title: Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: a prospective study.
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/m(2), 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.
authors.affiliation: Division of Gastroenterology, University of California at San Diego, La Jolla, CA; NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA; Division of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Loomba
authors.forename: Tanya
authors.initials: T
authors.lastname: Wolfson
authors.forename: Brandon
authors.initials: B
authors.lastname: Ang
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hooker
authors.forename: Cynthia
authors.initials: C
authors.lastname: Behling
authors.forename: Michael
authors.initials: M
authors.lastname: Peterson
authors.forename: Mark
authors.initials: M
authors.lastname: Valasek
authors.forename: Grace
authors.initials: G
authors.lastname: Lin
authors.forename: David
authors.initials: D
authors.lastname: Brenner
authors.forename: Anthony
authors.initials: A
authors.lastname: Gamst
authors.forename: Richard
authors.initials: R
authors.lastname: Ehman
authors.forename: Claude
authors.initials: C
authors.lastname: Sirlin
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies
references.citation: Clin Liver Dis (Hoboken). 2012 Sep 25;1(4):104-107
references.pmid: 31186861
references.citation: Radiology. 2013 Aug;268(2):411-9
references.pmid: 23564711
references.citation: Clin Gastroenterol Hepatol. 2007 Oct;5(10):1207-1213.e2
references.pmid: 17916548
references.citation: Magn Reson Med. 2007 Aug;58(2):354-64
references.pmid: 17654578
references.citation: Aliment Pharmacol Ther. 2012 Jul;36(1):22-9
references.pmid: 22554256
references.citation: J Magn Reson Imaging. 2012 Nov;36(5):1011-4
references.pmid: 22777847
references.citation: J Hepatol. 2005 Jan;42(1):132-8
references.pmid: 15629518
references.citation: Hepatology. 2012 Jan;55(1):199-208
references.pmid: 21898479
references.citation: Hepatology. 2008 Feb;47(2):455-60
references.pmid: 18038452
references.citation: Am J Gastroenterol. 2012 Dec;107(12):1862-71
references.pmid: 23032979
references.citation: J Magn Reson Imaging. 2014 Jun;39(6):1525-32
references.pmid: 24987758
references.citation: Hepatology. 2012 Sep;56(3):943-51
references.pmid: 22505194
references.citation: J Magn Reson Imaging. 2013 Mar;37(3):544-55
references.pmid: 23423795
references.citation: J Pediatr. 2013 Mar;162(3):496-500.e1
references.pmid: 23084707
references.citation: Aliment Pharmacol Ther. 2012 Nov;36(10):909-21
references.pmid: 23057494
references.citation: Gastroenterology. 2011 Jan;140(1):124-31
references.pmid: 20858492
references.citation: J Pediatr. 2014 Jan;164(1):186-8
references.pmid: 24064151
references.citation: Hepatology. 1999 Dec;30(6):1356-62
references.pmid: 10573511
references.citation: Hepatology. 2005 Jun;41(6):1313-21
references.pmid: 15915461
references.citation: J Hepatol. 2011 Sep;55(3):666-672
references.pmid: 21256907
references.citation: Hepatology. 2009 Mar;49(3):1017-44
references.pmid: 19243014
references.citation: Clin Liver Dis. 2009 Nov;13(4):511-31
references.pmid: 19818302
references.citation: N Engl J Med. 2002 Apr 18;346(16):1221-31
references.pmid: 11961152
references.citation: Hepatology. 2013 Dec;58(6):1930-40
references.pmid: 23696515
references.citation: Semin Liver Dis. 2008 Nov;28(4):380-5
references.pmid: 18956294
references.citation: Clin Gastroenterol Hepatol. 2009 Oct;7(10):1104-12
references.pmid: 19523535
references.citation: J Magn Reson Imaging. 2011 Oct;34(4):729-749
references.pmid: 22025886
references.citation: J Viral Hepat. 2012 Feb;19(2):e212-9
references.pmid: 22239521
references.citation: Hepatology. 2004 Dec;40(6):1387-95
references.pmid: 15565570
references.citation: J Magn Reson Imaging. 2009 Jun;29(6):1332-9
references.pmid: 19472390
references.citation: Gastroenterology. 1999 Jun;116(6):1413-9
references.pmid: 10348825
references.citation: J Hepatol. 2013 Jul;59(1):180-2
references.pmid: 23333447
references.citation: J Magn Reson Imaging. 2011 Oct;34(4):928-34
references.pmid: 21769986
references.citation: Gastroenterology. 2005 Jul;129(1):113-21
references.pmid: 16012941
references.citation: Radiology. 2013 May;267(2):422-31
references.pmid: 23382291
references.citation: Magn Reson Imaging. 2008 Apr;26(3):347-59
references.pmid: 18093781
references.citation: Nat Rev Gastroenterol Hepatol. 2013 Nov;10(11):686-90
references.pmid: 24042449
references.citation: Nat Rev Gastroenterol Hepatol. 2013 Nov;10(11):666-75
references.pmid: 24061203
references.citation: Hepatology. 2012 Jun;55(6):2005-23
references.pmid: 22488764
references.citation: Magn Reson Imaging. 2010 Jul;28(6):767-76
references.pmid: 20409663
references.citation: Hepatology. 2012 Sep;56(3):922-32
references.pmid: 22431131
references.citation: Hepatology. 2006 Oct;44(4):865-73
references.pmid: 17006923
references.citation: Hepatology. 2007 Apr;45(4):846-54
references.pmid: 17393509
references.citation: Hepatology. 2006 Apr;43(4):682-9
references.pmid: 16502396
references.citation: J Hepatol. 2014 Jan;60(1):167-74
references.pmid: 23973932
references.citation: Radiology. 2011 Jun;259(3):749-56
references.pmid: 21460032
references.citation: Arch Pathol Lab Med. 2008 Nov;132(11):1761-6
references.pmid: 18976012
references.citation: Magn Reson Imaging. 2012 Feb;30(2):151-7
references.pmid: 22055856
references.citation: N Engl J Med. 2010 Sep 30;363(14):1341-50
references.pmid: 20879883
references.citation: Radiology. 2011 Mar;258(3):749-59
references.pmid: 21212366
references.citation: Hum Pathol. 2004 Feb;35(2):196-9
references.pmid: 14991537
references.citation: NMR Biomed. 2011 Aug;24(7):784-90
references.pmid: 21834002
references.citation: Radiology. 2009 Apr;251(1):67-76
references.pmid: 19221054
references.citation: J Hepatol. 2014 May;60(5):934-9
references.pmid: 24362072