MRI定量评价肝脏纤维化的研究进展
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摘要
肝纤维化是各种急性或慢性肝损伤所致的愈合反应。早期诊断及评价肝纤维化并给予干预措施,可以有效控制甚至逆转疾病的进展。近年来,在超声、CT、MRI基础上的多种成像技术用于肝纤维化的定量评估。作者主要对弥散加权成像、扩散张量成像、扩散峰度成像、增强T1 mapping、磁共振弹性成像几种技术的原理及评价肝纤维化的应用进行综述。
Liver fibrosis is a healing reaction caused by various acute or chronic liver injuries. Early diagnosis and evaluation of liver fibrosis and then timely intervention can effectively control or even halt the progression of the disease. In recent years,a variety of imaging techniques based on ultrasound,CT,and MRI have been used for quantitative assessment of hepatic fibrosis. This article aims to review the principle of diffusion-weighted imaging(DWI),diffusion kurtosis imaging(DKI),dynamic contrast-enhanced T1 mapping,and magnetic resonance elastography(MRE) based on MR imaging and the application to liver fibrosis.
Liver fibrosis is a healing reaction caused by various acute or chronic liver injuries. Early diagnosis and evaluation of liver fibrosis and then timely intervention can effectively control or even halt the progression of the disease. In recent years,a variety of imaging techniques based on ultrasound,CT,and MRI have been used for quantitative assessment of hepatic fibrosis. This article aims to review the principle of diffusion-weighted imaging(DWI),diffusion kurtosis imaging(DKI),dynamic contrast-enhanced T1 mapping,and magnetic resonance elastography(MRE) based on MR imaging and the application to liver fibrosis.
引文
[1]Zhang CY,Yuan WG,He P,et al.Liver fibrosis and hepatic stellate cells:Etiology,pathological hallmarks and therapeutic targets.World J Gastroenterol,2016,22(48):10512-10522.
[2]Forner A,Llovet JM,Bruix J.Hepatocellular carcinoma.Lancet,2012,379(9822):1245-1255.
[3]Brancatelli G,Federle MP,Ambrosini R,et al.Cirrhosis:CT and MR imaging evaluation.Eur J Radiol,2007,61(1):57-69.
[4]Chin JL,Pavlides M,Moolla A,et al.Non-invasive markers of liver fibrosis:adjuncts or alternatives to liver biopsy?Front Pharmacol,2016,7(159):1-19.
[5]Lewis S,Dyvorne H,Cui Y,et al.Diffusion-weighted imaging of the liver:techniques and applications.Magn Reson Imaging Clin North Am,2014,22(3):373-395.
[6]Shenoy-Bhangle A,Baliyan V,Kordbacheh H,et al.Diffusion weighted magnetic resonance imaging of liver:Principles,clinical applications and recent updates.World J Hepatol,2017,9(26):1081-1091.
[7]Chilla GS,Tan CH,Xu C,et al.Diffusion weighted magnetic resonance imaging and its recent trend-a survey.Quant Imaging Med Surg,2015,5(3):407-422.
[8]Bonekamp S,Torbenson MS,Kamel IR.Diffusion-weighted magnetic resonance imaging for the staging of liver fibrosis.J Clin Gastroenterol,2011,45(10):885-892.
[9]Lu PX,Huang H,Yuan J,et al.Decreases in molecular diffusion,perfusion fraction and perfusion-related diffusion in fibrotic livers:a prospective clinical intravoxel incoherent motion MR imaging study.Plos One,2014,9(12):e113846.
[10]Patel J,Sigmund EE,Rusinek H,et al.Diagnosis of cirrhosis with intravoxel incoherent motion diffusion MRI and dynamic contrastenhanced MRI alone and in combination:preliminary experience.J Magn Reson Imaging,2010,31(3):589-600.
[11]Dijkstra H,Wolff D,van Melle JP,et al.Diminished liver microperfusion in fontan patients:a biexponential DWI study.Plos One,2017,12(3):e0173149.
[12]Ni P,Lin Y,Zhong Q,et al.Technical advancements and protocol optimization of diffusion-weighted imaging(DWI)in liver.Abdomin Radiol,2016,41(1):189-202.
[13]Tokgoz O,Unal I,Turgut GG,et al.The value of liver and spleen ADC measurements in the diagnosis and follow up of hepatic fibrosis in chronic liver disease.Acta clinica Belgica,2014,69(6):426-432.
[14]Li H,Li N,Xiang Q,et al.Value of hepatic diffusion-weighted magnetic resonance imaging in evaluating liver fibrosis following transarterial chemoembolization with low doses of chemotherapy.Exp Therap Med,2014,8(2):642-646.
[15]Gurcan NI,Sakci Z,Akhan S,et al.Liver apparent diffusion coefficient changes during telaprevir-based therapy for chronic hepatitis C.Balkan Med J,2016,33(6):602-606.
[16]Kovac JD,Jesic R,Stanisavljevic D,et al.MR imaging of primary sclerosing cholangitis:additional value of diffusion-weighted imaging and ADC measurement.Acta Radiol,2013,54(3):242-248.
[17]Besheer T,Razek A,El Bendary M,et al.Does steatosis affect the performance of diffusion-weighted MRI values for fibrosis evaluation in patients with chronic hepatitis C genotype 4?Turkish J Gastroenterol,2017,28(4):283-288.
[18]Harada TL,Saito K,Araki Y,et al.Prediction of high-stage liver fibrosis using ADC value on diffusion-weighted imaging and quantitative enhancement ratio at the hepatobiliary phase of GdEOB-DTPA-enhanced MRI at 1.5 T.Acta Radiol,2017,59(5):509-516.
[19]Zhan Y,Liang X,Han X,et al.Correlation between the m RNA expression of tissue inhibitor of metalloproteinase-1 and apparent diffusion coefficient on diffusion-weighted imaging in rats'liver fibrosis.J Central South University Med Sci,2017,42(2):161-167.
[20]Zhang H,Yang Q,Yu T,et al.Comparison of T2,T1rho,and diffusion metrics in assessment of liver fibrosis in rats.J Magn Reson Imaging,2017,45(3):741-750.
[21]Ichikawa S,Motosugi U,Morisaka H,et al.MRI-based staging of hepatic fibrosis:comparison of intravoxel incoherent motion diffusion-weighted imaging with magnetic resonance elastography.J Magn Reson Imaging,2015,42(1):204-210.
[22]Dyvorne HA,Jajamovich GH,Bane O,et al.Prospective comparison of magnetic resonance imaging to transient elastography and serum markers for liver fibrosis detection.Liver Int,2016,36(5):659-666.
[23]Li X,Liang Q,Zhuang L,et al.Preliminary study of MR diffusion tensor imaging of the liver for the diagnosis of hepatocellular carcinoma.Plos One,2015,10(8):e0135568.
[24]Shen YQ,Hu DY,Li JJ,et al.Diffusion tensor imaging in quantification of two kinds of liver fibrosis animal model.Radiol Pract,2012,27(2):145-150.沈亚琪,胡道予,李建军,等.DTI对两种肝纤维化动物模型的定量研究.放射学实践,2012,27(2):145-150.
[25]Cheung JS,Fan SJ,Gao DS,et al.Diffusion tensor imaging of liver fibrosis in an experimental model.J Magn Reson Imaging,2010,32(5):1141-1148.
[26]Tosun M,Inan N,Sarisoy HT,et al.Diagnostic performance of conventional diffusion weighted imaging and diffusion tensor imaging for the liver fibrosis and inflammation.Eur J Radiol,2013,82(2):203-207.
[27]Taouli B,Chouli M,Martin AJ,et al.Chronic hepatitis:role of diffusion-weighted imaging and diffusion tensor imaging for the diagnosis of liver fibrosis and inflammation.J Magn Reson Imaging,2008,28(1):89-95.
[28]Lee Y,Kim H.Assessment of diffusion tensor MR imaging(DTI)in liver fibrosis with minimal confounding effect of hepatic steatosis.Magn Reson Med,2015,73(4):1602-1608.
[29]Sheng RF,Wang HQ,Yang L,et al.Diffusion kurtosis imaging and diffusion-weighted imaging in assessment of liver fibrosis stage and necroinflammatory activity.Abdom Radiol,2017,42(4):1176-1182.
[30]Rosenkrantz AB,Sigmund EE,Winnick A,et al.Assessment of hepatocellular carcinoma using apparent diffusion coefficient and diffusion kurtosis indices:preliminary experience in fresh liver explants.Magn Reson Imaging,2012,30(10):1534-1540.
[31]Filli L,Wurnig M,Nanz D,et al.Whole-body diffusion kurtosis imaging:initial experience on non-Gaussian diffusion in various organs.Invest Radiol,2014,49(12):773-778.
[32]Hu G,Liang W,Wu M,et al.Staging of rat liver fibrosis using monoexponential,stretched exponential and diffusion kurtosis models with diffusion weighted imaging-magnetic resonance.Oncotarget,2018,9(2):2357-2366.
[33]Yang L,Rao S,Wang W,et al.Staging liver fibrosis with DWI:is there an added value for diffusion kurtosis imaging?Eur Radiol,2018,28(7):3041-3049.
[34]Yoshimaru D,Miyati T,Suzuki Y,et al.Diffusion kurtosis imaging with the breath-hold technique for staging hepatic fibrosis:a preliminary study.Magn Resone Iimaging,2018,47:33-38.
[35]Petitclerc L,Gilbert G,Nguyen BN,et al.Liver fibrosis quantification by magnetic resonance imaging.Top Magn Reson Imaging,2017,26(6):229-241.
[36]Venkatesh SK,Wells ML,Miller FH,et al.Magnetic resonance elastography:beyond liver fibrosis-a case-based pictorial review.Abdom Radiol,2017:1-22.
[37]Venkatesh SK,Yin M,Ehman RL.Magnetic resonance elastography of liver:technique,analysis,and clinical applications.J Magn Reson Imaging,2013,37(3):544-555.
[38]Kim BH,Lee JM,Lee YJ,et al.MR elastography for noninvasive assessment of hepatic fibrosis:experience from a tertiary center in Asia.J Magn Reson Imaging,2011,34(5):1110-1116.
[39]Godfrey EM,Patterson AJ,Priest AN,et al.A comparison of MR elastography and 31P MR spectroscopy with histological staging of liver fibrosis.Eur Radiol,2012,22(12):2790-2797.
[40]Ichikawa S,Motosugi U,Ichikawa T,et al.Magnetic resonance elastography for staging liver fibrosis in chronic hepatitis C.Magn Reson Med Sci,2012,11(4):291-297.
[41]Choi YR,Lee JM,Yoon JH,et al.Comparison of magnetic resonance elastography and gadoxetate disodium-enhanced magnetic resonance imaging for the evaluation of hepatic fibrosis.Inves Radiol,2013,48(8):607-613.
[42]Batheja M,Vargas H,Silva AM,et al.Magnetic resonance elastography(MRE)in assessing hepatic fibrosis:performance in a cohort of patients with histological data.Abdom Imaging,2015,40(4):760-765.
[43]Wang J,Malik N,Yin M,et al.Magnetic resonance elastography is accurate in detecting advanced fibrosis in autoimmune hepatitis.World J Gastroenterol,2017,23(5):859-868.
[44]Yin M,Glaser KJ,Talwalkar JA,et al.Hepatic MR Elastography:clinical performance in a series of 1377 consecutive examinations.Radiology,2016,278(1):114-124.
[45]Wang J,Glaser KJ,Zhang T,et al.Assessment of advanced hepatic MR elastography methods for susceptibility artifact suppression in clinical patients.J Magn Reson Imaging,2018,47(4):976-987.
[46]Barr RG,Ferraioli G,Palmeri ML,et al.Elastography assessment of liver fibrosis:society of radiologists in ultrasound consensus conference statement.Radiology,2015,276(3):845-861.
[47]Wang LL,Lei LQ,Guo JG,et al.The study of Gd-EOB-DTPA enhanced MRI for the evaluation of liver funtion.J Clin Hepatol,2015,(5):749-753.王莉莉,雷军强,郭吉刚,等.钆塞酸二钠特异性增强磁共振成像评估肝功能的临床价值.临床肝胆病杂志,2015,(5):749-753.
[48]Sheng RF,Wang HQ,Yang L,et al.Assessment of liver fibrosis using T1 mapping on Gd-EOB-DTPA-enhanced magnetic resonance.Digest Liver Dis,2017,49(7):789-795.
[49]Haimerl M,Verloh N,Zeman F,et al.Assessment of clinical signs of liver cirrhosis using T1 mapping on Gd-EOB-DTPA-Enhanced 3T MRI.Plos One,2013,8(12):e85658.
[50]Besa C,Bane O,Jajamovich G,et al.3D T1 relaxometry pre and post gadoxetic acid injection for the assessment of liver cirrhosis and liver function.Magn Reson Imaging,2015,33(9):1075-1082.
[51]Ding Y,Rao SX,Zhu T,et al.Liver fibrosis staging using T1mapping on gadoxetic acid-enhanced MRI compared with DW imaging.Clin Radiol,2015,70(10):1096-1103.
[52]Haimerl M,Utpatel K,Verloh N,et al.Gd-EOB-DTPA-enhanced MR relaxometry for the detection and staging of liver fibrosis.Sci Rep,2017,7(10):1-10.
[53]Ding Y,Rao S,Yang L,et al.Comparison of the effect of region-ofinterest methods using gadoxetic acid-enhanced MR imaging with diffusion-weighted imaging on staging hepatic fibrosis.Radiol Med,2016,121(11):821-827.
[54]Yang L,Ding Y,Rao S,et al.Staging liver fibrosis in chronic hepatitis B with T1 relaxation time index on gadoxetic acid-enhanced MRI:comparison with aspartate aminotransferase-to-platelet ratio index and FIB-4.J Magn Reson imaging,2017,45(4):1186-1194.
[55]Tang A,Cloutier G,Szeverenyi NM,et al.Ultrasound elastography and mr elastography for assessing liver fibrosis:Part 2,diagnostic performance,confounders,and future directions.AJR Am J Roentgenol,2015,205(1):33-40.
[2]Forner A,Llovet JM,Bruix J.Hepatocellular carcinoma.Lancet,2012,379(9822):1245-1255.
[3]Brancatelli G,Federle MP,Ambrosini R,et al.Cirrhosis:CT and MR imaging evaluation.Eur J Radiol,2007,61(1):57-69.
[4]Chin JL,Pavlides M,Moolla A,et al.Non-invasive markers of liver fibrosis:adjuncts or alternatives to liver biopsy?Front Pharmacol,2016,7(159):1-19.
[5]Lewis S,Dyvorne H,Cui Y,et al.Diffusion-weighted imaging of the liver:techniques and applications.Magn Reson Imaging Clin North Am,2014,22(3):373-395.
[6]Shenoy-Bhangle A,Baliyan V,Kordbacheh H,et al.Diffusion weighted magnetic resonance imaging of liver:Principles,clinical applications and recent updates.World J Hepatol,2017,9(26):1081-1091.
[7]Chilla GS,Tan CH,Xu C,et al.Diffusion weighted magnetic resonance imaging and its recent trend-a survey.Quant Imaging Med Surg,2015,5(3):407-422.
[8]Bonekamp S,Torbenson MS,Kamel IR.Diffusion-weighted magnetic resonance imaging for the staging of liver fibrosis.J Clin Gastroenterol,2011,45(10):885-892.
[9]Lu PX,Huang H,Yuan J,et al.Decreases in molecular diffusion,perfusion fraction and perfusion-related diffusion in fibrotic livers:a prospective clinical intravoxel incoherent motion MR imaging study.Plos One,2014,9(12):e113846.
[10]Patel J,Sigmund EE,Rusinek H,et al.Diagnosis of cirrhosis with intravoxel incoherent motion diffusion MRI and dynamic contrastenhanced MRI alone and in combination:preliminary experience.J Magn Reson Imaging,2010,31(3):589-600.
[11]Dijkstra H,Wolff D,van Melle JP,et al.Diminished liver microperfusion in fontan patients:a biexponential DWI study.Plos One,2017,12(3):e0173149.
[12]Ni P,Lin Y,Zhong Q,et al.Technical advancements and protocol optimization of diffusion-weighted imaging(DWI)in liver.Abdomin Radiol,2016,41(1):189-202.
[13]Tokgoz O,Unal I,Turgut GG,et al.The value of liver and spleen ADC measurements in the diagnosis and follow up of hepatic fibrosis in chronic liver disease.Acta clinica Belgica,2014,69(6):426-432.
[14]Li H,Li N,Xiang Q,et al.Value of hepatic diffusion-weighted magnetic resonance imaging in evaluating liver fibrosis following transarterial chemoembolization with low doses of chemotherapy.Exp Therap Med,2014,8(2):642-646.
[15]Gurcan NI,Sakci Z,Akhan S,et al.Liver apparent diffusion coefficient changes during telaprevir-based therapy for chronic hepatitis C.Balkan Med J,2016,33(6):602-606.
[16]Kovac JD,Jesic R,Stanisavljevic D,et al.MR imaging of primary sclerosing cholangitis:additional value of diffusion-weighted imaging and ADC measurement.Acta Radiol,2013,54(3):242-248.
[17]Besheer T,Razek A,El Bendary M,et al.Does steatosis affect the performance of diffusion-weighted MRI values for fibrosis evaluation in patients with chronic hepatitis C genotype 4?Turkish J Gastroenterol,2017,28(4):283-288.
[18]Harada TL,Saito K,Araki Y,et al.Prediction of high-stage liver fibrosis using ADC value on diffusion-weighted imaging and quantitative enhancement ratio at the hepatobiliary phase of GdEOB-DTPA-enhanced MRI at 1.5 T.Acta Radiol,2017,59(5):509-516.
[19]Zhan Y,Liang X,Han X,et al.Correlation between the m RNA expression of tissue inhibitor of metalloproteinase-1 and apparent diffusion coefficient on diffusion-weighted imaging in rats'liver fibrosis.J Central South University Med Sci,2017,42(2):161-167.
[20]Zhang H,Yang Q,Yu T,et al.Comparison of T2,T1rho,and diffusion metrics in assessment of liver fibrosis in rats.J Magn Reson Imaging,2017,45(3):741-750.
[21]Ichikawa S,Motosugi U,Morisaka H,et al.MRI-based staging of hepatic fibrosis:comparison of intravoxel incoherent motion diffusion-weighted imaging with magnetic resonance elastography.J Magn Reson Imaging,2015,42(1):204-210.
[22]Dyvorne HA,Jajamovich GH,Bane O,et al.Prospective comparison of magnetic resonance imaging to transient elastography and serum markers for liver fibrosis detection.Liver Int,2016,36(5):659-666.
[23]Li X,Liang Q,Zhuang L,et al.Preliminary study of MR diffusion tensor imaging of the liver for the diagnosis of hepatocellular carcinoma.Plos One,2015,10(8):e0135568.
[24]Shen YQ,Hu DY,Li JJ,et al.Diffusion tensor imaging in quantification of two kinds of liver fibrosis animal model.Radiol Pract,2012,27(2):145-150.沈亚琪,胡道予,李建军,等.DTI对两种肝纤维化动物模型的定量研究.放射学实践,2012,27(2):145-150.
[25]Cheung JS,Fan SJ,Gao DS,et al.Diffusion tensor imaging of liver fibrosis in an experimental model.J Magn Reson Imaging,2010,32(5):1141-1148.
[26]Tosun M,Inan N,Sarisoy HT,et al.Diagnostic performance of conventional diffusion weighted imaging and diffusion tensor imaging for the liver fibrosis and inflammation.Eur J Radiol,2013,82(2):203-207.
[27]Taouli B,Chouli M,Martin AJ,et al.Chronic hepatitis:role of diffusion-weighted imaging and diffusion tensor imaging for the diagnosis of liver fibrosis and inflammation.J Magn Reson Imaging,2008,28(1):89-95.
[28]Lee Y,Kim H.Assessment of diffusion tensor MR imaging(DTI)in liver fibrosis with minimal confounding effect of hepatic steatosis.Magn Reson Med,2015,73(4):1602-1608.
[29]Sheng RF,Wang HQ,Yang L,et al.Diffusion kurtosis imaging and diffusion-weighted imaging in assessment of liver fibrosis stage and necroinflammatory activity.Abdom Radiol,2017,42(4):1176-1182.
[30]Rosenkrantz AB,Sigmund EE,Winnick A,et al.Assessment of hepatocellular carcinoma using apparent diffusion coefficient and diffusion kurtosis indices:preliminary experience in fresh liver explants.Magn Reson Imaging,2012,30(10):1534-1540.
[31]Filli L,Wurnig M,Nanz D,et al.Whole-body diffusion kurtosis imaging:initial experience on non-Gaussian diffusion in various organs.Invest Radiol,2014,49(12):773-778.
[32]Hu G,Liang W,Wu M,et al.Staging of rat liver fibrosis using monoexponential,stretched exponential and diffusion kurtosis models with diffusion weighted imaging-magnetic resonance.Oncotarget,2018,9(2):2357-2366.
[33]Yang L,Rao S,Wang W,et al.Staging liver fibrosis with DWI:is there an added value for diffusion kurtosis imaging?Eur Radiol,2018,28(7):3041-3049.
[34]Yoshimaru D,Miyati T,Suzuki Y,et al.Diffusion kurtosis imaging with the breath-hold technique for staging hepatic fibrosis:a preliminary study.Magn Resone Iimaging,2018,47:33-38.
[35]Petitclerc L,Gilbert G,Nguyen BN,et al.Liver fibrosis quantification by magnetic resonance imaging.Top Magn Reson Imaging,2017,26(6):229-241.
[36]Venkatesh SK,Wells ML,Miller FH,et al.Magnetic resonance elastography:beyond liver fibrosis-a case-based pictorial review.Abdom Radiol,2017:1-22.
[37]Venkatesh SK,Yin M,Ehman RL.Magnetic resonance elastography of liver:technique,analysis,and clinical applications.J Magn Reson Imaging,2013,37(3):544-555.
[38]Kim BH,Lee JM,Lee YJ,et al.MR elastography for noninvasive assessment of hepatic fibrosis:experience from a tertiary center in Asia.J Magn Reson Imaging,2011,34(5):1110-1116.
[39]Godfrey EM,Patterson AJ,Priest AN,et al.A comparison of MR elastography and 31P MR spectroscopy with histological staging of liver fibrosis.Eur Radiol,2012,22(12):2790-2797.
[40]Ichikawa S,Motosugi U,Ichikawa T,et al.Magnetic resonance elastography for staging liver fibrosis in chronic hepatitis C.Magn Reson Med Sci,2012,11(4):291-297.
[41]Choi YR,Lee JM,Yoon JH,et al.Comparison of magnetic resonance elastography and gadoxetate disodium-enhanced magnetic resonance imaging for the evaluation of hepatic fibrosis.Inves Radiol,2013,48(8):607-613.
[42]Batheja M,Vargas H,Silva AM,et al.Magnetic resonance elastography(MRE)in assessing hepatic fibrosis:performance in a cohort of patients with histological data.Abdom Imaging,2015,40(4):760-765.
[43]Wang J,Malik N,Yin M,et al.Magnetic resonance elastography is accurate in detecting advanced fibrosis in autoimmune hepatitis.World J Gastroenterol,2017,23(5):859-868.
[44]Yin M,Glaser KJ,Talwalkar JA,et al.Hepatic MR Elastography:clinical performance in a series of 1377 consecutive examinations.Radiology,2016,278(1):114-124.
[45]Wang J,Glaser KJ,Zhang T,et al.Assessment of advanced hepatic MR elastography methods for susceptibility artifact suppression in clinical patients.J Magn Reson Imaging,2018,47(4):976-987.
[46]Barr RG,Ferraioli G,Palmeri ML,et al.Elastography assessment of liver fibrosis:society of radiologists in ultrasound consensus conference statement.Radiology,2015,276(3):845-861.
[47]Wang LL,Lei LQ,Guo JG,et al.The study of Gd-EOB-DTPA enhanced MRI for the evaluation of liver funtion.J Clin Hepatol,2015,(5):749-753.王莉莉,雷军强,郭吉刚,等.钆塞酸二钠特异性增强磁共振成像评估肝功能的临床价值.临床肝胆病杂志,2015,(5):749-753.
[48]Sheng RF,Wang HQ,Yang L,et al.Assessment of liver fibrosis using T1 mapping on Gd-EOB-DTPA-enhanced magnetic resonance.Digest Liver Dis,2017,49(7):789-795.
[49]Haimerl M,Verloh N,Zeman F,et al.Assessment of clinical signs of liver cirrhosis using T1 mapping on Gd-EOB-DTPA-Enhanced 3T MRI.Plos One,2013,8(12):e85658.
[50]Besa C,Bane O,Jajamovich G,et al.3D T1 relaxometry pre and post gadoxetic acid injection for the assessment of liver cirrhosis and liver function.Magn Reson Imaging,2015,33(9):1075-1082.
[51]Ding Y,Rao SX,Zhu T,et al.Liver fibrosis staging using T1mapping on gadoxetic acid-enhanced MRI compared with DW imaging.Clin Radiol,2015,70(10):1096-1103.
[52]Haimerl M,Utpatel K,Verloh N,et al.Gd-EOB-DTPA-enhanced MR relaxometry for the detection and staging of liver fibrosis.Sci Rep,2017,7(10):1-10.
[53]Ding Y,Rao S,Yang L,et al.Comparison of the effect of region-ofinterest methods using gadoxetic acid-enhanced MR imaging with diffusion-weighted imaging on staging hepatic fibrosis.Radiol Med,2016,121(11):821-827.
[54]Yang L,Ding Y,Rao S,et al.Staging liver fibrosis in chronic hepatitis B with T1 relaxation time index on gadoxetic acid-enhanced MRI:comparison with aspartate aminotransferase-to-platelet ratio index and FIB-4.J Magn Reson imaging,2017,45(4):1186-1194.
[55]Tang A,Cloutier G,Szeverenyi NM,et al.Ultrasound elastography and mr elastography for assessing liver fibrosis:Part 2,diagnostic performance,confounders,and future directions.AJR Am J Roentgenol,2015,205(1):33-40.