Liver Lobe-Based Magnetic Resonance Diffusion Weighted Imaging Using Intravoxel Incoherent Motion In Patients With Liver Cirrhosis: Association With The Presence And Child-Pugh Classification

Objective:To investigate association of liver lobe-based parameters derived from diffusion weighted imaging using intravoxel incoherent motion（IVIM）with the presence and Child-Pugh class of cirrhosis.Methods:The institutional ethics committee in our hospital approved this study and written informed consent from the participants were obtained.Seventy-four cirrhotic patients and 25 healthy volunteers were enrolled and underwent upper abdominal IVIM diffusion weighted imaging with eight b values,which concluded 0,20,50,80,100,200,400,600,800 s/mm².The IVIM derived parameters（pure molecular diffusion,D value;pseudo diffusion,D*value;and perfusion fraction,f value）were measured on the left lateral lobe（LLL）,left medial lobe（LML）,right lobe（RL）and caudate lobe（CL）of liver,respectively.The Kruskal-Wallis test and One-Way ANOVA of variance analysis were performed to compare liver lobe based IVIM derived parameters（D value,D*value,and f value）between the control group and liver cirrhosis group,or among the Child-Pugh class.To assess the correlation between the liver lobe based IVIM derived parameters（D value,D*value,and f value）and the Child-Pugh class,the Spearman rank correlation analysis was used.Receiver operating characteristic（ROC）analysis was performed to investigate which liver lobe based IVIM derived parameters could be excellent at assessing liver cirrhosis and Child-Pugh class.Results:D,D*or f value from the LLL,LML,RL and CL had inverse correlation with the Child-Pugh class（r=-0.236 to-0.606,all p<0.05）.Among liver lobes,D,D*and f of each lobe could differentiate cirrhotic liver from normal liver（all p<0.05）,all IVIM derived parameters were decreasing from normal to cirrhotic liver.According to ROC analysis,D value from RL could best distinguish liver cirrhosis from normal group with an area under the ROC（AUC）of 0.857,and the cut off value,specificity and sensitivity were 1.11×10^-3mm²/s,0.93,and 0.68,respectively.D value from LLL,LML,RL and CL could distinguish Child-Pugh class A and C with AUC of 0.756,0.805,0.759,0.706,respectively.Conclusions:Liver lobe based IVIM derived parameters（D value,D*value,and f value）can be used to assess the presence,and Liver lobe based D value could distinguish Child-Pugh class of liver cirrhosis.