Comparison of the effect of region-of-interest methods using gadoxetic acid-enhanced MR imaging with diffusion-weighted imaging on staging hepatic fibrosis

To evaluate the utility of T1 mapping on gadoxetic acid-enhanced MRI and DWI for staging liver fibrosis and assess the influence of ROI positioning on interobserver variability, T1 relaxation time and ADC value. This retrospective study was approved by the institutional review board and included 150 patients (mean age 58 years old; 91 men and 59 women). Liver fibrosis stages (S) were histopathologically determined. T1 relaxation time and ADC value of liver were measured by three distinct ROI protocols (the whole left lobe liver, the whole right lobe liver and the individual ROIs). T1 relaxation time measurements were compared with ADC values according to S scores. Interobserver variability for the T1 relaxation times and ADC values by the three distinct ROI protocols was analyzed by calculating the ICC. T1 relaxation time measurements by the three distinct ROI protocols on severe fibrosis stage were significantly higher than the relative values on mild fibrosis stage. The mean ADC values on severe fibrosis stage showed no significantly different when measured by means of the whole right lobe liver (p = 0.057) and the individual ROIs (p = 0.10), compared with the relative values on mild fibrosis stage. AUCs of T1 relaxation time and ADC value by the means of the three distinct ROI protocols were 0.614, 0.676, 0.677 and 0.656, 0.585, 0.575 for identification of severe fibrosis stage. The interobserver reproducibility was excellent for measuring the right lobe liver T1 relaxation time and the individual ROIs T1 relaxation time (ICC 0.814, 0.883, respectively). T1 relaxation time measurements by means of the three distinct ROI protocols on gadoxetic acid-enhanced MR imaging were a potential biomarker in staging of hepatic fibrosis, which were more accuracy than DWI-ADC measurements. The more reproducible results were obtained when measuring T1 relaxation time of the whole right lobe liver and the individual ROIs.