Comparison between magnetic resonance and ultrasound-derived indicators of hepatic steatosis in a pooled NAFLD cohort

Abstract

Background & aims MRI-based proton density fat fraction (PDFF) and the ultrasound-derived controlled attenuation parameter (CAP) are non-invasive techniques for quantifying liver fat, which can be used to assess steatosis in patients with non-alcoholic fatty liver disease (NAFLD). This study compared both of these techniques to histopathological graded steatosis for the assessment of fat levels in a large pooled NAFLD cohort. Methods This retrospective study pooled N = 581 participants from two suspected NAFLD cohorts (mean age (SD) 56 (12.7), 60% females). Steatosis was graded according to NASH-CRN criteria. Liver fat was measured non-invasively using PDFF (with Liver MultiScan’s Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation method, LMS-IDEAL, Perspectum, Oxford) and CAP (FibroScan, Echosens, France), and their diagnostic performances were compared. Results LMS-IDEAL and CAP detected steatosis grade ≥ 1 with AUROCs of 1.00 (95% CI, 0.99–1.0) and 0.95 (95% CI, 0.91–0.99), respectively. LMS-IDEAL was superior to CAP for detecting steatosis grade ≥ 2 with AUROCs of 0.77 (95% CI, 0.73–0.82] and 0.60 (95% CI, 0.55–0.65), respectively. Similarly, LMS-IDEAL outperformed CAP for detecting steatosis grade ≥ 3 with AUROCs of 0.81 (95% CI, 0.76–0.87) and 0.63 (95% CI, 0.56–0.70), respectively. Conclusion LMS-IDEAL was able to diagnose individuals accurately across the spectrum of histological steatosis grades. CAP performed well in identifying individuals with lower levels of fat (steatosis grade ≥1); however, its diagnostic performance was inferior to LMS-IDEAL for higher levels of fat (steatosis grades ≥2 and ≥3). Trial registration ClinicalTrials.gov (NCT03551522); https://clinicaltrials.gov/ct2/show/NCT03551522. UMIN Clinical Trials Registry (UMIN000026145); https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000026145.

Diagnostic Modalities of Non-Alcoholic Fatty Liver Disease: From Biochemical Biomarkers to Multi-Omics Non-Invasive Approaches

“…Recently, an MRI-PDFF technique known as iterative decomposition of water and fat with Echo Asymmetry and Least-squares estimation (IDEAL) has been further developed with regard to data processing [ 165 ]. These refinements have led to a software modality called Liver MultiScan (LMS-IDEAL), which is used to quantitatively characterise the hepatic parenchyma in terms of fat composition, iron, inflammation and fibrosis [ 165 ]. LMS (Perspectum Diagnostics, Oxford, UK) is compatible with various MRI machines, with the advantage of no need for contrast [ 166 ].…”

Clinical Utility of Magnetic Resonance Imaging Biomarkers for Identifying Nonalcoholic Steatohepatitis Patients at High Risk of Progression: A Multicenter Pooled Data and Meta-Analysis

“…Quantitative multiparametric MRI are non-invasively derived metrics, which can be used to objectively evaluate and monitor liver tissue characteristics. Proton density fat fraction (PDFF, also referred to here as MRI liver fat) has been demonstrated as a reliable, accurate metric for quantifying liver fat and identifying patients with NAFLD [14][15][16][17] . MRI liver fat strongly correlates with histological steatosis, but because liver fat declines with advanced fibrosis [18][19][20] , it cannot be used to stage disease severity or to identify patients with NASH who have significant fibrosis.…”

Magnetic resonance imaging metrics and the predictability of adverse outcomes in on‐treatment Asian chronic hepatitis B

“…28 LiverMultiscan (Perspectum, Oxford) was used to analyze anonymized MR liver scans and provided results on PDFF, cT1, and T2* mapping. 9,10,14 PDFF measures liver fat content from the fat-water separated image data. 8 T1-relaxation time measures extracellular fluid and interstitial space.…”

“…9 Multiparametric MR liver is an emerging technique that involves measurement of iron-corrected T1-relaxation time (cT1), T2*, and proton density fat fraction (PDFF), enabling simultaneous assessment of liver fibroinflammation, iron content, and fat content, respectively. [9][10][11] Multiparametric MR liver has been validated against histology in NAFLD and mixed chronic liver disease cohorts [9][10][11][12][13][14] and can predict liver-related adverse outcomes. 15 While VCTE has been studied extensively on assessing treatment response and predicting complications in on-treatment CHB, 16,17 the use of multiparametric MR in this aspect has yet to be explored.…”