.

Materials And Methods: Thirty subjects (16 with noncirrhotic liver, 14 with cirrhosis) were prospectively assessed with IVIM DW-MRI (n = 27) and DCE-MRI (n = 20). IVIM parameters included perfusion fraction (PF), pseudodiffusion coefficient (D*), true diffusion coefficient (D), and apparent diffusion coefficient (ADC). Model-free DCE-MR parameters included time to peak (TTP), upslope, and initial area under the curve at 60 seconds (IAUC60). A dual input single compartmental perfusion model yielded arterial flow (Fa), portal venous flow (Fp), arterial fraction (ART), mean transit time (MTT), and distribution volume (DV). The diagnostic performances for diagnosis of cirrhosis were evaluated for each modality alone and in combination using logistic regression and receiver operating characteristic analyses. IVIM and DCE-MR parameters were compared using a generalized estimating equations model.

Results: PF, D*, D, and ADC values were significantly lower in cirrhosis (P = 0.0056-0.0377), whereas TTP, DV, and MTT were significantly increased in cirrhosis (P = 0.0006-0.0154). There was no correlation between IVIM- and DCE-MRI parameters. The highest Az (areas under the curves) values were observed for ADC (0.808) and TTP-DV (0.952 for each). The combination of ADC with DV and TTP provided 84.6% sensitivity and 100% specificity for diagnosis of cirrhosis.

Conclusion: The combination of DW-MRI and DCE-MRI provides an accurate diagnosis of cirrhosis.