Yonsei Med J.  2014 May;55(3):651-659. 10.3349/ymj.2014.55.3.651.

Histogram Analysis of Hepatobiliary Phase MR Imaging as a Quantitative Value for Liver Cirrhosis: Preliminary Observations

• Choi JY
• Kim H
• Sun M
• Sirlin CB

• KMID: 2068674
• DOI: http://doi.org/10.3349/ymj.2014.55.3.651

Abstract

PURPOSE
To investigate whether histogram analysis of the hepatobiliary phase on gadoxetate enhanced-MRI could be used as a quantitative index for determination of liver cirrhosis.
MATERIALS AND METHODS
A total of 63 patients [26 in a normal liver function (NLF) group and 37 in a cirrhotic group] underwent gadoxetate-enhanced MRI, and hepatobiliary phase images were obtained at 20 minutes after contrast injection. The signal intensity of the hepatic parenchyma was measured at four different regions of interest (ROI) of the liver, avoiding vessels and bile ducts. Standard deviation (SD), coefficient of variation (CV), and corrected CV were calculated on the histograms at the ROIs. The distributions of CVs calculated from the ROI histogram were examined and statistical analysis was carried out.
RESULTS
The CV value was 0.041+/-0.009 (mean CV+/-SD) in the NLF group, while that of cirrhotic group was 0.071+/-0.020. There were statistically significant differences in the CVs and corrected CV values between the NLF and cirrhotic groups (p<0.001). The most accurate cut-off value among CVs for distinguishing normal from cirrhotic group was 0.052 (sensitivity 83.8% and specificity 88.5%). There was no statistically significant differences in SD between NLF and cirrhotic groups (p=0.307).
CONCLUSION
The CV of histograms of the hepatobiliary phase on gadoxetate-enhanced MRI may be useful as a quantitative value for determining the presence of liver cirrhosis.

Keyword

Cirrhosis; gadoxetate disodium; magnetic resonance imaging; histogram

MeSH Terms

Adult
Aged
Aged, 80 and over
Contrast Media/diagnostic use
Female
Gadolinium DTPA/diagnostic use
Humans
Liver Cirrhosis/*diagnosis
Magnetic Resonance Imaging/methods
Male
Middle Aged
Retrospective Studies
Young Adult
Contrast Media
Gadolinium DTPA

Figure

• 

  Fig. 1 Different histograms of normal function liver and cirrhotic liver on hepatobiliary phase images. (A) Axial T1-weighted hepatobiliary phase image obtained after injection of gadoxetate disodium in a 56-year-old woman with normal function liver and a coefficient of variation (CV) value of 0.035. (B) Histogram of selected region of interest (ROI) on hepatobiliary phase image shows a narrow distribution. The horizontal axis represents signal intensity of ROI and vertical axis shows frequency of observations. (C) Axial T1-weighted hepatobiliary phase image obtained after injection of gadoxetate disodium in a 48-year-old man with cirrhosis and a CV value of 0.062. (D) Histogram of selected ROI on hepatobiliary phase image shows a wide distribution.

• 

  Fig. 2 Box plots show the results of analysis of (A) the SD, (B) CV values, and (C) corrected CV for the NLF and cirrhotic groups. Each box stretches from the 25th percentile at lower edge to the 75th percentile at upper edge; the median is shown as a line across the box. There are two adjacent values below and above the box: the largest value is below the upper inner limit and the smallest value is above the lower inner limit. Outside values below or above the inner limit but within the outer limit are outliers. Star marks in Fig. 2A indicates outlying values meaning wide range of pixel values in cirrhosis. SD, standard deviation; CV, coefficient of variation; NLF, normal liver function.

• 

  Fig. 3 Histograms of NLF and cirrhosis groups. (A) The CV for NLF group showed a normal distribution, showing a skewness value of 1.11. (B) The CV for cirrhosis group showed a normal distribution, showing a skewness value of 0.94. CV, coefficient of variation; NLF, normal liver function.

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