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Liver ﬁbrosis is a response of stellate cells for chronic injury caused by hepatitis C virus and many other factors. The ﬁbrosis leads to liver cirrhosis after many years, and finally can be deadly.
Liver biopsy is a broadly known technique for detecting and sorting liver ﬁbrosis. But it is related to chief problems in 0.3% of patients and with death in 0.018%). Also, due to the heterogeneity of liver ﬁbrosis, sampling faults can also happen.
Consequently, substitute non-invasive diagnostic methods that can exactly assess liver ﬁbrosis are needed. One such method, transient elastography (TE), is a simple, safe and effective method to evaluate liver fibrosis. FibroScan is the most widespread non-invasive maneuver used to assess liver ‘toughness (or stiffness) via TE. When done in the proper clinical situation, TE delivers a dependable technique of spotting cirrhosis and ignoring significant fibrosis, mainly when the results are reinforced by clinical and laboratory data.
Other method such as diﬀusion weighted imaging (DWI) have been presented to assess liver ﬁbrosis. DWI do not need special devices and can be done within routine clinical work.
Liver fibrosis causes extracellular gathering of collagen and glycosaminoglycans that may limit the cellular water diffusion, thus signifying that DWI may be beneficial for evaluating fibrosis.
But, DWI of the liver is affected by numerous complications. These complications contain susceptibility to movement artefact and poor SNR, especially when strong diffusion-sensitizing gradients (i.e., high b values) are utilized in the scan system.
Most studies of DWI have reported that the apparent diffusion coefficient (ADC) of cirrhotic livers is substantially lesser than that of non-cirrhotic livers. ADC value is a hopeful quantitative method utilized for detection of hepatitis C hepatic fibrosis
A problem to the widespread clinical application of DWI is the lack of standardization of techniques and reproducibility of ADC quantification.
Normalization of ADC using a reference organ that stills persistent across patients or devices may aid decrease changeability in ADC measurement. The spleen can be a perfect reference organ, as it sustains a quite constant ADC even in the situation of chronic liver disease.
In conclusion, our study results stated that normalizing liver ADC by spleen ADC enhance diagnostic accurateness for diagnosing liver fibrosis and cirrhosis when utilizing breathing hold EPI DWI.
• National and international standardization of the MRI technique (normalization of ADC) as a hepatic protocol with standard b values should be settled in grading of grades of fibrosis.
• Multiparametric MR imaging: by combining DWI, hepato-specific contrast-enhanced sequences MRI, and susceptibility weighted image (SWI).
Further studies should be performed
• To evaluate a bigger number of patients.
• To relate DWI with findings attained with newer methods of perfusion MRI and MR elastography and with laboratory serologic markers of fibrosis.
• to use normalized liver ADC as a non-invasive marker for liver fibrosis still to be presented in more prospective studies using free-breathing or respiratory-triggered diffusion techniques.
• To test the reproducibility of the cut-off values derived from our study.