{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T02:27:25Z","timestamp":1789871245597,"version":"4.0.1"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T00:00:00Z","timestamp":1614816000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Siriraj Research Development Fund"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Accurate noninvasive methods for the assessment of liver fibrosis are urgently needed. This prospective study evaluated the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DWI) for the staging of liver fibrosis and proposed a diagnostic algorithm using DWI to identify cirrhosis in patients with chronic viral hepatitis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>One hundred twenty-one treatment-na\u00efve patients with chronic hepatitis B or C were evaluated with DWI followed by liver biopsy on the same day. Breath-hold single-shot echo-planar DWI was performed to measure the apparent diffusion coefficient (ADC) of the liver and spleen. Normalized liver ADC was calculated as the ratio of liver ADC to spleen ADC.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>There was an inverse correlation between fibrosis stage and normalized liver ADC (p&lt;0.05). For the prediction of fibrosis stage \u22652, stage \u22653, and cirrhosis, the area under the receiver-operating curve of normalized liver ADC was 0.603, 0.704, and 0.847, respectively. The normalized liver ADC value \u22641.02\u00d710<jats:sup>\u22123<\/jats:sup> mm<jats:sup>2<\/jats:sup>\/s had 88% sensitivity, 81% specificity, 25% positive predictive value (PPV), and 99% negative predictive value (NPV) for the diagnosis of cirrhosis. Using a sequential approach with the Fibrosis-4 index followed by DWI, normalized liver ADC \u22641.02\u00d710<jats:sup>\u22123<\/jats:sup> mm<jats:sup>2<\/jats:sup>\/s in patients with Fibrosis-4 &gt;3.25 yielded an 80% PPV for cirrhosis, and a 100% NPV to exclude cirrhosis in patients with Fibrosis-4 between 1.45 and 3.25. Only 15.7% of patients would require a liver biopsy. This sequential strategy can reduce DWI examinations by 53.7%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Normalized liver ADC measurement on DWI is an accurate and noninvasive tool for the diagnosis of cirrhosis in patients with chronic viral hepatitis.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0248024","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T18:56:51Z","timestamp":1614884211000},"page":"e0248024","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Diffusion-weighted magnetic resonance imaging for the assessment of liver fibrosis in chronic viral hepatitis"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8334-0267","authenticated-orcid":true,"given":"Phunchai","family":"Charatcharoenwitthaya","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamonthip","family":"Sukonrut","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pornpim","family":"Korpraphong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananya","family":"Pongpaibul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pairash","family":"Saiviroonporn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,3,4]]},"reference":[{"issue":"2","key":"pone.0248024.ref001","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.jhepr.2019.04.002","article-title":"Global progress on the elimination of viral hepatitis as a major public health threat: An analysis of WHO Member State responses 2017","volume":"1","author":"S Smith","year":"2019","journal-title":"JHEP Rep"},{"issue":"1","key":"pone.0248024.ref002","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1155\/2014\/675409","article-title":"Physicians\u2019 practices for diagnosing liver fibrosis in chronic liver diseases: a nationwide, Canadian survey","volume":"28","author":"G Sebastiani","year":"2014","journal-title":"Can J Gastroenterol Hepatol"},{"issue":"1","key":"pone.0248024.ref003","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.jhep.2015.04.006","article-title":"Asociacion Latinoamericana para el Estudio del H. 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