Head-to-head comparison of magnetic resonance elastography-based liver stiffness, fat fraction, and T1 relaxation time in identifying at-risk NASH

Abstract

Background and Aims: The presence of at-risk NASH is associated with an increased risk of cirrhosis and complications. Therefore, noninvasive identification of at-risk NASH with an accurate biomarker is a critical need for pharmacologic therapy. We aim to explore the performance of several magnetic resonance (MR)-based imaging parameters in diagnosing at-risk NASH. Approach and Results: This prospective clinical trial (NCT02565446) includes 104 paired MR examinations and liver biopsies performed in patients with suspected or diagnosed NAFLD. Magnetic resonance elastography-assessed liver stiffness (LS), 6-point Dixon-derived proton density fat fraction (PDFF), and single-point saturation-recovery acquisition-calculated T1 relaxation time were explored. Among all predictors, LS showed the significantly highest accuracy in diagnosing at-risk NASH [AUCLS: 0.89 (0.82, 0.95), AUCPDFF: 0.70 (0.58, 0.81), AUCT1: 0.72 (0.61, 0.82), z-score test z >1.96 for LS vs any of others]. The optimal cutoff value of LS to identify at-risk NASH patients was 3.3 kPa (sensitivity: 79%, specificity: 82%, negative predictive value: 91%), whereas the optimal cutoff value of T1 was 850 ms (sensitivity: 75%, specificity: 63%, and negative predictive value: 87%). PDFF had the highest performance in diagnosing NASH with any fibrosis stage [AUCPDFF: 0.82 (0.72, 0.91), AUCLS: 0.73 (0.63, 0.84), AUCT1: 0.72 (0.61, 0.83), |z| <1.96 for all]. Conclusion: Magnetic resonance elastography-assessed LS alone outperformed PDFF, and T1 in identifying patients with at-risk NASH for therapeutic trials.

Erratum: Head-to-head comparison of magnetic resonance elastography-based liver stiffness, fat fraction, and T1 relaxation time in identifying at-risk NASH

“…In the original article by Li et al 1 the x-axial labels in Figure 2 and Figure 3 were wrong. Updated figures with corrected x-axial labels are shown below.…”

The role of MRI technology in liver evaluation for NAFLD patients: Advancements and opportunities

“…This study also discussed the cost of each MRI technique, with quantitative MRI being the most expensive at $1300 and having more difficult imaging conditions than MRE (Figure 1). 7 …”

“…Patients with NASH and F2-4 fibrosis are at higher risk for liver-related events and mortality and are considered to have "at-risk" NASH. [5] T1 Mapping utilized the Saturation Method using Adaptive Recovery time for T1 (SMART1Map method) mapping, [7] which is considered more accurate in measuring T1 values than the commonly used modified look-locker inversion recovery (MOLLI) method. [8] A brief overview of MRE is also presented.…”

“…This study also discussed the cost of each MRI technique, with quantitative MRI being the most expensive at $1300 and having more difficult imaging conditions than MRE (Figure 1). [7] In the past decade, MRE has emerged as the most accurate noninvasive diagnostic method for diagnosing NASH fibrosis. [4,5,10] Although the number of units in use is limited compared with general MRI, with 1000 facilities worldwide, according to the Mayo Clinic website (https:// www.mayoclinic.org/tests-procedures/magnetic-resonance-elastography/about/pac-20385177), its usage is expected to increase, with the growing prevalence of NAFLD/NASH.…”

Letter to the Editor: Comparing quantitative MRI technologies in steatotic liver disease

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To the editor, We read the article "Head-to-head comparison of magnetic resonance elastography-based liver stiffness, fat fraction, and T1 relaxation time in identifying at-risk NASH" by Li et al [1] with interest. This is a pivotal clinical research area that paves the way for the potential elimination of invasive biopsies in treating patients with NAFLD.

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