Clinical utility of mono-exponential model diffusion weighted imaging using two b-values compared to the bi- or stretched exponential model for the diagnosis of biliary atresia in infant liver MRI

Autoři: Jisoo Kim aff001;  Haesung Yoon aff001;  Mi-Jung Lee aff001;  Myung-Joon Kim aff001;  Kyunghwa Han aff001;  Seok Joo Han aff002;  Hong Koh aff002;  Seung Kim aff002;  Hyun Joo Shin aff001
Působiště autorů: Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea aff001;  Severance Pediatric Liver Disease Research Group, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea aff002;  Department of Pediatric Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea aff003;  Department of Pediatric Gastroenterology, Hepatology and Nutrition, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226627



To investigate the clinical utility of mono-exponential model diffusion weighted imaging (DWI) using two b-values compared to the bi- or stretched exponential model to differentiate biliary atresia (BA) from non-BA in pediatric liver magnetic resonance imaging (MRI).


Patients who underwent liver MRI with DWI for suspected BA from November 2017 to September 2018 were retrospectively included and divided into BA and non-BA groups. Laboratory results including γ-glutamyl transferase (γGT) were compared between the two groups using the Mann-Whitney U test and Fisher’s exact test. The hepatic apparent diffusion coefficient (ADC) 10 using ten b-values and ADC 2 using two b-values were obtained from the mono-exponential model. The slow diffusion coefficient (D), fast diffusion coefficient (D*), and perfusion fraction (f) were obtained from the bi-exponential model. The distributed diffusion coefficient (DDC) and heterogeneity index (α) were measured from the stretched exponential model. Parameters were compared between the two groups using a linear mixed model and diagnostic performance was assessed using the area under the curve (AUC) analysis.


For 12 patients in the BA and five patients in the non-BA group, the ADC 10 (median 0.985 ×10−3 mm2/s vs. 1.332 ×10−3 mm2/s, p = 0.008), ADC 2 (median 0.987 ×10−3 mm2/s vs. 1.335 ×10−3 mm2/s, p = 0.017), D* (median 33.2 ×10−3 mm2/s vs. 55.3 ×10−3 mm2/s, p = 0.021), f (median 13.4%, vs. 22.1%, p = 0.009), and DDC (median 0.889 ×10−3 mm2/s vs. 1.323 ×10−3 mm2/s, p = 0.009) values were lower and the γGT (median 368.0 IU/L vs. 93.5 IU/L, p = 0.02) and α (median 0.699 vs. 0.556, p = 0.023) values were higher in the BA group. The AUC values for γGT (AUC 0.867 95% confidence interval [CI] 0.616–0.984), ADC 10 (AUC 0.963, 95% CI 0.834–0.998), ADC 2 (AUC 0.925, 95% CI 0.781–0.987), f (AUC 0.850, 95% CI 0.686–0.949), and DDC (AUC 0.925, 95% CI 0.781–0.987) were not significantly different, except for the D* and α values.


Patients with BA had lower ADC 10, ADC 2, D*, f, and DDC values and higher γGT and α values than those in the non-BA group. The diagnostic performance of ADC 2 using only two b-values showed excellent diagnostic performance and was not significantly different from that of γGT, ADC 10, f, and DDC for diagnosing BA.

Klíčová slova:

Diagnostic medicine – Fatty liver – Liver and spleen scan – Liver fibrosis – Magnetic resonance imaging – Mass diffusivity – Pediatrics – Diffusion weighted imaging


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2019 Číslo 12