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• Clinical Article •
Study on the value of IVIM, DKI and their combination with ultrasound transient elastography in the staging of liver fibrosis in patients with chronic liver disease
YANG Shuyi  ZHAO Xuelian  ZHAO Lichen  JIANG Yanli 

DOI:10.12015/issn.1674-8034.2026.02.014.


[Abstract] Objective This study aimed to compare the application value of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) in the staging diagnosis of liver fibrosis.Materials and Methods A total of 64 patients with chronic liver disease and 17 healthy controls were prospectively enrolled. All participants underwent multi-b-value diffusion-weighted imaging (DWI) and liver transient elastography (TE). Liver fibrosis stage was confirmed by subsequent liver biopsy in patients. The DWI data were post-processed to generate five parameter maps derived from DKI and IVIM models, yielding the parameters apparent diffusivity (MD), excess kurtosis (MK), true diffusion coefficient (D), pseudo-diffusion coefficient (D*) and perfusion fraction (f). TE provided liver stiffness measurement (LSM). Biopsy results served as the gold standard for fibrosis staging. We analyzed parameter differences across fibrosis stages, correlations between DKI/IVIM parameters and LSM, and the diagnostic performance of combined DKI, IVIM, and TE parameters for significant fibrosis (≥ S2).Results Among all parameters, only D showed statistically significant differences across groups (P = 0.029). D (ρ = -0.270, P = 0.031), f (ρ = -0.288, P = 0.021), and MD (ρ = -0.278, P = 0.026) were negatively correlated with LSM. Individual imaging parameters demonstrated moderate diagnostic efficacy for significant fibrosis, with area under the curve (AUC) of receiver operating characteristic ranging from 0.537 to 0.627. The IVIM model achieved an AUC of 0.714 [95% confidence interval (CI): 0.598 to 0.831] for diagnosing significant fibrosis, and the DKI model reached an AUC of 0.717 (95% CI: 0.597 to 0.836). Fusion models combining IVIM with TE and DKI with TE showed significantly higher diagnostic performance, with AUCs of 0.897 (95% CI: 0.825 to 0.970) and 0.901 (95% CI: 0.825 to 0.978), respectively (P < 0.001 vs. single DWI models). Calibration curves indicated that the IVIM-TE fusion model had the best calibration performance.Conclusions DKI and IVIM alone are insufficient for non-invasive diagnosis and staging of liver fibrosis. However, the IVIM-TE fusion model demonstrates promising clinical value for diagnosing significant fibrosis. Integrating multiple imaging modalities may serve as a potential biomarker for significant fibrosis assessment.
[Keywords] hepatic fibrosis；magnetic resonance imaging；diffusion-weighted imaging；intravoxel incoherent motion；diffusion kurtosis imaging；transient elastography

YANG Shuyi1   ZHAO Xuelian2   ZHAO Lichen2   JIANG Yanli3*  

1 Department of Radiology, Zhouqu County People's Hospital, Gannan Tibetan Autonomous Prefecture 746300, China

2 Second Clinical School, Lanzhou University, Lanzhou 730000, China

3 Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China

Corresponding author: JIANG Y L, E-mail: 61961048@qq.com

Conflicts of interest   None.

Received  2025-11-05
Accepted  2026-01-23
DOI: 10.12015/issn.1674-8034.2026.02.014
DOI:10.12015/issn.1674-8034.2026.02.014.

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