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. 2013 Aug;268(2):411-9.
doi: 10.1148/radiol.13121193. Epub 2013 Apr 5.

Advanced fibrosis in nonalcoholic fatty liver disease: noninvasive assessment with MR elastography

Donghee Kim  1 , W Ray Kim, Jayant A Talwalkar, Hwa Jung Kim, Richard L Ehman
Affiliations

Advanced fibrosis in nonalcoholic fatty liver disease: noninvasive assessment with MR elastography (V体育平台登录)

Donghee Kim et al. Radiology. 2013 Aug.

Abstract

Purpose: To evaluate the diagnostic accuracy of magnetic resonance (MR) elastography as a method to help diagnose clinically substantial fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) and, by using MR elastography as a reference standard, to compare various laboratory marker panels in the identification of patients with NAFLD and advanced fibrosis VSports手机版. .

Materials and methods: This retrospective study was institutional review board approved and HIPAA complaint. Informed consent was waived. This study was conducted in patients with NAFLD, who were identified by imaging characteristics consistent with steatosis in a prospective database that tracks all MR elastographic examinations. Six laboratory-based models of fibrosis were compared with MR elastographic results as well as fibrosis stage from liver biopsy results V体育安卓版. The area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive predictive value, and negative predictive value of each data set were compared. .

Results: Among 325 patients with NAFLD with MR elastographic data, there were 142 patients who underwent liver biopsy within 1 year of MR elastography. When comparing MR elastography results with liver biopsy results, the best cutoff for advanced fibrosis (stage F3-F4, 46 [32. 4%] of 142) was 4. 15 kPa (AUROC = 0. 954, sensitivity = 0. 85, specificity = 0. 929). This cutoff value identified 104 patients with advanced fibrosis (32. 0% of 325 patients). The FIB-4 score (AUROC = 0. 827) and NAFLD fibrosis score (AUROC = 0. 821) had the best diagnostic accuracy for advanced fibrosis, with high negative predictive values (NAFLD fibrosis score = 0 V体育ios版. 90 and FIB-4 score = 0. 899). .

Conclusion: MR elastography is a useful diagnostic tool for detecting advanced fibrosis in NAFLD. Of the laboratory-based methods, the NAFLD fibrosis and FIB-4 scores can most reliably detect advanced fibrosis VSports最新版本. .

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Figures

Figure 1:
Figure 1:
Flow diagram of patient selection and inclusion and exclusion criteria for the study. MRE = MR elastography.
Figure 2a:
Figure 2a:
MR elastographic data in a patient with NAFLD without advanced fibrosis. (a) Morphologic MR image as established with biopsy results. (b) MR elastogram (stiffness map) of same section shown in a. The liver outline is shown with a dashed line, and the mean stiffness is 2.1 kPa (within the normal range).
Figure 2b:
Figure 2b:
MR elastographic data in a patient with NAFLD without advanced fibrosis. (a) Morphologic MR image as established with biopsy results. (b) MR elastogram (stiffness map) of same section shown in a. The liver outline is shown with a dashed line, and the mean stiffness is 2.1 kPa (within the normal range).
Figure 3a:
Figure 3a:
MR elastographic data in patient with NAFLD with advanced fibrosis. (a) Morphologic MR image in patient with stage 3 liver fibrosis as established with biopsy results. Ascites is present. (b) MR elastogram of the same section shown in a shows markedly increased hepatic stiffness, with a mean value of 9.8 kPa.
Figure 3b:
Figure 3b:
MR elastographic data in patient with NAFLD with advanced fibrosis. (a) Morphologic MR image in patient with stage 3 liver fibrosis as established with biopsy results. Ascites is present. (b) MR elastogram of the same section shown in a shows markedly increased hepatic stiffness, with a mean value of 9.8 kPa.
Figure 4:
Figure 4:
Graph shows liver stiffness measured at MR elastography for early (F0–F2) versus advanced (F3–F4) stages of fibrosis. The best discriminating cutoff of liver stiffness to diagnose advanced fibrosis was 4.15 kPa. This cutoff was associated with a sensitivity and specificity of MR elastography in detecting advanced fibrosis of 85.0% and 92.9%, respectively.
Figure 5:
Figure 5:
Receiver operating characteristic curves for serum marker panels for a diagnosis of advanced fibrosis (liver stiffness > 4.15 kPa). The mean scores of all six panels were significantly different between patients with and those without advanced fibrosis. The AUROC was highest for FIB-4 at 0.827, followed by the NAFLD fibrosis score and APRI, with the latter two markers not being significantly different from FIB-4.
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