title: Comparative diagnostic accuracy of magnetic resonance elastography vs. eight clinical prediction rules for non-invasive diagnosis of advanced fibrosis in biopsy-proven non-alcoholic fatty liver disease: a prospective study.
abstract: BACKGROUND
  Two-dimensional magnetic resonance elastography (2D-MRE) is an advanced magnetic resonance method with high diagnostic accuracy for predicting advanced fibrosis in non-alcoholic fatty liver disease (NAFLD) patients. However, no prospective, head-to-head comparisons between 2D-MRE and clinical prediction rules (CPRs) have been performed in patients with biopsy-proven NAFLD.
  
  
  OBJECTIVE
  To compare the diagnostic utility of 2D-MRE against that of eight CPRs (AST:ALT ratio, APRI, BARD, FIB-4, NAFLD Fibrosis Score, Bonacini cirrhosis discriminant score, Lok Index and NASH CRN model) for predicting advanced fibrosis in a prospective cohort with paired liver biopsy as the gold standard.
  
  
  METHODS
  This is a cross-sectional analysis of a prospective study of 102 patients (58.8% women) with biopsy-proven NAFLD, 2D-MRE and clinical research assessment within 90 days of biopsy. Receiver operating characteristic (ROC) analysis was performed to assess the performance of 2D-MRE and CPRs for predicting advanced fibrosis.
  
  
  RESULTS
  The mean (±s.d.) age and BMI were 51.3 (±14.0) years and 31.7 (±5.5) kg/m(2) respectively. 48, 26, 9, 13 and 6 patients had stage 0, 1, 2, 3 and 4 fibrosis respectively. The area under ROC curve (AUROC) was 0.957 for 2D-MRE and between 0.796 and 0.861 for the CPRs. FIB-4 was the best-performing CPR at predicting advanced fibrosis with AUROC of 0.861. In head-to-head comparisons using the DeLong test, 2D-MRE had significantly better AUROC (P < 0.05) than each CPR for predicting advanced fibrosis.
  
  
  CONCLUSIONS
  Compared to clinical prediction rules, 2D-MRE provides significantly higher accuracy for the diagnosis of advanced fibrosis in NAFLD patients.
authors: NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA, USA.
authors: J
authors: J
authors: Cui
authors: NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA, USA.
authors: B
authors: B
authors: Ang
authors: Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, USA.
authors: W
authors: W
authors: Haufe
authors: NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA, USA.
authors: C
authors: C
authors: Hernandez
authors: Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors: E C
authors: EC
authors: Verna
authors: Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA, USA.
authors: C B
authors: CB
authors: Sirlin
authors: NAFLD Translational Research Unit, Department of Medicine, University of California at San Diego, La Jolla, CA, USA.|Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, CA, USA.|Division of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA, USA.
authors: R
authors: R
authors: Loomba
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers; D001706:Biopsy; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D015415:Biomarkers