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

Janowski, Kamil; Shumbayawonda, Elizabeth; Cheng, Lin; Langford, Caitlin; Dennis, Andrea; Kelly, Matt; Pronicki, Maciej; Grajkowska, Wiesława; Woźniak, Małgorzata; Pawliszak, Piotr; Chełstowska, Sylwia; Jurkiewicz, Elżbieta; Banerjee, Rajarshi; Socha, Piotr

doi:10.1038/s41598-021-94754-9

Cited by 16 publications

(10 citation statements)

References 29 publications

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“…12 LiverMultiScan has also shown utility within the AIH context to significantly impact clinical decision-making and physician intended patient management plans, 23 as well as showing utility in longterm management of paediatric patients. 11 The National Institute for Health Research (NIHR) has shown that by conducting early economic evaluation of diagnostic techniques, modelling can reduce commercial risk by providing evidence on cost-effectiveness. 24 Typically, a hypothetical early economic model is developed to compare the indicative cost consequences of using a different method versus standard testing for a particular patient group within a healthcare setting and highlight the clinical need for the proposed technology.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…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%

“…Serum liver enzymes, such as alanine aminotransferase and aspartate aminotransferase are used to inform clinical management. However, their normalisation does not always exclude underlying residual hepatic inflammation 9–12…”

Section: Introductionmentioning

confidence: 99%

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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: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“… 14 Very recently, 2 studies conducted in 65 and 76 adult persons with PSC found that MRCP+ metrics were significantly associated with biochemical prognostic scores and liver stiffness measurement (LSM) and suggested a role for refining risk stratification. 15 , 16 MRCP+ metrics have also shown utility in characterising disease, stratification, and monitoring in paediatric patients 17 , 18 ; however, at present, there are no studies that have investigated the correlation between MRCP+ and clinical outcomes in PSC. Therefore, here, we aimed to assess the role of MRCP+ for detecting biliary changes in a large retrospective cohort of people with PSC and to explore their association with disease severity and clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

Quantitative magnetic resonance cholangiopancreatography metrics are associated with disease severity and outcomes in people with primary sclerosing cholangitis

Cazzagon¹,

Mouhadi²,

Vanderbecq³

et al. 2022

JHEP Reports

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Simultaneous Multiparameter Mapping of the Liver in a Single Breath‐Hold or Respiratory‐Triggered Acquisition Using Multi‐Inversion Spin and Gradient Echo MRI

Manhard,

Kilpattu Ramaniharan,

Tkach

et al. 2024

Magnetic Resonance Imaging

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BackgroundQuantitative parametric mapping is an increasingly important tool for noninvasive assessment of chronic liver disease. Conventional parametric mapping techniques require multiple breath‐held acquisitions and provide limited anatomic coverage.PurposeTo investigate a multi‐inversion spin and gradient echo (MI‐SAGE) technique for simultaneous estimation of T1, T2, and T2* of the liver.Study TypeProspective.SubjectsSixteen research participants, both adult and pediatric (age 17.5 ± 4.6 years, eight male), with and without known liver disease (seven asymptomatic healthy controls, two fibrotic liver disease, five steatotic liver disease, and two fibrotic and steatotic liver disease).Field Strength/Sequence1.5 T, single breath‐hold and respiratory triggered MI‐SAGE, breath‐hold modified Look–Locker inversion recovery (MOLLI, T1 mapping), breath‐hold gradient and spin echo (GRASE, T2 mapping), and multiple gradient echo (mGRE, T2* mapping) sequences.AssessmentAgreement between hepatic T1, T2, and T2* estimated using MI‐SAGE and conventional parametric mapping sequences was evaluated. Repeatability and reproducibility of MI‐SAGE were evaluated using a same‐session acquisition and second‐session acquisition.Statistical TestsBland–Altman analysis with bias assessment and limits of agreement (LOA) and intraclass correlation coefficients (ICC).ResultsHepatic T1, T2, and T2* estimates obtained using the MI‐SAGE technique had mean biases of 72 (LOA: −22 to 166) msec, −3 (LOA: −10 to 5) msec, and 2 (LOA: −5 to 8) msec (single breath‐hold) and 36 (LOA: −43 to 120) msec, −3 (LOA: −17 to 11) msec, and 4 (LOA: −3 to 11) msec (respiratory triggered), respectively, in comparison to conventional acquisitions using MOLLI, GRASE, and mGRE. All MI‐SAGE estimates had strong repeatability and reproducibility (ICC > 0.72).Data ConclusionHepatic T1, T2, and T2* estimates obtained using an MI‐SAGE technique were comparable to conventional methods, although there was a 12%/6% for breath‐hold/respiratory triggered underestimation of T1 values compared to MOLLI. Both respiratory triggered and breath‐hold MI‐SAGE parameter maps demonstrated strong repeatability and reproducibility.Level of Evidence1Technical EfficacyStage 2

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

Cited by 16 publications

References 29 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 magnetic resonance cholangiopancreatography metrics are associated with disease severity and outcomes in people with primary sclerosing cholangitis

Simultaneous Multiparameter Mapping of the Liver in a Single Breath‐Hold or Respiratory‐Triggered Acquisition Using Multi‐Inversion Spin and Gradient Echo MRI

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