Multiparametric Magnetic Resonance Imaging, Autoimmune Hepatitis, and Prediction of Disease Activity

Arndtz, Katherine; Shumbayawonda, Elizabeth; Hodson, James; Eddowes, Peter; Dennis, Andrea; Thomaides-Brears, Helena; Mouchti, Sofia; Kelly, Matt; Banerjee, Rajarshi; Neubauer, Stefan; Hirschfield, Gideon

doi:10.1002/hep4.1687

Cited by 26 publications

(21 citation statements)

References 41 publications

(56 reference statements)

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“…However, their normalisation does not always exclude underlying residual hepatic inflammation. [9][10][11][12] LiverMultiScan is a non-invasive diagnostic technology, not requiring the purchase of any additional physical kit, that postprocesses…”

Section: Introductionmentioning

confidence: 99%

LiverMultiScan as an alternative to liver biopsy to monitor autoimmune hepatitis in the National Health Service in England: an economic evaluation

et al. 2022

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BackgroundAutoimmune hepatitis (AIH) is a rare chronic progressive liver disease, managed with corticosteroids and immunosuppressants and monitored using a combination of liver biochemistry and histology. Liver biopsy (gold standard) is invasive, costly and has risk of complications. Non-invasive imaging using multiparametric magnetic resonance (mpMR) can detect the presence and extent of hepatic fibroinflammation in a risk-free manner.ObjectiveTo conduct early economic modelling to assess the affordability of using mpMR as an alternative to liver biopsy.MethodsMedical test costs associated with following 100 patients over a 5-year time horizon were assessed from a National Health Service payor perspective using tariff costs and average biopsy-related adverse events costs. Sensitivity analyses modelling the cost consequences of increasing the frequency of mpMR monitoring within the fixed cost of liver biopsy were performed.ResultsPer 100 moderate/severe AIH patients receiving an annual mpMR scan (in place of biopsy), early economic modelling showed minimum cost savings of £232 333. Per 100 mild/moderate AIH patients receiving three mpMR scans over 5 years estimated minimum cost savings were £139 400. One-way sensitivity analyses showed increasing the frequency of mpMR scans from 5 to 10 over 5 years in moderate/severe AIH patients results in a cost saving of £121 926.20. In patients with mild/moderate AIH, an increase from 3 to 6 mpMR scans over 5 years could save £73 155.72. In a minimalistic approach, the use of 5 mpMR scans was still cost saving (£5770.48) if they were to replace two biopsies over the 5-year period for all patients with moderate/severe or mild/moderate AIH.ConclusionsIntegration of mpMR scans in AIH patient pathways leads to significant cost savings when liver biopsy frequency is either reduced or eliminated, in addition to improved patient experience and clinician acceptability as well as providing detailed phenotyping to improve patient outcomes.Trial registrationNCT03979053.

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Section: Introductionmentioning

confidence: 99%

LiverMultiScan as an alternative to liver biopsy to monitor autoimmune hepatitis in the National Health Service in England: an economic evaluation

et al. 2022

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“…Non-invasive techniques have a unique role in disease characterisation 7 – 10 , assessment of treatment response 11 , clinical outcome prediction 12 , 13 , and patient monitoring 14 . Magnetic resonance cholangiopancreatography (MRCP) is an MRI technique that characterises the health of the biliary tree and has a recognised role as a surrogate marker for diagnosis and disease monitoring.…”

Section: Introductionmentioning

confidence: 99%

“…In addition to evaluating the differences in the biliary tree characteristics between ASC and AIH using MRCP +, characterising the fibrosis and inflammation within the liver parenchyma and the changes brought on by treatment can also help in monitoring disease progression. Iron corrected T1 (cT1), a multiparametric MRI (mpMRI) measure of fibrosis and inflammation (fibro-inflammation) 7 – 11 , 14 , 19 , 20 , has shown utility in the rapid assessment of treatment response in liver disease 11 as well as the prediction of future loss of biochemical remission and the occurrence of flares in AIH 13 . cT1 has also been shown to identify children and adolescents with normal biochemistry but having (histologically confirmed) active sub-clinical disease 14 , and to indicate the presence of radiologic portal hypertension in chronic progressive paediatric autoimmune liver diseases 12 .…”

Section: Introductionmentioning

confidence: 99%

Quantitative multiparametric MRI as a non-invasive stratification tool in children and adolescents with autoimmune liver disease

Janowski

Shumbayawonda²,

Cheng³

et al. 2021

Sci Rep

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Autoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (ASC) are two very closely related autoimmune liver diseases with overlapping clinical features and similar management strategies. The purpose of this study was to assess the utility of quantitative imaging markers to distinguish ASC from AIH in paediatrics. 66 participants (N = 52 AIH, N = 14 ASC) aged 14.4 ± 3.3 years scheduled to undergo routine biopsy and baseline serum liver biochemistry testing were invited to undergo MRI (non-contrast abdominal MRI and 3D fast spin-echo MRCP). Multiparametric MRI was used to measure fibro-inflammation with corrected T1 (cT1), while the biliary tree was modelled using quantitative MRCP (MRCP +). Mann–Whitney U tests were performed to compare liver function tests with imaging markers between patient groups (ASC vs AIH). Receiver operating characteristic curves and stepwise logistic regressions were used to identify the best combination of markers to discriminate between ASC and AIH. Correlations between liver function tests and imaging markers were performed using Spearman’s rank correlation. cT1 was significantly correlated with liver function tests (range 0.33 ≤ R ≤ 56, p < 0.05), as well as with fibrosis, lobular and portal inflammation (range 0.31 ≤ R ≤ 42, p < 0.05). 19 MRCP + metrics correlated significantly with liver function tests (range 0.29 ≤ R ≤ 0.43, p < 0.05). GGT and MRCP + metrics were significantly higher in ASC compared to those with AIH. The best multivariable model for distinguishing ASC from AIH included total number of ducts and the sum of relative severity of both strictures and dilatations AUC: 0.91 (95% CI 0.78–1). Quantitative MRCP metrics are a good discriminator of ASC from AIH.

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“…Liver MultiScan is a multi-parametric MRI diagnostic tool that allows assessment of fat, iron and fibro-inflammation [ 13 ]. The Liver MultiScan cT1 score reflects fibro-inflammation and has demonstrated predictive value in non-alcoholic steatohepatitis (NASH) disease progression, autoimmune hepatitis disease activity, and ability to monitor responses to treatment in patients with hepatitis C [ 17 – 20 ]. Recently, the Liver MultiScan cT1 score has been recommended for the evaluation of patients at risk of non-alcoholic fatty liver disease (NAFLD) as part of a pathway that includes multiparametric MRI [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Patient understanding and experience of non-invasive imaging diagnostic techniques and the liver patient pathway

McKay¹,

Pantoja²,

Hall³

et al. 2021

J Patient Rep Outcomes

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Background Clinical and patient-reported outcomes are positively affected when efforts to increase patient understanding of underlying diseases and foster patient participation are part of care pathways. The prevalence of liver diseases is increasing globally, and successful communication of results from liver diagnostic tests will be important for physicians to ensure patient engagement and encourage adherence to lifestyle changes and therapy. Here, we aimed to explore the impact of non-invasive liver tests on patient experience and patient comprehension of liver disease in chronic liver disease diagnostic pathways typically managed with liver biopsies. Results 101 participants diagnosed with a range of liver disease aetiologies (90 patients, 11 caregivers) underwent a multiparametric magnetic resonance imaging (MRI) test. A subset of 33 participants was subjected to transient elastography (TE) with FibroScan® in addition to multiparametric MRI. MRI results were analysed using LiverMultiScan™. Participants received results on their liver-health status followed by a semi-structured interview to assess the scan procedure experience, comprehension of the results, and experiences of liver disease. A subset of participants (N = 5) was also engaged in the design, execution, and thematic analysis of the interview transcripts of the study. Analysis of semi-structured interviews revealed: (1) Presentation and discussion of the LiverMultiScan visual report by a physician was an effective contributor to better patient experience and increased comprehension of liver disease. (2) Patients demonstrated preference for non-invasive tests over biopsy for management of liver disease. (3) Patients reported positive experiences with the MRI test during the path for liver disease management. Conclusions Patients presented with visual reports of liver test results developed increased understanding of liver disease care which may have contributed to an overall more positive experience. Patients reported that clinical information obtained through non-invasive methods and transmitted through visual reports contributed to clarity, understanding and overall increased satisfaction. We conclude that a shift toward non-invasive testing and visual reporting of clinical information (e.g. picture of liver with visual scale) when possible are likely to contribute to improved physician engagement with patients and lead to better outcomes in the management of chronic liver diseases. Plain English summary Evidence suggests that patient experience and understanding can affect several aspects of clinical care and patient well-being. In this study, 101 patients and patient caregivers affected by liver diseases were recruited to determine how patient experiences of liver disease were affected with the introduction of non-invasive evaluation of the liver with an MRI or ultrasound-based elastography. All 101 participants received an MRI followed by a LiverMultiScan report. 33 participants received an additional FibroScan and report. Following the reports, participants were interviewed and asked to reflect on factors which affected their experience of the procedure and the understanding of their results. We focused on factors related to the layout of the standardised report and the delivery of its results. The interviews were transcribed and analysed for common themes and patterns. Patients and patient advocacy groups were involved in the design and conduct of the study, and analysis of the interview transcripts. Here, we report the perception of patients and patient caregivers on the quality of care and diagnostic experience. Trial registration ClinicalTrials.gov identifier—NCT02877602.

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Multiparametric Magnetic Resonance Imaging, Autoimmune Hepatitis, and Prediction of Disease Activity

Cited by 26 publications

References 41 publications

LiverMultiScan as an alternative to liver biopsy to monitor autoimmune hepatitis in the National Health Service in England: an economic evaluation

LiverMultiScan as an alternative to liver biopsy to monitor autoimmune hepatitis in the National Health Service in England: an economic evaluation

Quantitative multiparametric MRI as a non-invasive stratification tool in children and adolescents with autoimmune liver disease

Patient understanding and experience of non-invasive imaging diagnostic techniques and the liver patient pathway

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