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3-D spin-echo echo planar imaging accurately predicts liver fibrosis in HBV, HCV

Three-dimensional spin-echo echo planar imaging was more accurate in diagnosing liver fibrosis among patients with chronic hepatitis B or hepatitis C virus infections compared with 2-D gradient-recalled echo, according to published findings in The American Journal of Gastroenterology.

Researchers evaluated 179 consecutive patients with chronic HBV or chronic HCV who underwent magnetic resonance elastography (MRE) and liver biopsy. Liver stiffness was measured using both 3-D spin-echo echo planar imaging (3D-SE-EPI) and 2-D gradient-recalled echo (2D-GRE) to determine stage of liver fibrosis.

“[We used] a receiver-operating characteristic analysis using the area under the receiver-operating characteristic curve (AUC) to compare the diagnostic performance in predicting liver fibrosis between these two techniques, and compared them to serum markers of fibrosis,” Qi-yong Guo, MD, of the department of radiology, Shengjing Hospital, China Medical University, and colleagues wrote.

The technical failure rate of 3D-SE-EPI was lower compared with 2D-GRE (2.2% vs. 8.3%). Liver stiffness measured via 3D-SE-EPI was lower compared with 2D-GRE (mean difference, 0.57 kPa).

The areas under the receiving curve (AUCs) when using 3D-SE-EPI were: 0.957 (95% CI, 0.913–0.983) for stage F1 fibrosis, 0.971 (95% CI, 0.932–0.991) for stage F2, 0.991 (95% CI, 0.961–0.999) for stage F3 and 0.979 (0.942–0.995) for stage F4. These were slightly higher compared with AUCs from 2D-GRE at each fibrosis stage; F1: 0.948 (0.901–0.977), F2: 0.959 (0.915–0.981), F3: 0.979 (0.943–0.995) and F4: 0.976 (0.938–0.994). However, these did not reach statistical significance (P = .160 to .585), according to the research.

In an intention-to-diagnose analysis, the diagnostic accuracy by EPI (86.7%–91.3%; n = 169) was higher compared with gradient-recalled echo (80.9%–82.1%; n = 158) after applying optimal cutoffs. In addition, both 3D-SE-EPI and 2D-GRE had better outcomes compared with serum fibrosis markers, such as aspartate aminotransferase to platelet ratio index and Fibrosis-4 (P < .001 for all).

“With respect to 2D-GRE, 3D-SE-EPI has the advantage of lower failure rate with equivalent high diagnostic performance for staging liver fibrosis in [chronic HBV and chronic HCV] patients, and thus more helpful for those challenging cases in 2D-GRE,” the researchers concluded. – by Melinda Stevens

Disclosure: Shi and Guo report no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.