Comparison between ROI-based and volumetric measurements in quantifying heterogeneity of liver stiffness using MR elastography

Objectives: This study was conducted to quantify the heterogeneity of liver stiffness (LS) on MR elastography (MRE) by comparing ROI-based and volumetric measurements. Methods: LS was measured by ROI-based and volumetric segmentation of the liver parenchyma. Mean LS (MLS) was calculated and used to assign stages of fibrosis. Volumetric measurements of stiffness maps were used to determine the percentage of liver volume above/below MLS and presence of LS heterogeneity. Heterogeneous stiffness was defined when the first and second most predominant stages were more than one category apart. MLS values by each method were compared using the Wilcoxon signed-rank test. Results: We included 128 patients with suspected liver fibrosis (mean age 54.4 ± 14.8 years). MLS was 2.7 ± 1.0 kPa for ROI measurements and 2.6 ± 0.9 kPa for the volumetric method (p = 0.001). Of 59 patients with normal stage (F0), 31 patients (52.5%) had > 20% of liver volume with abnormal LS (F1–F4). Heterogeneous LS was reported in 18 patients (14%). Conclusions: MLS measurement may not represent the entire spectrum of hepatic fibrosis. Volumetric segmentation may potentially improve the detection of heterogeneous fibrosis and the accuracy of LS measurement. Key Points: • Heterogeneity of hepatic fibrosis may occur in patients with chronic liver disease. • MR elastography is used to assess hepatic fibrosis by measuring liver stiffness. • Measuring liver stiffness by the ROI method and reporting a mean value may fail to detect heterogeneity of hepatic fibrosis. Volumetric assessment of liver stiffness by MR elastography may detect heterogeneity of parenchymal involvement.