Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: A prospective study

Authors

  • Rohit Loomba,

    Corresponding author
    1. Division of Gastroenterology, University of California at San Diego, La Jolla, CA
    2. NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA
    3. Division of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA
    • Address reprint requests to: Rohit Loomba, M.D., M.H.Sc., Division of Gastroenterology and Epidemiology, University of California at San Diego, 9500 Gilman Drive, MC 0063, La Jolla, CA 92093. E-mail: roloomba@ucsd.edu; fax: +1-858-534-3338 or Claude Sirlin, M.D., Liver Imaging Group, Department of Radiology, University of California at San Diego, 408 Dickinson Street, San Diego, CA 92103-8226. E-mail: csirlin@ucsd.edu; Fax: +1-619-471-0503.

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    • These authors contributed equally to this work.

  • Tanya Wolfson,

    1. Departments of Mathematics, University of California at San Diego, La Jolla, CA
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  • Brandon Ang,

    1. NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA
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  • Jonathan Hooker,

    1. Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA
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  • Cynthia Behling,

    1. Department of Pathology, Sharp Health System, San Diego,, CA
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  • Michael Peterson,

    1. Pathology, University of California at San Diego, La Jolla, CA
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  • Mark Valasek,

    1. Pathology, University of California at San Diego, La Jolla, CA
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  • Grace Lin,

    1. Pathology, University of California at San Diego, La Jolla, CA
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  • David Brenner,

    1. Division of Gastroenterology, University of California at San Diego, La Jolla, CA
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  • Anthony Gamst,

    1. Departments of Mathematics, University of California at San Diego, La Jolla, CA
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  • Richard Ehman,

    1. Department of Radiology, Mayo Clinic, Rochester, MN
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  • Claude Sirlin

    Corresponding author
    1. Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA
    • Address reprint requests to: Rohit Loomba, M.D., M.H.Sc., Division of Gastroenterology and Epidemiology, University of California at San Diego, 9500 Gilman Drive, MC 0063, La Jolla, CA 92093. E-mail: roloomba@ucsd.edu; fax: +1-858-534-3338 or Claude Sirlin, M.D., Liver Imaging Group, Department of Radiology, University of California at San Diego, 408 Dickinson Street, San Diego, CA 92103-8226. E-mail: csirlin@ucsd.edu; Fax: +1-619-471-0503.

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    • These authors contributed equally to this work.

Errata

This article is corrected by:

  1. Errata: Correction Volume 62, Issue 5, 1646, Article first published online: 2 September 2015

  • Correction added after publication October 29, 2014: Author name Jonathan Booker was changed to Jonathan Hooker.

  • Potential conflict of interest: Dr. Ehman owns stock in, holds intellectual property rights to, and received grants from Resoundant, Inc. Dr. Sirlin consults, advises, and is on the speakers' bureau for Bayer. He received grants from GE Healthcare.

  • The study was conducted at the Clinical and Translational Research Institute, University of California at San Diego. R.L. is supported, in part, by the American Gastroenterological Association (AGA) Foundation (Sucampo) ASP Designated Research Award in Geriatric Gastroenterology and by a T. Franklin Williams Scholarship Award; funding provided by: Atlantic Philanthropies, Inc; the John A. Hartford Foundation, the Association of Specialty Professors, and the American Gastroenterological Association and grant K23-DK090303. Additional funding provided by R01DK088925 (principal investigator [PI]: C.S.) and National Institutes of Health grant EB001981 (PI: R.E.).

  • The study sponsor(s) had no role in the study design, collection, analysis, interpretation of the data, and/or drafting of the manuscript.

Abstract

Retrospective studies have shown that two-dimensional magnetic resonance elastography (2D-MRE), a novel MR method for assessment of liver stiffness, correlates with advanced fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Prospective data on diagnostic accuracy of 2D-MRE in the detection of advanced fibrosis in NAFLD are needed. The aim of this study is to prospectively assess the diagnostic accuracy of 2D-MRE, a noninvasive imaging biomarker, in predicting advanced fibrosis (stage 3 or 4) in well-characterized patients with biopsy-proven NAFLD. This is a cross-sectional analysis of a prospective study including 117 consecutive patients (56% women) with biopsy-proven NAFLD who underwent a standardized research visit: history, exam, liver biopsy assessment (using the nonalcoholic steatohepatitis Clinical Research Network histological scoring system), and 2D-MRE from 2011 to 2013. The radiologist and pathologist were blinded to clinical and pathology/imaging data, respectively. Receiver operating characteristics (ROCs) were examined to assess the diagnostic test performance of 2D-MRE in predicting advanced fibrosis. The mean (± standard deviation) of age and body mass index was 50.1 (± 13.4) years and 32.4 (± 5.0) kg/m2, respectively. The median time interval between biopsy and 2D-MRE was 45 days (interquartile range: 50 days). The number of patients with fibrosis stages 0, 1, 2, 3, and 4 was 43, 39, 13, 12, and 10, respectively. The area under the ROC curve for 2D-MRE discriminating advanced fibrosis (stage 3-4) from stage 0-2 fibrosis was 0.924 (P < 0.0001). A threshold of >3.63 kPa had a sensitivity of 0.86 (95% confidence interval [CI]: 0.65-0.97), specificity of 0.91 (95% CI: 0.83-0.96), positive predictive value of 0.68 (95% CI: 0.48-0.84), and negative predictive value of 0.97 (95% CI: 0.91-0.99). Conclusions: MRE is accurate in predicting advanced fibrosis and may be utilized for noninvasive diagnosis of advanced fibrosis in patients with NAFLD. (Hepatology 2014;60:1919–1927)

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