Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2019; 25(11): 1366-1377
Published online Mar 21, 2019. doi: 10.3748/wjg.v25.i11.1366
Diffusion-weighted magnetic resonance imaging and micro-RNA in the diagnosis of hepatic fibrosis in chronic hepatitis C virus
Tarek Besheer, Hatem Elalfy, Mohamed Abd El-Maksoud, Ahmed Abd El-Razek, Saher Taman, Khaled Zalata, Wagdy Elkashef, Hossam Zaghloul, Heba Elshahawy, Doaa Raafat, Wafaa Elemshaty, Eman Elsayed, Abdel-Hady El-Gilany, Mahmoud El-Bendary
Tarek Besheer, Hatem Elalfy, Mohamed Abd El-Maksoud, Mahmoud El-Bendary, Department of Tropical Medicine and Hepatology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
Ahmed Abd El-Razek, Saher Taman, Department of Diagnostic Radiology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
Khaled Zalata, Wagdy Elkashef, Department of Pathology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
Hossam Zaghloul, Heba Elshahawy, Doaa Raafat, Wafaa Elemshaty, Eman Elsayed, Department of Clinical Pathology, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
Abdel-Hady El-Gilany, Department of Public Health and Preventive Medicine, Mansoura Faculty of Medicine - Mansoura University, Mansoura 35111, Egypt
Author contributions: Besheer T, Elalfy H, and El-Bendary M were involved in study conception and design; Abd El-Razek A and Taman S performed radiological imaging; Zaghloul H, Elshahawy H, Raafat D, Elemshaty W, and Elsayed E performed laboratory techniques; Zalata K and Elkashef W performed pathological diagnosis of the liver biopsies; El-Gilany AH and Abd El-Maksoud M acquired the data and performed analysis and interpretation of data; all authors were involved in the drafting and critical revision of the manuscript; all authors approved the final version of the manuscript.
Supported by Science and Technology Development Foundation (STDF), Project NO. 3457 (TC/4/Health/2010/hep-1.6).
Institutional review board statement: The study protocol was reviewed and approved by the institutional ethics committee of the Mansoura Faculty of Medicine. (R.18.04.139.R1-2018/04/17).
Informed consent statement: Written informed consent was obtained from all eligible patients who were included in the study.
Conflict-of-interest statement: No conflict of interest.
STROBE Statement: The guidelines of the STROBE statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mahmoud El-Bendary, MD, Professor, Department of Tropical Medicine and Hepatology, Mansoura Faculty of Medicine - Mansoura University, Elgomhoria Street, Mansoura 35111, Dakahlia, Egypt. mm_elbendary@mans.edu.eg
Telephone: +20-1002592205 Fax: +20-502267016
Received: November 12, 2018
Peer-review started: November 12, 2018
First decision: December 28, 2018
Revised: January 30, 2019
Accepted: February 15, 2019
Article in press: February 15, 2019
Published online: March 21, 2019
Processing time: 129 Days and 2.5 Hours
ARTICLE HIGHLIGHTS
Research background

Hepatitis C virus infection is considered one of the most widespread causes of chronic liver disease that results in cirrhosis, fibrosis together with portal hypertension, and hepatocellular carcinoma. When it is possible to diagnose early hepatic fibrosis, the therapy will be more effective in the reduction of hepatic decompensation and improvement of patient survival. Liver biopsy is considered the gold standard for early detection of hepatic fibrosis, but it is invasive and has many side effects. Multiple non-invasive laboratory and imaging modalities could be used in detection and quantification of hepatic fibrosis but have variable accuracy. The liver contains multiple micro-RNAs (miR) (21, 200b and 29b) that have been correlated to the presence and degree of hepatic fibrosis. Magnetic resonance imaging (MRI) with diffusion-weighted imaging and apparent diffusion coefficient (ADC) can also detect and are correlated with hepatic fibrosis.

Research motivation

Early detection and staging of hepatic fibrosis are of great value in treatment of chronic liver disease caused by hepatitis C virus. The available methods to detect and stage fibrosis are either invasive (like biopsy) or non-invasive (like laboratory and imaging), which is not accurate. The combination of serum markers of hepatic fibrosis (miR 21, 200b and 29b) together with MRI with diffusion-weighted imaging is a potential new dependable and non-invasive method to help in early detection and staging of hepatic fibrosis and cirrhosis.

Research objectives

In this prospective study, we evaluated the role of combining ADC and miR (21, 200b and 29b) as an alternative non-invasive tool for detection and staging of hepatic fibrosis in patients with chronic hepatitis C viral infection.

Research methods

From October 2012 to December 2015, 215 consecutive patients with histopathological evidence of chronic hepatitis C virus cirrhosis were included in our study. Seven cases were excluded, so the final number of the study patients was 208. Diffusion-weighted MRI (DWI) together with hepatitis C serum markers and serum miR (21, 200b and 29b) were performed for all patients. The MRI and laboratory results were compared with that of the control group containing 82 normal volunteers and with the results of liver biopsy histopathological examination.

Research results

In the current study, it was found that there was a significant decrease in ADC values in patients with early hepatic fibrosis and late fibrosis when compared to controls. Combining ADC results and miR data (200b, 21 and 29b) provided a highly sensitive, specific, and accurate tool to differentiate patients with hepatic fibrosis from normal control patients. This tool was best at differentiating patients from controls, with and accuracy of 96.9% and had an accuracy of 80.2% for differentiating early from late fibrosis.

Research conclusions

Combination of ADC and miR (21, 200b and 29b) is considered a safe, easy, and non-invasive tool in the detection and staging of hepatic fibrosis resulting from chronic hepatitis C viral infection.

Research perspectives

Combining imaging and laboratory results in detection and staging of hepatic fibrosis resulting from chronic hepatitis C virus infection is a valuable method because it is easy and non-invasive. However, a study with more patients will generate more accurate results. Also, use of advanced MRI machines with advanced post processing technology like diffusion tensor and diffusion kurtosis will improve the effectiveness and power of our findings.