Feasibility study on using the diffusion-weighted imaging liver pulsation artifact as marker of liver fibrosis
Abstract
BackgroundLiver diffusion-weighted imaging (DWI) often shows signal loss in the left lobe due to cardiac pulsation, known as the pulsation artifact.
PurposeThis study was conducted to turn this bug into a feature. We hypothesized that the pulsation artifact, caused by mechanically transmitted waves, is influenced by tissue stiffness and, thereby, indicative of cirrhosis in the left liver lobe. Thus, we evaluated the potential of DWI pulsation artifacts to detect liver cirrhosis.
Study typeThis study included both retrospective patients and prospective healthy volunteers.
Study populationThirteen healthy volunteers, 16 patients with cirrhosis (Ishak 5 or 6), and three patients without cirrhosis (Ishak 0, 1, or 2) were included.
Field Strength/SequenceImaging was performed at 1.5 T and 3 T using echoplanar DWI of the liver with two b-values, b50 = 50 s/mm{superscript 2} and b800 = 800 s/mm{superscript 2}.
AssessmentAfter manual segmentation of the left and right liver lobes, 18 first-order features were extracted from b50 and b800 images. We assumed the pulsation artifact was predominantly present in the left liver lobe in the b800 images. Thus, we computed the ratios of the intensity-normalized b800 features obtained from the left and right liver lobes. Additionally, we performed an intensity normalization to address the sometimes different signal intensities of left and right liver lobe. Then, we conducted a receiver operating characteristic (ROC) analysis to differentiate cirrhotic from non-cirrhotic livers.
Statistical testsROC analysis and leave-one-out bootstrapping were applied, both yielding area under the curve (AUC) values.
ResultsLeft liver pulsation artifacts were more pronounced in non-cirrhotic livers and largely absent in cirrhotic livers. The first quartile feature, i.e. the first quartile of the normalized signal, best distinguished cirrhotic from non-cirrhotic livers (AUC = 0.95; 95% confidence interval 0.87 - 1.00).
Data conclusionThe left liver DWI pulsation artifact reflects liver stiffness and could serve as a simple, intrinsic marker of liver cirrhosis. Analysis of the signal magnitude can differentiate cirrhotic from non-cirrhotic livers.
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BibTeX
@misc{gross2026feasibility,
title = {{Feasibility study on using the diffusion-weighted imaging liver pulsation artifact as marker of liver fibrosis}},
author = {F. J. Gross and F. Guillaume and O. Chaudry and T.-T. Nguyen and I. Abbas and S. Bickelhaupt and S. Mathy and C. Arnold and T. Bäuerle and H.-P. Fautz and K. Hellwig and M. Uder and M. Saake and F. Laun},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.23.26358292},
url = {https://www.medrxiv.org/content/10.64898/2026.10.23.26358292v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Feasibility study on using the diffusion-weighted imaging liver pulsation artifact as marker of liver fibrosis
AU - F. J. Gross
AU - F. Guillaume
AU - O. Chaudry
AU - T.-T. Nguyen
AU - I. Abbas
AU - S. Bickelhaupt
AU - S. Mathy
AU - C. Arnold
AU - T. Bäuerle
AU - H.-P. Fautz
AU - K. Hellwig
AU - M. Uder
AU - M. Saake
AU - F. Laun
PY - 2026
DA - 2026/10/23
PB - medRxiv
DO - 10.64898/2026.10.23.26358292
UR - https://www.medrxiv.org/content/10.64898/2026.10.23.26358292v1
AB - BackgroundLiver diffusion-weighted imaging (DWI) often shows signal loss in the left lobe due to cardiac pulsation, known as the pulsation artifact. PurposeThis study was conducted to turn this bug into a feature. We hypothesized that the pulsation artifact, caused by mechanically transmitted waves, is influenced by tissue stiffness and, thereby, indicative of cirrhosis in the left liver lobe. Thus, we evaluated the potential of DWI pulsation artifacts to detect liver cirrhosis. Study typeThis study included both retrospective patients and prospective healthy volunteers. Study populationThirteen healthy volunteers, 16 patients with cirrhosis (Ishak 5 or 6), and three patients without cirrhosis (Ishak 0, 1, or 2) were included. Field Strength/SequenceImaging was performed at 1.5 T and 3 T using echoplanar DWI of the liver with two b-values, b50 = 50 s/mm{superscript 2} and b800 = 800 s/mm{superscript 2}. AssessmentAfter manual segmentation of the left and right liver lobes, 18 first-order features were extracted from b50 and b800 images. We assumed the pulsation artifact was predominantly present in the left liver lobe in the b800 images. Thus, we computed the ratios of the intensity-normalized b800 features obtained from the left and right liver lobes. Additionally, we performed an intensity normalization to address the sometimes different signal intensities of left and right liver lobe. Then, we conducted a receiver operating characteristic (ROC) analysis to differentiate cirrhotic from non-cirrhotic livers. Statistical testsROC analysis and leave-one-out bootstrapping were applied, both yielding area under the curve (AUC) values. ResultsLeft liver pulsation artifacts were more pronounced in non-cirrhotic livers and largely absent in cirrhotic livers. The first quartile feature, i.e. the first quartile of the normalized signal, best distinguished cirrhotic from non-cirrhotic livers (AUC = 0.95; 95% confidence interval 0.87 - 1.00). Data conclusionThe left liver DWI pulsation artifact reflects liver stiffness and could serve as a simple, intrinsic marker of liver cirrhosis. Analysis of the signal magnitude can differentiate cirrhotic from non-cirrhotic livers.
ER -