title: Multiparametric magnetic resonance for the non-invasive diagnosis of liver disease.
abstract: OBJECTIVE
  With the increasing prevalence of liver disease worldwide, there is an urgent clinical need for reliable methods to diagnose and stage liver pathology. Liver biopsy, the current gold standard, is invasive and limited by sampling and observer dependent variability. In this study, we aimed to assess the diagnostic accuracy of a novel magnetic resonance protocol for liver tissue characterisation.
  
  
  METHODS
  We conducted a prospective study comparing our magnetic resonance technique against liver biopsy. The individual components of the scanning protocol were T1 mapping, proton spectroscopy and T2* mapping, which quantified liver fibrosis, steatosis and haemosiderosis, respectively. Unselected adult patients referred for liver biopsy as part of their routine care were recruited. Scans performed prior to liver biopsy were analysed by physicians blinded to the histology results. The associations between magnetic resonance and histology variables were assessed. Receiver-operating characteristic analyses were also carried out.
  
  
  RESULTS
  Paired magnetic resonance and biopsy data were obtained in 79 patients. Magnetic resonance measures correlated strongly with histology (r(s)=0.68 p<0.0001 for fibrosis; r(s)=0.89 p<0.001 for steatosis; r(s)=-0.69 p<0.0001 for haemosiderosis). The area under the receiver operating characteristic curve was 0.94, 0.93, and 0.94 for the diagnosis of any degree of fibrosis, steatosis and haemosiderosis respectively.
  
  
  CONCLUSIONS
  The novel scanning method described here provides high diagnostic accuracy for the assessment of liver fibrosis, steatosis and haemosiderosis and could potentially replace liver biopsy for many indications. This is the first demonstration of a non-invasive test to differentiate early stages of fibrosis from normal liver.
authors.affiliation: Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Oxford, UK.
authors.forename: Rajarshi
authors.initials: R
authors.lastname: Banerjee
authors.affiliation: Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Oxford, UK; Translational Gastroenterology Unit, University of Oxford, Level 5, John Radcliffe Hospital, Oxford, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Pavlides
authors.affiliation: Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Oxford, UK.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Tunnicliffe
authors.affiliation: Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Oxford, UK.
authors.forename: Stefan K
authors.initials: SK
authors.lastname: Piechnik
authors.affiliation: Medical Sciences Division, University of Oxford, Medical Sciences Office, John Radcliffe Hospital, Oxford, UK.
authors.forename: Nikita
authors.initials: N
authors.lastname: Sarania
authors.affiliation: Department of Radiology, Churchill Hospital, Old Road, Oxford, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Philips
authors.affiliation: Translational Gastroenterology Unit, University of Oxford, Level 5, John Radcliffe Hospital, Oxford, UK.
authors.forename: Jane D
authors.initials: JD
authors.lastname: Collier
authors.affiliation: Department of Gastroenterology, Royal Berkshire Hospital, London Road, Reading, UK.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Booth
authors.affiliation: Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Oxford, UK.
authors.forename: Jurgen E
authors.initials: JE
authors.lastname: Schneider
authors.affiliation: Department of Histopathology, John Radcliffe Hospital, Headley Way, Oxford, UK.
authors.forename: Lai Mun
authors.initials: LM
authors.lastname: Wang
authors.affiliation: Department of Histopathology, John Radcliffe Hospital, Headley Way, Oxford, UK.
authors.forename: David W
authors.initials: DW
authors.lastname: Delaney
authors.affiliation: Medical Sciences Division, University of Oxford, Medical Sciences Office, John Radcliffe Hospital, Oxford, UK; Department of Histopathology, John Radcliffe Hospital, Headley Way, Oxford, UK.
authors.forename: Ken A
authors.initials: KA
authors.lastname: Fleming
authors.affiliation: Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Oxford, UK.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Robson
authors.affiliation: Translational Gastroenterology Unit, University of Oxford, Level 5, John Radcliffe Hospital, Oxford, UK; Oxford NIHR Biomedical Research Centre, Nuffield Department of Medicine, and Peter Medawar Building, University of Oxford, South Parks Rd, Oxford, UK.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Barnes
authors.affiliation: Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Oxford, UK. Electronic address: stefan.neubauer@cardiov.ox.ac.uk.
authors.forename: Stefan
authors.initials: S
authors.lastname: Neubauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D005234:Fatty Liver / Q000175:diagnosis; D005260:Female; D006801:Humans; D007501:Iron / Q000032:analysis; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis; D008107:Liver Diseases / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D007501:Iron
keywords: (1)H MRS; ANOVA; AUROC; Analysis of Variance; Area Under the Receiver Operating Characteristic Curve; BMI; Body Mass Index; CPA; CoV; Coefficient of Variance; Collagen Proportionate Area; HLC; Hepatic Lipid Content; Iron corrected T1; Liver fibrosis; Liver haemosiderosis; Liver steatosis; MR; Magnetic Resonance; Magnetic resonance T1 mapping; Magnetic resonance T2(⁎) mapping; NAFLD; Non-Alcoholic Fatty Liver Disease; Proton Magnetic Resonance Spectroscopy; Proton magnetic resonance spectroscopy; ROI; Region of interest; shMOLLI; shortened Modified Look Locker Inversion
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