title: Novel 3D Magnetic Resonance Elastography for the Noninvasive Diagnosis of Advanced Fibrosis in NAFLD: A Prospective Study.
abstract: Recent studies show two-dimensional (2D)-magnetic resonance elastography (MRE) is accurate in diagnosing advanced fibrosis (stages 3 and 4) in nonalcoholic fatty liver disease (NAFLD) patients. Three-dimensional (3D)-MRE is a more advanced version of the technology that can image shear-wave fields in 3D of the entire liver. The aim of this study was to prospectively compare the diagnostic accuracy of 3D-MRE and 2D-MRE for diagnosing advanced fibrosis in patients with biopsy-proven NAFLD.
  
  
  
  This cross-sectional analysis of a prospective study included 100 consecutive patients (56% women) with biopsy-proven NAFLD who also underwent MRE. Area under the receiver operating characteristic (AUROC) analysis was performed to assess the accuracy of 2D- and 3D-MRE in diagnosing advanced fibrosis.
  
  
  
  The mean (±s.d.) of age and body mass index were 50.2 (±13.6) years and 32.1 (±5.0) kg/m(2), respectively. The AUROC for diagnosing advanced fibrosis was 0.981 for 3D-MRE at 40 Hz, 0.927 for 3D-MRE at 60 Hz (standard shear-wave frequency), and 0.921 for 2D-MRE at 60 Hz (standard shear-wave frequency). At a threshold of 2.43 kPa, 3D-MRE at 40 Hz had sensitivity 1.0, specificity 0.94, positive predictive value 0.72, and negative predictive value 1.0 for diagnosing advanced fibrosis. 3D-MRE at 40 Hz had significantly higher AUROC (P<0.05) than 2D-MRE at 60 Hz for diagnosing advanced fibrosis.
  
  
  
  Utilizing a prospective study design, we demonstrate that 3D MRE at 40 Hz has the highest diagnostic accuracy in diagnosing NAFLD advanced fibrosis. Both 2D- and 3D-MRE at 60 Hz, the standard shear-wave frequency, are also highly accurate in diagnosing NAFLD advanced fibrosis.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, California, USA.|NAFLD Research Center, Department of Medicine, University of California at San Diego, La Jolla, California, USA.|Division of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, California, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Loomba
authors.affiliation: NAFLD Research Center, Department of Medicine, University of California at San Diego, La Jolla, California, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cui
authors.affiliation: Department of Mathematics, University of California at San Diego, La Jolla, California, USA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Wolfson
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, California, USA.
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, California, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hooker
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, California, USA.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Szeverenyi
authors.affiliation: NAFLD Research Center, Department of Medicine, University of California at San Diego, La Jolla, California, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Ang
authors.affiliation: NAFLD Research Center, Department of Medicine, University of California at San Diego, La Jolla, California, USA.
authors.forename: Archana
authors.initials: A
authors.lastname: Bhatt
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, California, USA.
authors.forename: Kang
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Radiology, University of California at San Diego, La Jolla, California, USA.
authors.forename: Hamed
authors.initials: H
authors.lastname: Aryafar
authors.affiliation: Department of Pathology, Sharp Health System, San Diego, California, USA.
authors.forename: Cindy
authors.initials: C
authors.lastname: Behling
authors.affiliation: Department of Pathology, University of California at San Diego, La Jolla, California, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Valasek
authors.affiliation: Department of Pathology, University of California at San Diego, La Jolla, California, USA.
authors.forename: Grace Y
authors.initials: GY
authors.lastname: Lin
authors.affiliation: Department of Mathematics, University of California at San Diego, La Jolla, California, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Gamst
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, California, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Brenner
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Meng
authors.initials: M
authors.lastname: Yin
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Glaser
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Ehman
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, California, USA.
authors.forename: Claude B
authors.initials: CB
authors.lastname: Sirlin
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods; D002140:California; D057186:Comparative Effectiveness Research; D003430:Cross-Sectional Studies; D061827:Dimensional Measurement Accuracy; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000175:diagnosis; D062072:Patient Acuity; D011446:Prospective Studies