title: Magnetic resonance elastography is superior to acoustic radiation force impulse for the Diagnosis of fibrosis in patients with biopsy-proven nonalcoholic fatty liver disease: A prospective study.
abstract: Magnetic resonance elastography (MRE), an advanced magnetic resonance-based imaging technique, and acoustic radiation force impulse (ARFI), an ultrasound-based imaging technique, are accurate for diagnosing nonalcoholic fatty liver disease (NAFLD) fibrosis. However, no head-to-head comparisons between MRE and ARFI for diagnosing NAFLD fibrosis have been performed. We compared MRE versus ARFI head-to-head for diagnosing fibrosis in well-characterized patients with biopsy-proven NAFLD. This cross-sectional analysis of a prospective cohort involved 125 patients (54.4% female) who underwent MRE, ARFI, and contemporaneous liver biopsies scored using the Nonalcoholic Steatohepatitis Clinical Research Network histological scoring system. The performances of MRE versus ARFI for diagnosing fibrosis were evaluated using area under the receiver operating characteristic curves (AUROCs). The mean (± standard deviation) age and body mass index were 48.9 (±15.4) years and 31.8 (±7.0) kg/m(2) , respectively. For diagnosing any fibrosis (≥ stage 1), the MRE AUROC was 0.799 (95% confidence interval [CI] 0.723-0.875), significantly (P = 0.012) higher than the ARFI AUROC of 0.664 (95% CI 0.568-0.760). In stratified analysis by presence or absence of obesity, MRE was superior to ARFI for diagnosing any fibrosis in obese patients (P < 0.001) but not in nonobese patients (P = 0.722). The MRE AUROCs for diagnosing ≥stages 2, 3, and 4 fibrosis were 0.885 (95% CI 0.816-0.953), 0.934 (95% CI 0.863-1.000), and 0.882 (95% CI 0.729-1.000); and the ARFI AUROCs were 0.848 (95% CI 0.776-0.921), 0.896 (95% CI 0.824-0.968), and 0.862 (95% CI 0.721-1.000). MRE had higher AUROCs than ARFI for discriminating dichotomized fibrosis stages at all dichotomization cutoff points, but the AUROC differences decreased as the cutoff points (fibrosis stages) increased.
  
  
  CONCLUSIONS
  MRE is more accurate than ARFI for diagnosing any fibrosis in NAFLD patients, especially those who are obese.
authors.affiliation: NAFLD Translational Research Unit, Department of Medicine.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cui
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA.
authors.forename: Elhamy
authors.initials: E
authors.lastname: Heba
authors.affiliation: NAFLD Translational Research Unit, Department of Medicine.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Hernandez
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA.
authors.forename: William
authors.initials: W
authors.lastname: Haufe
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hooker
authors.affiliation: Department of Radiology, University of California, San Diego, CA.|San Diego VA Healthcare System, La Jolla, CA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Andre
authors.affiliation: Department of Pathology.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Valasek
authors.affiliation: Department of Radiology.
authors.forename: Hamed
authors.initials: H
authors.lastname: Aryafar
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, CA.
authors.forename: Claude B
authors.initials: CB
authors.lastname: Sirlin
authors.affiliation: NAFLD Translational Research Unit, Department of Medicine.|Division of Gastroenterology, Department of Medicine.|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
mesh_terms: D000328:Adult; D001706:Biopsy; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000473:pathology; D011446:Prospective Studies