Diagnosis of Liver Fibrosis and Cirrhosis With Diffusion-Weighted Imaging: Value of Normalized Apparent Diffusion Coefficient Using the Spleen as Reference Organ

OBJECTIVE. The purpose of this study is to compare the diagnostic accuracy of liver apparent diffusion coefficient (ADC) versus normalized liver ADC using the spleen as a reference organ for the diagnosis of liver fibrosis and cirrhosis. MATERIALS AND METHODS. Fifty-six patients, 34 with liver disease and 22 control subjects, were assessed with breath-hold single-shot echo-planar diffusion-weighted imaging using b values of 0, 50, and 500 s/mm(2). Liver ADC and normalized liver ADC (defined as the ratio of liver ADC to spleen ADC) were compared between patients stratified by fibrosis stage. Receiver operating characteristic (ROC) analysis was used to determine the performance of ADC and normalized liver ADC for prediction of liver fibrosis and cirrhosis. Reproducibility was assessed by measuring coefficient of variation (n = 7). RESULTS. Liver ADC failed to distinguish individual stages of fibrosis, except between stages 0 and 4. There were significant differences in normalized liver ADC between control livers and intermediate stages of fibrosis (stages 2-3) and cirrhosis (stage 4) and between stages 1 and 4, and there was a trend toward significance between stages 0 and 1 (p = 0.051) and stages 1 and 3 (p = 0.06). ROC analysis showed that normalized liver ADC was superior to liver ADC for detection of stage >= 2 (area under the ROC curve, 0.864 vs 0.655; p = 0.013) and stage >= 3 (0.805 vs 0.689; p = 0.015), without a difference for diagnosing cirrhosis (0.935 vs 0.720; p = 0.185). Normalized liver ADC had higher reproducibility than ADC (mean coefficient of variation, 3.5% vs 12.6%). CONCLUSION. Our results suggest that normalizing liver ADC with spleen ADC improves diagnostic accuracy for detection of liver fibrosis and cirrhosis when using breath-hold diffusion-weighted imaging, with better reproducibility.