Liver Apparent Diffusion Coefficient Changes during Telaprevir-Based Therapy for Chronic Hepatitis C

Year 2016, Volume: 33 Issue: 6, 602 - 606, 01.11.2016

Nagihan İnan Gürcan Zakir Sakçı Sıla Akhan Elif Sargın Altunok Aynur Aynıoğlu Yeşim Gürbüz Hasan Tahsin Sarisoy Gür Akansel

Abstract

Background: Diffusion-weighted imaging (DWI) has become an established diagnostic modality for the evaluation of liver parenchymal changes in diseases such as diffuse liver fibrosis.  Aims: To evaluate the parenchymal apparent diffusion coefficient value (ADC) changes using diffusion-weighted imaging (DWI) during telaprevir-based triple therapy. Study Design: Diagnostic accuracy study. Methods: Seventeen patients with chronic hepatitis C virus (HCV) virus and twenty-five normal volunteers were included. All of the patients took 12-weeks of telaprevir-based triple therapy followed by 12-weeks of PEGylated interferon and ribavirin therapy. They were examined before treatment (BT), as well as 12-weeks (W12) and 24-weeks (W24) after treatment by 3 Tesla magnetic resonance imaging (MRI). DWI was obtained using a breath-hold single-shot echo-planar spin echo sequence. Histopathologically, liver fibrosis was classified in accordance with the modified Knodell score described by Ishak. Quantitatively, liver ADCs were compared between patients and normal volunteers to detect the contribution of DWI in the detection of fibrosis. In addition, liver ADCs were compared during the therapy to analyze the effect of antiviral medication on liver parenchyma.  Results: The liver ADC values of fibrotic liver parenchyma were significantly lower than those of the healthy liver parenchyma (p<0.001). However, we were not able to reach a sufficiently discriminative threshold value. The ADC values showed a declining trend with increasing fibrotic stage. No statistically significant correlation (p=0.204) was observed. Compared with those before treatment, the liver ADC values after telaprevir-based triple therapy were significantly decreased at W12. A significant increase in the liver ADC values was also observed after the cessation of telaprevir therapy at W24 with a return to initial values. Conclusion: Liver ADC values appear to indicate the present but not the stage of liver fibrosis. DWI may be a helpful research tool for the assessment of antiviral drug effects.

Keywords

Liver, fibrosis, magnetic resonance imaging, diffusion-weighted magnetic resonance imaging, chronic hepatitis C, telaprevir

References

• 1. Shiffman ML, Esteban R. Triple therapy for HCV genotype 1 infection: telaprevir or boceprevir? Liver Int 2012;32(Suppl 1): 54-60. [CrossRef]
• 2. Forestier N, Zeuzem S. Triple therapy with telaprevir: results in hepatitis C virus-genotype 1 infected relapsers and non-responders. Liver Int 2012;32(Suppl 1):44-50. [CrossRef]
• 3. Tsochatzis EA, Crossan C, Longworth L, Gurusamy K, Rodriguez-Peralvarez M, Mantzoukis K, et al. Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C. Hepatology 2014;60:832-43. [CrossRef]
• 4. Aubé C, Racineux PX, Lebigot J, Oberti F, Croquet V, Argaud C, et al. [Diagnosis and quantification of hepatic fibrosis with diffusion weighted MR imaging: preliminary results]. J Radiol 2004;85:301-6. [CrossRef]
• 5. Koinuma M, Ohashi I, Hanafusa K, Shibuya H. Apparent diffusion coefficient measurements with diffusion-weighted magnetic resonance imaging for evaluation of hepatic fibrosis. J Magn Reson Imaging 2005;22:80-5. [CrossRef]
• 6. Taouli B, Tolia AJ, Losada M, Babb JS, Chan ES, Bannan MA, et al. Diffusion-weighted MRI for quantification of liver fibrosis: preliminary experience. AJR Am J Roentgenol 2007;189:799- 806. [CrossRef]
• 7. Luciani A, Vignaud A, Cavet M, Nhieu JT, Mallat A, Ruel L, et al. Liver cirrhosis: intravoxel incoherent motion MR imaging- -pilot study. Radiology 2008;249:891-9. [CrossRef]
• 8. Lewin M, Poujol-Robert A, Boëlle PY, Wendum D, Lasnier E, Viallon M, et al. Diffusion-weighted magnetic resonance imaging for the assessment of fibrosis in chronic hepatitis C. Hepatology 2007;46:658-65. [CrossRef]
• 9. Wang Y, Ganger DR, Levitsky J, Sternick LA, McCarthy RJ, Chen ZE, et al. Assessment of chronic hepatitis and fibrosis: comparison of MR elastography and diffusion-weighted imaging. AJR Am J Roentgenol 2011;196:553-61. [CrossRef]
• 10. Watanabe H, Kanematsu M, Goshima S, Kondo H, Onozuka M, Moriyama N, et al. Staging hepatic fibrosis: comparison of gadoxetate disodium-enhanced and diffusion-weighted MR imaging--preliminary observations. Radiology 2011;259:142-50. [CrossRef]
• 11. Girometti R, Esposito G, Bagatto D, Avellini C, Bazzocchi M, Zuiani C. Is water diffusion isotropic in the cirrhotic liver? a study with diffusion-weighted imaging at 3.0 Tesla. Acad Radiol 2012;19:55-61. [CrossRef]
• 12. Sun L, Xia Z, Gong J, Ma J, Huang G, Zang D, et al. Monitor ADC value changes in liver before and after receiving nucleoside analogue antiviral treatment in patients with active hepatitis B virus using diffusion-weighted magnetic resonance imaging value of apparent diffusion coefficient in liver cirrhosis. Journal of Medical Imaging 2013;6:200903027.
• 13. Knodell RG, Ishak KG, Black WC, Chen TS, Craig R, Kaplowitz N, et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1981;1:431. [CrossRef]
• 14. Aguirre DA, Behling CA, Alpert E, Hassanein TI, Sirlin CB. Liver fibrosis: noninvasive diagnosis with double contrast material-enhanced MR imaging. Radiology 2006;239:425-37. [CrossRef]
• 15. Hagiwara M, Rusinek H, Lee VS, Losada M, Bannan MA, Krinsky GA, et al. Advanced liver fibrosis: diagnosis with 3D whole-liver perfusion MR imaging--initial experience. Radiology 2008;246:926-34. [CrossRef]
• 16. Rouvière O, Yin M, Dresner MA, Rossman PJ, Burgart LJ, Fidler JL, et al. MR elastography of the liver: preliminary results. Radiology 2006;240:440-8. [CrossRef]
• 17. Rosenkrantz AB, Oei M, Babb JS, Niver BE, Taouli B. Diffusion-weighted imaging of the abdomen at 3.0 Tesla: image quality and apparent diffusion coefficient reproducibility compared with 1.5 Tesla. J Magn Reson Imaging 2011;33:128-35. [CrossRef]
• 18. Ichikawa T, Haradome H, Hachiya J, Nitatori T, Araki T. Characterization of hepatic lesions by perfusion-weighted MR imaging with an echoplanar sequence. AJR Am J Roentgenol 1998;170:1029-34. [CrossRef]
• 19. Tosun M, Inan N, Sarisoy HT, Akansel G, Gumustas S, Gürbüz Y, et al. Diagnostic performance of conventional diffusion weighted imaging and diffusion tensor imaging for the liver fibrosis and inflammation. Eur J Radiol 2013;82:203-7. [CrossRef]
• 20. Virlogeux V, Pradat P, Bailly F, Funingana G, Gonçalves F, Maynard M, et al. Boceprevir and telaprevir-based triple therapy for chronic hepatitis C: virological efficacy and impact on kidney function and model for end-stage liver disease score. J Viral Hepat 2014;21: e98-107. [CrossRef]