title: Multiparametric magnetic resonance imaging predicts clinical outcomes in patients with chronic liver disease.
abstract: OBJECTIVE
  Multiparametric magnetic resonance (MR) imaging has been demonstrated to quantify hepatic fibrosis, iron, and steatosis. The aim of this study was to determine if MR can be used to predict negative clinical outcomes in liver disease patients.
  
  
  METHODS
  Patients with chronic liver disease (n=112) were recruited for MR imaging and data on the development of liver related clinical events were collected by medical records review. The median follow-up was 27months. MR data were analysed blinded for the Liver Inflammation and Fibrosis score (LIF; <1, 1-1.99, 2-2.99, and ⩾3 representing normal, mild, moderate, and severe liver disease, respectively), T2∗ for liver iron content and proportion of liver fat. Baseline liver biopsy was performed in 102 patients.
  
  
  RESULTS
  Liver disease aetiologies included non-alcoholic fatty liver disease (35%) and chronic viral hepatitis (30%). Histologically, fibrosis was mild in 54 (48%), moderate in 17 (15%), and severe in 31 (28%) patients. Overall mortality was 5%. Ten patients (11%) developed at least one liver related clinical event. The negative predictive value of LIF<2 was 100%. Two patients with LIF 2-2.99 and eight with LIF⩾3 had a clinical event. Patients with LIF⩾3 had a higher cumulative risk for developing clinical events, compared to those with LIF<1 (p=0.02) and LIF 1-1.99 (p=0.03). Cox regression analysis including all 3 variables (fat, iron, LIF) resulted in an enhanced LIF predictive value.
  
  
  CONCLUSIONS
  Non-invasive standardised multiparametric MR technology may be used to predict clinical outcomes in patients with chronic liver disease.
authors.affiliation: Translational Gastroenterology Unit, University of Oxford, UK; Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Pavlides
authors.affiliation: Perspectum Diagnostics, 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, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Sellwood
authors.affiliation: Perspectum Diagnostics, Oxford, UK.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Kelly
authors.affiliation: Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Robson
authors.affiliation: Royal Berkshire Hospital, Reading, UK.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Booth
authors.affiliation: Translational Gastroenterology Unit, University of Oxford, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Collier
authors.affiliation: Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK.
authors.forename: Stefan
authors.initials: S
authors.lastname: Neubauer
authors.affiliation: Translational Gastroenterology Unit, University of Oxford, UK; Peter Medawar Building, University of Oxford, Oxford, UK. Electronic address: ellie.barnes@ndm.ox.ac.uk.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Barnes
mesh_terms: D000328:Adult; D001706:Biopsy; D005260:Female; D005355:Fibrosis / Q000000981:diagnostic imaging / Q000473:pathology; D006521:Hepatitis, Chronic / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000821:virology; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging / Q000473:pathology; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology
keywords: Iron corrected T(1); LIF score; LiverMultiScan; T(1) mapping