Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2022; 28(20): 2214-2226
Published online May 28, 2022. doi: 10.3748/wjg.v28.i20.2214
Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced magnetic resonance imaging for evaluating fibrosis regression in chronic hepatitis C patients after direct-acting antiviral
Xiao-He Li, Rui Huang, Ming Yang, Jian Wang, Ying-Hui Gao, Qian Jin, Dan-Li Ma, Lai Wei, Hui-Ying Rao
Xiao-He Li, Rui Huang, Ming Yang, Jian Wang, Ying-Hui Gao, Qian Jin, Dan-Li Ma, Lai Wei, Hui-Ying Rao, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Peking University People’s Hospital, Beijing 100044, China
Ming Yang, Lai Wei, Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 100044, China
Author contributions: Li XH, Rao HY and Wei L designed the protocol of this study; Li XH, Huang R, Yang M, Wang J, Gao YH, Jin Q and Ma DL collected the data; Li XH analyzed and interpreted the patient data and was major contributors in writing the manuscript; Wei L and Rao HY give advice in study design, statistical analysis and writing the manuscript; All authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81870406; and Nature Science Foundation of Beijing Municipality, No. 7182174.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Peking University People’s Hospital (2020PHB039-01), and the requirement for patient informed consent was waived.
Informed consent statement: Patients were not required to provide informed consent for this study, as the analysis used anonymous clinical data. The Institutional Review Board of Peking University People’s Hospital approved waiving the requirement for patient informed consent.
Conflict-of-interest statement: Prof. Rao reports grants from National Natural Science Foundation of China (NSFC), No. 81870406, and Beijing Natural Science Foundation, No. 7182174 during the conduct of the study.
Data sharing statement: No additional data are available.
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 NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Ying Rao, MD, Chief Doctor, Professor, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Peking University People’s Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing 100044, China. rao.huiying@163.com
Received: September 30, 2021
Peer-review started: September 30, 2021
First decision: March 11, 2022
Revised: March 25, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: May 28, 2022
ARTICLE HIGHLIGHTS
Research background

The histological change and non-invasive method surveillance after hepatitis C virus (HCV) eradication by direct acting antiviral (DAA) therapy have not been elucidated. As using a liver-specific magnetic resonance imaging (MRI) contrast, whether Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) enhanced MRI can be used to diagnose and follow-up the liver fibrosis in patients with chronic hepatitis C (CHC) has not been investigated.

Research motivation

The key issues are whether Gd-EOB-DTPA enhanced MRI can be used in diagnosing and following-up in patients with CHC. The result will provide important information on non-invasive method selection for dynamic assessment of liver fibrosis in patients with CHC and histology change after achieving SVR treated by DAAs.

Research objectives

To investigated the diagnostic and follow-up values of Gd-EOB-DTPA-enhanced MRI for hepatic histology in patients with CHC. We further explore the value of Gd-EOB-DTPA enhanced MRI in evaluating fibrosis regression in patients with CHC after achieving sustained virological response (SVR) treated by DAAs.

Research methods

Chronic HCV infected patients with paired liver biopsy and Gd-EOB-DTPA enhanced MRI before and after DAA treated was included. Contrast enhancement index (CEI) was calculated according with signal intensity via MRI, and the correlation between CEI and histology change was evaluated. Fibrosis regression was defined as a ≥ 1-point decrease in the Ishak fibrosis score. The diagnostic and follow-up values of the CEI, liver stiffness measurements (LSM), aminotransferase (AST)-to-platelet ratio (APRI) and Fibrosis-4 (FIB-4) were compared.

Research results

Thirty-nine patients with CHC were enrolled, with average age of 42.3 ± 14.4 years and 20/39 (51.3%) were male. Twenty-one enrolled patients had eligible paired Gd-EOB-DTPA-enhanced MRI and liver tissues after achieving SVR. According to correlation and the hierarchical analysis, the CEI mainly decreased with the progression of liver fibrosis. Compared with LSM, APRI and FIB-4, the CEI is more useful for liver fibrosis diagnosis, the correlation between the CEI and fibrosis stage was relatively stable and was not related to the treatment state. In paired analysis using liver pathology and CEI before and after treatment, only the dynamic change in the CEI can be used to evaluate fibrosis regression after achieving SVR.

Research conclusions

The CEI of Gd-EOB-DTPA-enhanced MRI can be used as a non-invasive method to diagnose liver fibrosis in patients with CHC. The dynamic change of the CEI can be used to monitor fibrosis regression post SVR in patients with CHC after DAA therapy.

Research perspectives

Larger and longer-term prospective studies in patients with CHC should be performed in future studies.