Korean J Radiol.  2018 Oct;19(5):916-922. 10.3348/kjr.2018.19.5.916.

Histogram Analysis of Diffusion Kurtosis Magnetic Resonance Imaging for Diagnosis of Hepatic Fibrosis

• Sheng RF
• Jin KP
• Yang L
• Wang HQ
• Liu H
• Ji Y
• Fu CX
• Zeng MS

• KMID: 2418555
• DOI: http://doi.org/10.3348/kjr.2018.19.5.916

Abstract

OBJECTIVE
To investigate the diagnostic value of diffusion kurtosis imaging (DKI) histogram analysis in hepatic fibrosis staging.
MATERIALS AND METHODS
Thirty-six rats were divided into carbon tetrachloride-induced fibrosis groups (6 rats per group for 2, 4, 6, and 8 weeks) and a control group (n = 12). MRI was performed using a 3T scanner. Histograms of DKI were obtained for corrected apparent diffusion (D), kurtosis (K) and apparent diffusion coefficient (ADC). Mean, median, skewness, kurtosis and 25th and 75th percentiles were generated and compared according to the fibrosis stage and inflammatory activity.
RESULTS
A total of 35 rats were included, and 12, 5, 5, 6, and 7 rats were diagnosed as F0-F4. The mean, median, 25th and 75th percentiles, kurtosis of D map, median, 25th percentile, skewness of K map, and 75th percentile of ADC map demonstrated significant correlation with fibrosis stage (r = −0.767 to 0.339, p < 0.001 to p = 0.039). The fibrosis score was the independent variable associated with histogram parameters compared with inflammatory activity grade (p < 0.001 to p = 0.041), except the median of K map (p = 0.185). Areas under the receiver operating characteristic curve of D were larger than K and ADC maps in fibrosis staging, although no significant differences existed in pairwise comparisons (p = 0.0512 to p = 0.847).
CONCLUSION
Corrected apparent diffusion of DKI histogram analysis provides added value and better diagnostic performance to detect various liver fibrosis stages compared with ADC.

Keyword

Liver; Fibrosis; Histogram analysis; Diffusion kurtosis imaging; Magnetic resonance imaging

MeSH Terms

Animals
Carbon
Diagnosis*
Diffusion*
Fibrosis*
Liver
Liver Cirrhosis
Magnetic Resonance Imaging*
Rats
ROC Curve
Carbon

Figure

• 

  Fig. 1 Example of DKI histogram analysis in rat graded A3F4.(A) Placement of region of interest on parametric map of K map. (B) Semi-logarithmic plot of hepatic diffusion-related signal decay with respect to increasing b-values demonstrates improved fit of measured data with diffusional kurtosis model compared with monoexponential ADC model. Corresponding histograms were generated for (C) D map, (D) K map, and (E) ADC map. Different distributions of parameters, as relatively low percentile D values with left-skewed broad distribution, high percentile K values with right-skewed broad distribution, and medium percentile ADC values are shown. (F) Microscopy shows liver with cirrhosis (F4) and severe inflammatory activity (A3) (hematoxylin-eosin stain, × 40). ADC = apparent diffusion coefficient, D = corrected apparent diffusion, DKI = diffusion kurtosis imaging, K = kurtosis

• 

  Fig. 2 ROC curves for identification of fibrosis grade (A) F1 or higher, (B) F2 or higher, and (C) F4 using histogram analyses for D, K, and ADC.Highest areas under ROC curve of all significant parameters for each magnetic resonance parameter are used. ROC analysis showed no significance in ADC for prediction of F4, and pairwise comparison was only conducted between D and K. ROC = receiver operating characteristics

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