Influence of liver stiffness heterogeneity on staging fibrosis in patients with nonalcoholic fatty liver disease

Abstract

Background and Aims: Despite that hepatic fibrosis often affects the liver globally, spatial distribution can be heterogeneous. This study aimed to investigate the effect of liver stiffness (LS) heterogeneity on concordance between MR elastography (MRE)-based fibrosis staging and biopsy staging in patients with NAFLD. Approach and Results:We retrospectively evaluated data from 155 NAFLD patients who underwent liver biopsy and 3 Tesla MRE and undertook a retrospective validation study of 169 NAFLD patients at three hepatology centers.Heterogeneity of stiffness was assessed by measuring the range between minimum and maximum MRE-based LS measurement (LSM). Variability of LSM was defined as the stiffness range divided by the maximum stiffness value. The cohort was divided into two groups (homogenous or heterogeneous), according to whether variability was below or above the average for the training cohort. Based on histopathology and receiver operating characteristic

Letter: association of laboratory indexes and magnetic resonance elastography‐associated liver stiffness with complications and mortality—authors' reply

“…8 We believe that our study results strengthen the evidence for MRE as a prognostic tool for complications and mortality. Liver fibrosis heterogeneity in the liver is interesting 9 and we are planning to investigate the association between liver fibrosis heterogeneity and complication development.…”

Prediction of outcomes in patients with metabolic dysfunction-associated steatotic liver disease based on initial measurements and subsequent changes in magnetic resonance elastography

“…Each patient underwent MRE using a 3.0-T MR system (GE Medical Systems, Milwaukee, WI, USA) after fasting for at least 4 h. MRE measurements were performed by an experienced hepatologist or radiologist who was blinded to information regarding clinical data and disease course as previously reported [ 17 ]. Regions of interest were drawn on each section of MRE images to only include the parenchyma of the right lobe while avoiding the liver edges and large blood vessels.…”

SWOT analysis of noninvasive tests for diagnosing NAFLD with severe fibrosis: an expert review by the JANIT Forum

“…Optimal MRE thresholds for the detection of liver fibrosis stages are 2.61 kPa (stages ≥ 1), 2.97 kPa (stages ≥ 2), 3.62 kPa (stages ≥ 3), and 4.69 kPa (stages ≥ 4) [ 122 ]. Moreover, MRE can visualize whole-liver stiffness, resulting in reduced sampling error [ 123 ], and be readily combined with other quantitative maps, such as proton density fat fraction (PDFF) and R2* [ 124 ]. However, MRE also has weaknesses—it is inaccessible, costly, and time-consuming compared with ultrasound methods.…”