Non-Invasive Evaluation of Hepatic Fibrosis: The Diagnostic Performance of Magnetic Resonance Elastography in Patients with Viral Hepatitis B or C

Abstract

PurposeTo compare the accuracy of magnetic resonance elastography (MRE) with that of aspartate aminotransferase-to-platelet ratio index (APRI) for estimating the stage of hepatic fibrosis in patients with chronic hepatitis B virus (HBV) or chronic hepatitis C virus (HCV) infection.Materials and MethodsWe retrospectively enrolled 160 patients with chronic hepatitis and 25 healthy living liver donors. Fibrosis stage (METAVIR, F0 to F4) was determined histopathologically for all patients. APRI was recorded at the time of histopathologic examination and liver stiffness values were measured on MRE quantitative stiffness maps. The cutoff values, sensitivity, and specificity of MRE and APRI for each fibrosis stage were determined using receiver operating characteristic (ROC) analysis.ResultsMRE had a significantly greater area under the ROC curve than APRI score for discriminating among METAVIR stages F2-F4. Using a cutoff value of 2.80 kPa, MRE had a sensitivity of 94.4% and a specificity of 97.8% for detecting significant fibrosis (≥F2). There were no significant differences in fibrosis stage between patients with HBV and those with HCV infection. For ≥F2, the cutoffs were 2.47 kPa (100% sensitivity), 2.80 kP (maximum sum of sensitivity and specificity), and 3.70 kPa (100% specificity).ConclusionsMRE is a more accurate modality than APRI for detecting significant fibrosis in patients with chronic HBV or HCV infection. Antiviral treatment should be considered in patients with liver stiffness values ≥ 2.8 kPa.

Prospective comparison of magnetic resonance imaging to transient elastography and serum markers for liver fibrosis detection

“…Proposed thresholds for F3‐F4 detection in previous reports range from 9.5 to 12.9 kPa, while we found an optimal threshold of 8.6 kPa. Our threshold of 6.8 kPa for detection of F2–F4 fibrosis was also in the lower range of published thresholds (6.5–8.9 kPa) . Liver stiffness values obtained from MRE and TE are supposed to be proportional, with a stiffness value 2.5–3‐fold higher for TE .…”

“…Our threshold of 6.8 kPa for detection of F2–F4 fibrosis was also in the lower range of published thresholds (6.5–8.9 kPa) . Liver stiffness values obtained from MRE and TE are supposed to be proportional, with a stiffness value 2.5–3‐fold higher for TE .…”

“…Magnetic resonance elastography has been compared to DWI and TE in previous studies. We found that MRE provided the highest performance for advanced fibrosis detection, with AUC as high as 0.94, in agreement with previous reports . For moderate‐to‐advanced fibrosis detection, we observed lower AUC compared to prior studies .…”

“…Magnetic resonance elastography (MRE) is an emerging technique that estimates tissue stiffness distribution using MRI-based wave imaging in the liver. Recent MRE studies also reported high performance for liver fibrosis detection (8)(9)(10)(11)(12)(13)(14)(15)(16), although published data are smaller than those of TE. Diffusion-weighted MRI (DWI) probes molecular diffusion properties of tissues, and has shown changes with fibrosis stage, with restricted diffusion occurring in the presence of fibrosis (9,17,18).…”

Fibrosis assessment in patients with chronic hepatitis B virus (HBV) infection

“…It is a non-invasive, reproducible, advanced diagnostic technique for staging hepatic fibrosis (116 (116). While the diagnostic performance of MRE in HBV patients appears similar to that in HCV (117,118) necroinflammation may contribute to increased hepatic stiffness by MRE in HBV patients with ≤F2 fibrosis (119). MRE using threedimensional spin-echo echo planar imaging (3D-SE-EPI) is a novel approach associated with a 2.2% failure rate and high diagnostic accuracy (AUROC values for ≥F1, ≥F2, ≥F3, and F4 of 0.957 to 0.991) in 179 patients with HBV or HCV (120).…”