title: Role of magnetic resonance elastography in compensated and decompensated liver disease.
abstract: OBJECTIVE
  Non-invasive predictors identifying subjects with compensated liver disease at highest risk for transitioning to a decompensated state are lacking. We hypothesized that liver shear stiffness as measured by magnetic resonance elastography is an important non-invasive predictor of hepatic decompensation.
  
  
  METHODS
  Among patients with advanced fibrosis undergoing magnetic resonance elastography (2007-2011), a baseline cohort and follow up cohort (compensated liver disease) were established. Cause specific cox proportional hazards analysis adjusting for competing risks was utilized to determine the association between elevated liver shear stiffness and development of decompensation (hepatic encephalopathy, ascites, variceal bleeding).
  
  
  RESULTS
  In the baseline cohort (n=430), subjects with decompensated liver disease had a significantly higher mean liver shear stiffness (6.8kPa, IQR 4.9-8.5) as compared to subjects with compensated liver disease (5.2kPa, IQR 4.1-6.8). After adjustment for Model for End Stage Liver Disease score, hepatitis C, age, gender, albumin, and platelet count, the mean liver shear stiffness (OR=1.13, 95% CI 1.03-1.27) was independently associated with decompensated cirrhosis at baseline. Over a median follow up of 27months (n=167), 7.2% of subjects with compensated disease experienced hepatic decompensation. In the follow up cohort, the hazard of hepatic decompensation was 1.42 (95% CI 1.16-1.75) per unit increase in liver shear stiffness over time. The hazard of hepatic decompensation was 4.96 (95% CI 1.4-17.0, p=0.019) for a subject with compensated disease and mean LSS value ⩾5.8kPa as compared to an individual with compensated disease and lower mean LSS values.
  
  
  CONCLUSIONS
  Baseline liver shear stiffness assessed by magnetic resonance elastography is independently associated with decompensated liver disease.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, United States; Baylor University Medical Center, Dallas, TX, United States.
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Asrani
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, United States. Electronic address: talwalkar.jayant@mayo.edu.
authors.forename: Jayant A
authors.initials: JA
authors.lastname: Talwalkar
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, United States.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Kamath
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, United States.
authors.forename: Vijay H
authors.initials: VH
authors.lastname: Shah
authors.affiliation: Baylor University Medical Center, Dallas, TX, United States.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Saracino
authors.affiliation: Baylor University Medical Center, Dallas, TX, United States.
authors.forename: Linda
authors.initials: L
authors.lastname: Jennings
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, United States.
authors.forename: John B
authors.initials: JB
authors.lastname: Gross
authors.affiliation: Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States.
authors.forename: Sudhakar
authors.initials: S
authors.lastname: Venkatesh
authors.affiliation: Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, United States.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Ehman
mesh_terms: D000368:Aged; D001201:Ascites / Q000209:etiology; D015331:Cohort Studies; D054459:Elasticity Imaging Techniques / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis
keywords: Cirrhosis; Natural history; Non-invasive; Outcomes; Prognosis