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Liver fibrosis is characterized by the accumulation of extracellular matrix proteins such as collagen in the liver interstitial space. All causes of chronic liver disease may lead to fibrosis and cirrhosis. The severity of liver fibrosis influences the decision to treat or the need to monitor hepatic or extrahepatic complications. The traditional reference standard for diagnosis of liver fibrosis is liver biopsy. However, this technique is invasive, associated with a risk of sampling error, and has low patient acceptance. Imaging techniques offer the potential for noninvasive diagnosis, staging, and monitoring of liver fibrosis. Recently, several of these have been implemented on ultrasound (US), computed tomography, or magnetic resonance imaging (MRI). Techniques that assess changes in liver morphology, texture, or perfusion that accompany liver fibrosis have been implemented on all three imaging modalities. Elastography, which measures changes in mechanical properties associated with liver fibrosis-such as strain, stiffness, or viscoelasticity-is available on US and MRI. Some techniques assessing liver shear stiffness have been adopted clinically, whereas others assessing strain or viscoelasticity remain investigational. Further, some techniques are only available on MRI-such as spin-lattice relaxation time in the rotating frame (T1 ρ), diffusion of water molecules, and hepatocellular function based on the uptake of a liver-specific contrast agent-remain investigational in the setting of liver fibrosis staging. In this review, we summarize the key concepts, advantages and limitations, and diagnostic performance of each technique. The use of multiparametric MRI techniques offers the potential for comprehensive assessment of chronic liver disease severity.Level Of Evidence: 5 J. MAGN. RESON. IMAGING 2017;45:1276-1295. [ABSTRACT FROM AUTHOR]

Purpose: To explore the value of T1 relaxation times in the rotating frame (T1 ρ or T1 rho) for evaluating liver fibrosis stage, compared to apparent diffusion coefficients (ADCs). Materials and Methods: Liver fibrosis in model rats (n = 50) was produced by carbon tetrachloride (CCl4 ) injection. Five rats died during the experiment. Surviving model rats (n = 45) and controls (n = 15) were subjected to 3.0T MRI and the ADCs (b-values: 0, 800 s/mm(2) ) and T1 ρ values were determined. Liver fibrosis stage (F0-F4) was defined based on METAVIR scoring. Nonparametric statistical methods and receiver operating characteristic (ROC) curve analyses were employed to determine diagnostic accuracy. Results: Mean ADC and T1 ρ associated negatively (r = -0.732 P < 0.001) and positively (r = 0.863 P < 0.001), respectively, with severity of fibrosis stage. Analysis of ROC curves for fibrosis staging showed that the area under the curve (AUC) for T1 ρ (stage F0 vs. F1-F4 = 0.976, stage F0-F1 vs. F2-F4 = 0.920, stage F0-F2 vs. F3-F4 = 0.938, and stage F0-F3 vs. F4 = 0.931) was larger than that for ADCs (0.917, 0.924, 0.842, and 0.781, respectively). Conclusion: ADC and T1 ρ values correlate with liver fibrosis stage. The performance of the T1 ρ parameter was superior to that of the ADC parameter in the differentiation of liver fibrosis stages in a CCl4 rat model. [ABSTRACT FROM AUTHOR]

Purpose: To explore the characteristics of intravoxel incoherent motion (IVIM) in various stages of liver fibrosis, and their relationships with fibrotic stages in rats. Materials and Methods: Fifty rats were given various doses of carbon tetrachloride (CCl4 ) to induce various fibrotic stages in rats; 15 untreated rats served as controls. Diffusion-weighted magnetic resonance imaging (MRI) was performed and eight b-values (0-800 s/mm(2) ) were applied to obtain IVIM parameters (D, pure molecular diffusion; f, perfusion fraction; D*, pseudodiffusion). The stages of liver fibrosis (stages F0-F4) were evaluated histologically using METAVIR scores. Fifty-seven rats (15 controls and 42 with fibrosis) were analyzed by nonparametric methods and receiver operating characteristic curves to determine diagnostic accuracy. Results: Significant differences (P < 0.001) were found between stages (stages F0-F4) by D, f, D*, and apparent diffusion coefficient (ADC). There were inverse correlations between fibrosis stages and D, f, D*, ADC (r = -0.657, r = -0.631, r = -0.711 r = -0.719, respectively). Multivariate analysis showed that the combination models (D, f, D*) were better than the individual parameter (ADC) for the evaluation fibrosis stages (area under the curve [AUC]: 0.821-1.000 vs. AUC: 0.753-0.918) CONCLUSION: IVIM-derived parameters showed significant correlations with stages of liver fibrosis in a rat model. [ABSTRACT FROM AUTHOR]

Purpose: To characterize longitudinal changes in molecular water diffusion, blood microcirculation, and their contributions to the apparent diffusion changes using intravoxel incoherent motion (IVIM) analysis in an experimental mouse model of liver fibrosis. Materials and Methods: Liver fibrosis was induced in male adult C57BL/6N mice (22-25 g; n = 12) by repetitive dosing of carbon tetrachloride (CCl4). The respiratory-gated diffusion-weighted (DW) images were acquired using single-shot spin-echo EPI (SE-EPI) with 8 b-values and single diffusion gradient direction. True diffusion coefficient (Dtrue), blood pseudodiffusion coefficient (Dpseudo), and perfusion fraction (Pfraction) were measured. Diffusion tensor imaging (DTI) was also performed for comparison. Histology was performed with hematoxylin-eosin and Masson's trichrome staining. Results: A significant decrease in Dtrue was found at 2 weeks and 4 weeks following CCl4 insult, as compared with that before insult. Similarly, Dpseudo values before injury was significantly higher than those at 2 weeks and 4 weeks after CCl4 insult. Meanwhile, Pfraction values showed no significant differences over different timepoints. For DTI, significant decrease in ADC was observed following CCl4 administration. Fractional anisotropy at 2 weeks after CCl4 insult was significantly lower than that before insult, and subsequently normalized at 4 weeks after the insult. Liver histology showed collagen deposition, the presence of intracellular fat vacuoles, and cell necrosis/apoptosis in livers with CCl4 insult. Conclusion: Both molecular water diffusion and blood microcirculation contribute to the alteration in apparent diffusion changes in liver fibrosis. Reduction in Dtrue and Dpseudo values resulted from diffusion and perfusion changes, respectively, during the progression of liver fibrosis. IVIM analysis may serve as valuable and robust tool in detecting and characterizing liver fibrosis at early stages, monitoring its progression in a noninvasive manner. J. Magn. Reson. Imaging 2012;36:159-167. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Purpose: To characterize changes in relaxation times of liver using quantitative magnetic resonance imaging (MRI) in an experimental mouse model of liver fibrosis. Quantitative MRI is a potentially robust method to characterize liver fibrosis. However, correlation between relaxation times and fibrosis stage has been controversial. Materials and Methods: Liver fibrosis was induced in male adult C57BL/6N mice (22-25 g; n = 12) by repetitive dosing of carbon tetrachloride (CCl4). The animals were examined with a series of spin-echo (SE) images with varying TRs and multiecho SE imaging sequence at 7 T before and 2, 4, 6, and 8 weeks after CCl4 insult. Hepatic T1 and T2 values were measured. Histology was performed with hematoxylin-eosin staining and Masson's trichrome staining. Results: Significant increase ( P < 0.001) in hepatic T1 was found at 2, 4, 6, and 8 weeks following CCl4 insult as compared with that before insult. Meanwhile, hepatic T2 at 2, 4, 6, and 8 weeks after CCl4 insult was significantly higher ( P < 0.001) than that before the insult. Liver histology showed collagen deposition, edema, and infiltration of inflammatory cells in livers with CCl4 insult. Conclusion: Both longitudinal and transverse relaxation times may serve as robust markers for liver fibrosis. With the advent of single breath-hold sequences for MR relaxometry, quantitative mapping of relaxation times can be routinely and reliably performed in abdominal organs and hence may be valuable and robust in detecting liver fibrosis at early phase and monitoring its progression. J. Magn. Reson. Imaging 2012;36:152-158. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]