Study of Ancillary and Novel Morphometric CT and MRI Biomarkers in Stage I-III Fibrosis in Chronic Liver Disease Patients
DOI:
https://doi.org/10.58600/eurjther3062Keywords:
chronic hepatitis B, chronic hepatitis C, computed tomography, liver cirrhosis, magnetic resonance imagingAbstract
Objective: F1-F3 chronic liver disease is often not recognized by conventional imaging methods; diagnosis and treatment at this stage are crucial in preventing the disease from progressing to the irreversible phase of cirrhosis and its complications. This study aimed to investigate ancillary and novel morphologic imaging findings in the liver using MRI/CT imaging in patients with F1-F3 chronic liver disease.
Methods: Abdominal CT/MR images of 66 patients with histopathological diagnosis of stage I-III fibrosis were retrospectively reviewed. Hemi-diaphragmatic crus thickness, hepato-diaphragmatic fat thickness, periportal fat thickness, gallbladder fossa angle, caudate/right lobe transverse diameter ratio and posterior hepatic notch were evaluated. The clinical and radiological features were compared with those of healthy controls.
Results: Of the F1-F3 chronic liver disease group, 39 (59.1%) were men and 27 (40.9%) were women. Periportal fat thickness, the increased right hemi-diaphragmatic thickness (r-DT Sign), and hilar periportal enlargement were significantly higher in the chronic liver disease group. There was no significant difference between the groups regarding hepato-diaphragmatic fat interposition (HDFI), posterior hepatic notch sign, and gallbladder fossa angle (p > 0.05). Hilar periportal enlargement demonstrated a specificity of 96.7%.
Conclusion: Although the overall sensitivity of routine CT/MRI remains limited for the detection of F1-F3 chronic liver disease, hilar periportal enlargement should be closely monitored as a reliable and specific early finding in the development of chronic liver disease.
References
[1] Brancatelli G, Federle MP, Ambrosini R, Lagalla R, Carriero A, Midiri M, Vilgrain V (2007) Cirrhosis: CT and MR imaging evaluation. Eur J Radiol. 61(1):57–69. https://doi.org/10.1016/j.ejrad.2006.11.003
[2] Chandarana H, Shanbhogue K (2021) Noninvasive Staging of Liver Fibrosis with Dual-Energy CT: Close but No Cigar. Radiology. 298(3):609–610. https://doi.org/10.1148/radiol.2021204315
[3] Kudo M, Zheng RQ, Kim SR, Okabe Y, Osaki Y, Iijima H, Itani T, Kasugai H, Kanematsu M, Ito K, Usuki N, Shimamatsu K, Kage M, Kojiro M (2008) Diagnostic accuracy of imaging for liver cirrhosis compared to histologically proven liver cirrhosis. A multicenter collaborative study. Intervirology. 51(Suppl 1):17–26. https://doi.org/10.1159/000122595
[4] Bota S, Herkner H, Sporea I, Salzl P, Sirli R, Neghina AM, Radosavljevic MP (2013) Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis. Liver Int. 33(8):1138–1147. https://doi.org/10.1111/liv.12240
[5] Imajo K, Honda Y, Kobayashi T, Nagai K, Ozaki A, Iwaki M, Kessoku T, Ogawa Y, Takahashi H, Saigusa Y, Yoneda M, Kirikoshi H, Utsunomiya D, Aishima S, Saito S, Nakajima A (2022) Direct comparison of US and MR elastography for staging liver fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 20(4):908–917. https://doi.org/10.1016/j.cgh.2020.12.016
[6] Ghonge NP, Sahu A (2020) 'Hepato-diaphragmatic fat interposition' and 'increased right hemi-diaphragmatic thickness': new imaging signs for early diagnosis of hepatic cirrhosis on routine CT abdomen. Abdom Radiol (NY). 45(1):153–160. https://doi.org/10.1007/s00261-019-02230-w
[7] Bashir MR, Horowitz JM, Kamel IR, Tiwari H, Asrani SK, Chernyak V, Goldstein A, Grajo JR, Hindman NM, Kamaya A, McNamara MM, Porter KK, Solnes LB, Srivastava PK, Zaheer A, Carucci LR (2020) ACR Appropriateness Criteria® Chronic Liver Disease. J Am Coll Radiol. 17(5S): S70–S80. https://doi.org/10.1016/j.jacr.2020.01.023
[8] Venkatesh SK, Torbenson MS (2022) Liver fibrosis quantification. Abdom Radiol (NY). 47(3):1032–1052. https://doi.org/10.1007/s00261-021-03396-y
[9] Mamone G, Miraglia R (2019) The "enlarged hilar periportal space sign" in liver cirrhosis. Abdom Radiol (NY). 44(5):1936–1937. https://doi.org/10.1007/s00261-018-1876-6
[10] Numminen K, Tervahartiala P, Halavaara J, Isoniemi H, Höckerstedt K (2005) Non-invasive diagnosis of liver cirrhosis: magnetic resonance imaging presents special features. Scand J Gastroenterol. 40(1):76–82. https://doi.org/10.1080/00365520410009384
[11] Kanki A, Tamada T, Higaki A, Noda Y, Tanimoto D, Sato T, Higashi H, Ito K (2012) Hepatic parenchymal enhancement at Gd-EOB-DTPA-enhanced MR imaging: correlation with morphological grading of severity in cirrhosis and chronic hepatitis. Magn Reson Imaging. 30(3):356–360. https://doi.org/10.1016/j.mri.2011.11.002
[12] Ito K, Mitchell DG, Gabata T (2000) Enlargement of hilar periportal space: a sign of early cirrhosis at MR imaging. J Magn Reson Imaging. 11(2):136–140. https://doi.org/10.1002/(SICI)1522-2586(200002)11:2<136::AID-JMRI9>3.0.CO;2-B
[13] Ito K, Mitchell DG (2004) Imaging diagnosis of cirrhosis and chronic hepatitis. Intervirology. 47(3-5):134–143. https://doi.org/10.1159/000078465
[14] Rosenthal SJ, Harrison LA, Baxter KG, Wetzel LH, Cox GG, Batnitzky S (1995) Doppler US of helical flow in the portal vein. Radiographics. 15(5):1103–1111. https://doi.org/10.1148/radiographics.15.5.7501853
[15] Ito K, Mitchell DG, Gabata T, Hussain SM (1999) Expanded gallbladder fossa: simple MR imaging sign of cirrhosis. Radiology. 211(3):723–726. https://doi.org/10.1148/radiology.211.3.r99ma31723
[16] Ito K, Mitchell DG, Kim MJ, Awaya H, Koike S, Matsunaga N (2003) Right posterior hepatic notch sign: a simple diagnostic MR finding of cirrhosis. J Magn Reson Imaging. 18(5):561–566. https://doi.org/10.1002/jmri.10387
[17] Bolog N, Oancea I, Andreisek G, Mangrau A, Caruntu F (2009) Diagnosis Performance of Different MR Imaging Signs of Cirrhosis: the Caudate to Right Lobe Ratio, the Posterior Right Hepatic Notch, and the Expanded Gallbladder Fossa. Curr Health Sci J. 35(1):16–22.
[18] Harbin WP, Robert NJ, Ferrucci JT Jr (1980) Diagnosis of cirrhosis based on regional changes in hepatic morphology: a radiological and pathological analysis. Radiology. 135(2):273–283. https://doi.org/10.1148/radiology.135.2.7367613
[19] Awaya H, Mitchell DG, Kamishima T, Holland G, Ito K, Matsumoto T (2002) Cirrhosis: modified caudate-right lobe ratio. Radiology. 224(3):769–774. https://doi.org/10.1148/radiol.2243011495
[20] Horowitz JM, Venkatesh SK, Ehman RL, Jhaveri K, Kamath P, Ohliger MA, Samir AE, Silva AC, Taouli B, Torbenson MS, Wells ML, Yeh B, Miller FH (2017) Evaluation of hepatic fibrosis: a review from the society of abdominal radiology disease focus panel. Abdom Radiol (NY). 42(8):2037–2053. https://doi.org/10.1007/s00261-017-1211-7
[21] Desai A, Sandhu S, Lai JP, Sandhu DS (2019) Hepatocellular carcinoma in non-cirrhotic liver: a comprehensive review. World J Hepatol. 11(1):1–18. https://doi.org/10.4254/wjh.v11.i1.1
[22] Sebastiani G, Gkouvatsos K, Pantopoulos K (2014) Chronic hepatitis C and liver fibrosis. World J Gastroenterol. 20(32):11033–11053. https://doi.org/10.3748/wjg.v20.i32.11033
[23] Smith AD, Porter KK, Elkassem AA, Sanyal R, Lockhart ME (2019) Current Imaging Techniques for Noninvasive Staging of Hepatic Fibrosis. AJR Am J Roentgenol. 213(1):77–89. https://doi.org/10.2214/ajr.19.21144
[24] Ludwig DR, Fraum TJ, Cannella R, Tsai R, Naeem M, LeBlanc M, Salter A, Tsung A, Fleckenstein J, Shetty AS, Borhani AA, Furlan A, Fowler KJ (2019) Expanding the Liver Imaging Reporting and Data System (LI-RADS) v2018 diagnostic population: performance and reliability of LI-RADS for distinguishing hepatocellular carcinoma (HCC) from non-HCC primary liver carcinoma in patients who do not meet strict LI-RADS high-risk criteria. HPB (Oxford). 21(12):1697–1706. https://doi.org/10.1016/j.hpb.2019.04.007
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