title: Advanced fibrosis in nonalcoholic fatty liver disease: noninvasive assessment with MR elastography.
abstract: OBJECTIVE
  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.
  
  
  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. 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 = 0.90 and FIB-4 score = 0.899).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterology and Hepatology and Department of Diagnostic Radiology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Donghee
authors.initials: D
authors.lastname: Kim
authors.forename: W Ray
authors.initials: WR
authors.lastname: Kim
authors.forename: Jayant A
authors.initials: JA
authors.lastname: Talwalkar
authors.forename: Hwa Jung
authors.initials: HJ
authors.lastname: Kim
authors.forename: Richard L
authors.initials: RL
authors.lastname: Ehman
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001706:Biopsy; D054459:Elasticity Imaging Techniques; D005234:Fatty Liver / Q000473:pathology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
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