title: Non-invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE.
abstract: BACKGROUND
  Current guidelines do not recommend screening for non-alcoholic fatty liver disease (NAFLD) or advanced fibrosis. Patients with type 2 diabetes mellitus (T2DM) are known to be at increased risk for NAFLD and advanced fibrosis.
  
  
  OBJECTIVE
  To assess the feasibility in diabetics in a primary care setting of screening for NAFLD and advanced fibrosis, by using non-invasive magnetic resonance imaging (MRI) to estimate the hepatic proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE) to estimate hepatic stiffness.
  
  
  METHODS
  We performed a cross-sectional analysis of a prospective study that included 100 (53% men) consecutively enrolled diabetics who did not have any other aetiology of liver disease. All patients underwent a standardised research visit, laboratory tests, MRI-PDFF, and MRE.
  
  
  RESULTS
  Mean (±s.d.) age and body mass index (BMI) was 59.7 (±11.2) years and 30.8 (±6.5) kg/m(2) , respectively. The prevalence of NAFLD (defined as MRI-PDFF ≥5%) and advanced fibrosis (defined as MRE ≥3.6 kPa) was 65% and 7.1%, respectively. One patient with advanced fibrosis had definite hepatocellular carcinoma. When compared to those without NAFLD, patients with NAFLD were younger (P = 0.028) and had higher mean BMI (P = 0.0008), waist circumference (P < 0.0001) and prevalence of metabolic syndrome (84.6% vs. 40.0%, P < 0.0001). Only 26% of those with NAFLD had elevated alanine aminotransferase.
  
  
  CONCLUSIONS
  This proof-of-concept study demonstrates that T2DM has significant rates of both NAFLD and advanced fibrosis. Concomitant screening for NAFLD and advanced fibrosis by using MRI-proton density fat fraction and magnetic resonance elastography in T2DM is feasible and may be considered after validation in a larger cohort.
authors.affiliation: NAFLD Translational Research Unit, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
authors.forename: I
authors.initials: I
authors.lastname: Doycheva
authors.affiliation: NAFLD Translational Research Unit, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Cui
authors.affiliation: NAFLD Translational Research Unit, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.|Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, CA, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Costa
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Hooker
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
authors.forename: H
authors.initials: H
authors.lastname: Hofflich
authors.affiliation: Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Bettencourt
authors.affiliation: Department of Radiology, University of California, San Diego, La Jolla, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Brouha
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, CA, USA.
authors.forename: C B
authors.initials: CB
authors.lastname: Sirlin
authors.affiliation: NAFLD Translational Research Unit, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.|Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.|Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Loomba
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D055105:Waist Circumference