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

Abstract

Background and Aim: Liver fibrosis and steatosis are important factors affecting chronic hepatitis B (CHB) disease outcome. Multiparametric magnetic resonance (MR) imaging of the liver measures fibroinflammation, fat, and iron through iron-corrected T1 relaxation time (cT1), proton density fat fraction (PDFF), and T2*-weighted imaging, respectively. We assessed the utility of MR metrics for prognostication in CHB. Methods: Chronic hepatitis B patients receiving nucleos(t)ide analogs with advanced fibrosis documented by vibration-controlled transient elastography were recruited. Paired multiparametric MR liver and transient elastography were performed at baseline and after at least 2 years. Adverse outcomes including death, hepatocellular carcinoma (HCC), and liver decompensation were monitored. Results: One hundred and ninety-two patients (mean age 60.3 ± 8.5 years; 76.0% male) were recruited. Eight patients (4.2%) developed HCC after 11.6 (8.8-22.8) months, and increased baseline liver iron independently predicted HCC (hazard ratio 2.329 [1.030-5.266]; P = 0.042). Liver MR metrics were not predictive of death or hepatic decompensation. Among 150 patients with follow-up liver MR at 30.3 (25.2-35.6) months, longitudinal liver PDFF increase was associated with liver cT1 increase (odds ratio 1.571 [1.217-2.029]; P = 0.001). Ninety patients received simultaneous multiparametric MR pancreas during the follow-up MR. Pancreatic PDFF correlated with liver PDFF (r = 0.501, P < 0.001), while pancreatic T1 had no correlation with liver cT1 (r = À0.092, P = 0.479). Pancreatic T1 and PDFF were not associated with adverse outcomes. Conclusion: Among CHB patients with advanced disease, liver iron level on MR predicts HCC. Multiparametric MR can also simultaneously assess the pancreas and the liver. Multiparametric MR should be further studied as a one-stop option for monitoring and prognosticating CHB.speaker's fees from AbbVie, and is an advisory board member and received speaker's fees and researching funding from Gilead Sciences. The remaining authors have no conflict of interests. Author contributions: The authors declare that they have participated in the preparation of the manuscript and have seen and approved the final version. RWH Hui was involved in the study concept and design, acquisition of data, analysis and interpretation of data, and drafting of the manuscript. KWH Chiu, LY Mak, CHC Chang, KS Cheung, and J Fung were involved in the acquisition of data and interpretation of data.MF Yuen was involved in study concept and design and critical revision of manuscript. WK Seto was involved in study concept and design, securing research funding, analysis and interpretation of data, critical revision of manuscript, and overall study supervision.

Pancreatic steatosis and iron overload increases cardiovascular risk in non-alcoholic fatty liver disease

“…We also raise the hypothesis that pancreatic iron level might be implicated in CVD risk in an exponential manner with liver iron deposits (Figure 6). This findings are consistent with previous studies suggesting that MRI-determined liver R2* can predict adverse outcomes and do not correlate with pancreatic R2* (31,32).…”

Clinical practice guidelines and real-life practice on hepatocellular carcinoma: the Hong Kong perspective

“…7 The availability of CT and MR scans is increasing in our locality, and patients with suboptimal USG assessment (such as in obesity, ascites or high-lying liver) are referred for CT or MR. The use of artificial intelligence on CT scans 8 and advanced MR imaging metrics 9 have also been explored as surveillance options in exploratory studies in Hong Kong.…”

“…Kong has an increasing availability of advanced imaging services, 9,14,20 local guidelines on diagnostic pathways will be beneficial to enable earlier and more accurate diagnosis of HCC.…”