Thomas C. Lauenstein MD, Presenter: Nothing to Disclose

Khalil N. Salman MD, Abstract Co-Author: Nothing to Disclose

Puneet Sharma PhD, Abstract Co-Author: Nothing to Disclose

Roger Morreira, Abstract Co-Author: Nothing to Disclose

Dana L. Tudorascu MS, Abstract Co-Author: Nothing to Disclose

Diego R. Martin MD, PhD, Abstract Co-Author: Research grant, General Electric Company, Milwaukee, WI Research consultant, Schering AG (Berlex Inc) Research consultant, Bracco Group Research grant, Siemens AG, Erlangen, Germany

To determine if the degree of interstitial phase gadolinium reticular liver enhancement correlates with fibrosis, and if the degree of arterial phase irregular patchy enhancement correlates with the degree of hepatic inflammation.

25 normal subjects, 25 patients with intermediate and 25 patients with severe cirrhosis were studied. Diagnosis with grading of cirrhosis and grading of hepatic inflammation was based on the 5-point Scheuer ranking (0=absence of disease; 4=severe cirrhosis/inflammation). Liver MRI was performed on a current generation 1.5T scanner within 14 days of the biopsy. Gadolinium enhanced T1W 3D gradient echo sequences were acquired in arterial, venous and interstitial phases. Abnormal reticular liver enhancement on the interstitial phase images was graded as a marker of hepatic fibrosis. Abnormal patchy enhancement patterns on the arterial phase images were evaluated as a marker for acute hepatic inflammation. MRI based grading was performed using a scoring system of 0-4 in accordance with methods used for pathology. A t-test was used for comparison between the pathology and MRI results.

The MRI based scoring for hepatic fibrosis correlated well with histopathological findings. Average MRI values were 1.90, and for histopathology 1.92, p=.88. There were minor discrepancies with cirrhosis being underestimated in 9 patients and overestimated in 8 patients. The discrepancy between MRI and histopathology grading did not exceed one ranking point. There was also a good correlation between MRI assessment of active inflammation (mean score: 0.90) and histopathology (mean score: 0.85; p=.35). Concordance of findings was found in 48 of 75 patients. Inflammation was overestimated (underestimated) in 16 (11) patients. In 21 patients, discrepancy of scoring amounted to only one ranking point.

Gadolinium-enhanced MRI is an accurate method for the quantification of liver fibrosis and acute hepatic inflammation. The relative safety of a non-invasive MRI technique provides advantages over biopsy.

Gadolinium-enhanced MRI can be used as a surrogate for percutaneous liver biopsy to evaluate chronic liver disease with fibrosis and superimposed hepatic inflammation.

Lauenstein, T, Salman, K, Sharma, P, Morreira, R, Tudorascu, D, Martin, D, Grading of Liver Fibrosis and Acute Hepatic Inflammation: Correlation of Gadolinium-enhanced MRI with Histopathology.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5009700.html