Magnetic resonance elastography is as accurate as liver biopsy for liver fibrosis staging

Morisaka, Hiroyuki; Motosugi, Utaroh; Ichikawa, Shintaro; Nakazawa, Tadao; Kondo, Tetsuo; Funayama, Satoshi; Matsuda, Masanori; Ichikawa, Tomoaki; Oda, Hiroshi

doi:10.1002/jmri.25868

Cited by 61 publications

(43 citation statements)

References 39 publications

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“…A meta‐analysis of lifestyle modification for NAFLD found that weight reductions of 4%‐14% resulted in significant relative reductions in intrahepatic fat levels of 35%‐81% . As in the LEAN study which found less worsening of fibrosis on serial liver biopsies in subjects on liraglutide (9% vs 36% with placebo), hepatic fibrosis, as measured with MR elastography which is comparably accurate to biopsy for fibrosis staging, decreased significantly and similarly in both groups. Hepatic fibrosis is an important predictor of morbidity and mortality in NAFLD …”

Section: Discussionmentioning

confidence: 91%

Randomized trial comparing effects of weight loss by liraglutide with lifestyle modification in non‐alcoholic fatty liver disease

Khoo

Hsiang

Taneja

et al. 2019

Liver International

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Background & Aims We compared the effects of weight loss induced with the glucagon‐like peptide‐1 agonist liraglutide, with that of lifestyle modification, followed by weight maintenance after discontinuing intervention, in obese adults with non‐alcoholic fatty liver disease (NAFLD). Methods Thirty obese (mean age 40.7 ± 9.1 years, BMI 33.2 ± 3.6 kg/m2, 90% male) adults with NAFLD defined as liver fat fraction (LFF) > 5% on magnetic resonance imaging without other causes of hepatic steatosis were randomized to a supervised programme of energy restriction plus moderate‐intensity exercise to induce ≥ 5% weight loss (DE group, n = 15), or liraglutide 3 mg daily (LI group, n = 15) for 26 weeks, followed by 26 weeks with only advice to prevent weight regain. Results Diet and exercise and LI groups had significant (P < 0.01) and similar reductions in weight (−3.5 ± 3.3 vs −3.0 ± 2.2 kg), LFF (−8.1 ± 13.2 vs −7.0 ± 7.1%), serum alanine aminotransferase (−39 ± 35 vs −26 ± 33 U/L) and caspase‐cleaved cytokeratin‐18 (cCK‐18) (−206 ± 252 vs −130 ± 158 U/L) at 26 weeks. At 52 weeks, the LI group significantly (P < 0.05) regained weight (1.8 ± 2.1 kg), LFF (4.0 ± 5.3%) and cCK‐18 (72 ± 126 U/L), whereas these were unchanged in the DE group. Conclusions Liraglutide was effective for decreasing weight, hepatic steatosis and hepatocellular apoptosis in obese adults with NAFLD, but benefits were not sustained after discontinuation, in contrast with lifestyle modification. Continuing the exercise learned in the structured programme contributed to the maintenance of liver fat reduction.

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Section: Discussionmentioning

confidence: 91%

Randomized trial comparing effects of weight loss by liraglutide with lifestyle modification in non‐alcoholic fatty liver disease

Khoo

Hsiang

Taneja

et al. 2019

Liver International

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“…In this study, we used MRE instead of liver biopsy. Several studies have reported that MRE could be an alternative to liver biopsy [25,26]. The United States Food and Drug Administration (FDA) has approved MRE results without liver biopsy in NAFLD Phase IIa clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Sequential Combination of FIB-4 Followed by M2BPGi Enhanced Diagnostic Performance for Advanced Hepatic Fibrosis in an Average Risk Population

Kim

Jun

Park

et al. 2020

JCM

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The fibrosis-4 (FIB-4) index is the most widely used estimated formula to screen for advanced hepatic fibrosis; however, it has a considerable intermediate zone. Here, we propose an algorithm to reduce the intermediate zone and improve the diagnostic performance of screening for advanced liver fibrosis by incorporating Mac-2-binding protein glycan isomer (M2BPGi) into a FIB-4 based screening strategy in an average risk group. Four-hundred eighty-eight healthy and chronic liver disease subjects were analyzed using a 1:1 propensity score matched for age and sex. Advanced liver fibrosis (≥F3) was defined by magnetic resonance elastography (MRE, ≥3.6 kPa). Classification tree analysis was employed to improve diagnostic performance using a combination of the FIB-4 index and M2BPGi. The median serum M2BPGi levels of healthy subjects, patients without advanced fibrosis, and those with the condition were 0.48, 0.94, and 2.93, respectively. The area under the receiver operating characteristic (AUROC) curve of M2BPGi (0.918) for advanced fibrosis was the highest compared to those of the FIB-4 index (0.887), APRI (0.873), and AST/ALT ratio (0.794). When M2BPGi was incorporated following the FIB-4 index, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 87.1%, 82.5%, 54.0%, and 96.4%, respectively. Moreover, 74.3% (133/179) of cases in the intermediate zone of the FIB-4 index avoided unnecessary referrals. Two-step pathway (FIB-4 followed by M2BPGi) could reduce unnecessary referrals and/or liver biopsies in an average-risk population.

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“…However, liver biopsy samples 1/50,000th of the entire liver, and thus is susceptible to inadequate biopsy size, which can decrease accuracy of staging by 25% . Studies have shown that paired biopsies, from two different areas of the liver, can differ in histological fibrosis staging up to 40% of the time . Also, studies have demonstrated significant subjectivity in fibrosis staging, with different pathologists disagreeing on staging up to 50% of the time .…”

Section: Pros and Cons Of Methods Of Measurement Of Liver Fibrosismentioning

confidence: 99%

“…13 Studies have shown that paired biopsies, from two different areas of the liver, can differ in histological fibrosis staging up to 40% of the time. 14 Also, studies have demonstrated significant subjectivity in fibrosis staging, with different pathologists disagreeing on staging up to 50% of the time. 13,15,16 These inherent flaws in liver biopsy as a means for staging fibrosis in NAFLD have come to light only recently and further demonstrate the need for alternative methods (Table 1).…”

mentioning

confidence: 99%

Pro: Noninvasive Imaging Has Replaced Biopsy as the Gold Standard in the Evaluation of Nonalcoholic Fatty Liver Disease

Mumtaz¹,

Schomaker²,

Roenn³

2019

Clinical Liver Disease

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Magnetic resonance elastography is as accurate as liver biopsy for liver fibrosis staging

Abstract: 3. Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1268-1275.

Cited by 61 publications

References 39 publications

Randomized trial comparing effects of weight loss by liraglutide with lifestyle modification in non‐alcoholic fatty liver disease

Randomized trial comparing effects of weight loss by liraglutide with lifestyle modification in non‐alcoholic fatty liver disease

Sequential Combination of FIB-4 Followed by M2BPGi Enhanced Diagnostic Performance for Advanced Hepatic Fibrosis in an Average Risk Population

Pro: Noninvasive Imaging Has Replaced Biopsy as the Gold Standard in the Evaluation of Nonalcoholic Fatty Liver Disease

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