Non-contrast based approach for liver function quantification using Bayesian-based intravoxel incoherent motion diffusion weighted imaging: A pilot study

Monchai Phonlakrai; Saadallah Ramadan; John Simpson; Kate Skehan; Jonathan Goodwin; Yuvnik Trada; Jarad Martin; Swetha Sridharan; Lay Theng Gan; Sabbir Hossain Siddique; Peter Greer

doi:10.1002/acm2.14178

Non-contrast based approach for liver function quantification using Bayesian-based intravoxel incoherent motion diffusion weighted imaging: A pilot study

J Appl Clin Med Phys. 2023 Nov;24(11):e14178. doi: 10.1002/acm2.14178. Epub 2023 Oct 11.

Authors

Monchai Phonlakrai^{1

2}, Saadallah Ramadan^{3

4}, John Simpson^{5

6}, Kate Skehan⁵, Jonathan Goodwin^{5

6}, Yuvnik Trada^{5

7}, Jarad Martin^{5

8}, Swetha Sridharan^{5

8}, Lay Theng Gan⁹, Sabbir Hossain Siddique¹⁰, Peter Greer^{5

6}

Affiliations

¹ School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.
² School of Radiological Technology, Faculty of Health Science Technology, Chulabhorn Royal Academy, Bangkok, Thailand.
³ HMRI Imaging Centre, Hunter Medical Research Institute, Newcastle, NSW, Australia.
⁴ College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.
⁵ Radiation Oncology Department, Calvary Mater Newcastle, Newcastle, NSW, Australia.
⁶ School of Information and Physical Sciences, College of Engineering, Science and Environment, The University of Newcastle, Newcastle, NSW, Australia.
⁷ Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
⁸ School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, NSW, Australia.
⁹ The Gastroenterology Department at John Hunter Hospital, Newcastle, NSW, Australia.
¹⁰ Hunter New England Imaging, John Hunter Hospital, Newcastle, NSW, Australia.

Abstract

Purpose: Liver cirrhosis disrupts liver function and tissue perfusion, detectable by magnetic resonance imaging (MRI). Assessing liver function at the voxel level with 13-b value intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) could aid in radiation therapy liver-sparing treatment for patients with early impairment. This study aimed to evaluate the feasibility of IVIM-DWI for liver function assessment and correlate it with other multiparametric (mp) MRI methods at the voxel level.

Method: This study investigates the variability of apparent diffusion coefficient (ADC) derived from 13-b value IVIM-DWI and B1-corrected dual flip angle (DFA) T1 mapping. Experiments were conducted in-vitro with QIBA and NIST phantoms and in 10 healthy volunteers for IVIM-DWI. Additionally, 12 patients underwent an mp-MRI examination. The imaging protocol included a 13-b value IVIM-DWI sequence for generating IVIM parametric maps. B1-corrected DFA T1 pulse sequence was used for generating T1 maps, and Gadoxatate low temporal resolution dynamic contrast-enhanced (LTR-DCE) MRI was used for generating the Hepatic extraction fraction (HEF) map. The Mann-Whitney U test was employed to compare IVIM-DWI parameters (Pure Diffusion, D_slow ; Pseudo diffusion, D_fast ; and Perfusion Fraction, F_p ) between the healthy volunteer and patient groups. Furthermore, in the patient group, statistical correlations were assessed at a voxel level between LTR-DCE MRI-derived HEF, T1 post-Gadoxetate administration, ΔT1%, and various IVIM parameters using Pearson correlation.

Results: For-vitro measurements, the maximum coefficient of variation of the ADC and T1 parameters was 12.4% and 16.1%, respectively. The results also showed that F_p and D_fast were able to distinguish between healthy liver function and mild liver function impairment at the global level, with p = 0.002 for F_p and p < 0.001 for D_fast . Within the patient group, these parameters also exhibited a moderate correlation with HEF at the voxel level.

Conclusion: Overall, the study highlighted the potential of D_fast and F_p for detecting liver function impairment at both global and pixel levels.

Keywords: DCE-MRI; HCC; T1 mapping; intravoxel incoherent motion diffusion; liver cirrhosis; liver function.

MeSH terms

Bayes Theorem
Humans
Liver Cirrhosis* / diagnostic imaging
Motion
Pilot Projects