DIFFUSE LIVER DISEASE BN Dr. Bengt Norén M. D, Med Lic. Dep. of Radiology and CMIV University Hospital Linköping

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Conventional Biopsy Inflammation Fibrosis/cirrhosis Steatosis Fe BN Fibrosis grading – Biopsy F0- F4 ( Batts and Ludwig ) Grouped into : F0 – F2 F3 – F4

Non Invasive Liver Biopsy ”NILB” BN P MRS 2. DCE-MRI

Fibrosis/cirrhosis ; 31 P MRS BN

Conc mM PMEPiATPbPDE Fibrosis/cirrhosis ; 31 P MRS I Anabolic charge (AC) : [PME] / ([PME] + [PDE]) Patients had a significant larger AC than the control subjects, 0.29 vs 0.16 (p  0.005). BN Noren et al European Radiology, 2005, 15(1),

BN Fibrosis/cirrhosis ; 31 P MRS II

AC Group BN Fibrosis/cirrhosis ; 31 P MRS II

Degree of fibrosis predicted from AC P = Fisher’s exact test Fibrosis grade 0-2 Fibrosis grade 3-4 AC  AC  AC cut-off value of 0.27 showed a sensitivity of 93% and a specificity of 54 %. BN Noren et al European Journal of Radiology, 2008, 66(2), Fibrosis/cirrhosis ; 31 P MRS II

Can we identify and separate different stages of fibrosis by quantitatively measure the uptake of Gd-EOB-DTPA (Primovist) using DCE-MRI ? BN Fibrosis/cirrhosis; DCE-MRI

Prospective study. 38 patients ( 21 men, 17 women) Pathological liver function tests Liver biopsy BN Fibrosis/cirrhosis; DCE-MRI

1.5 T MR (Achieva, Philips Medical Systems ) T1-weighted 3D GRE ( native, arterial and venous portal phase; 3, 10, 20 and 30 min) BN Fibrosis/cirrhosis; DCE-MRI KHep – contrast uptake rate LSC_ N 10 and LSC_ N 20 LSC10 and LSC20

BN F0-2F3-4AUROCp-value† K Hep 0.436±0.255 a 0.293±0.254 c 0, * LSC_N ±0.120 a 1.243±0.138 c 0,80.004** LSC_N ±0.160 b 1.382±0.161 d 0, * LSC ±0.196 a 1.504±0.252 c 0,680,09 LSC ±0.265 b 1.663±0.291 d 0,640,223 Fibrosis/cirrhosis; DCE-MRI

NILB ”Multi parameter Q - MR approach” Inflammation Fibrosis/cirrhosis Steatosis Fe Biopsy MR techniques; MRS - 31 P MRS - 1 H DCE- MRI MRE T2/T2* Diffusion BN ?

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