title: Magnetic Resonance Elastography vs Transient Elastography in Detection of Fibrosis and Noninvasive Measurement of Steatosis in Patients With Biopsy-Proven Nonalcoholic Fatty Liver Disease.
abstract: Magnetic resonance imaging (MRI) techniques and ultrasound-based transient elastography (TE) can be used in noninvasive diagnosis of fibrosis and steatosis in patients with nonalcoholic fatty liver disease (NAFLD). We performed a prospective study to compare the performance of magnetic resonance elastography (MRE) vs TE for diagnosis of fibrosis, and MRI-based proton density fat fraction (MRI-PDFF) analysis vs TE-based controlled attenuation parameter (CAP) for diagnosis of steatosis in patients undergoing biopsy to assess NAFLD.
  
  
  
  We performed a cross-sectional study of 104 consecutive adults (56.7% female) who underwent MRE, TE, and liver biopsy analysis (using the histologic scoring system for NAFLD from the Nonalcoholic Steatohepatitis Clinical Research Network Scoring System) from October 2011 through May 2016 at a tertiary medical center. All patients received a standard clinical evaluation, including collection of history, anthropometric examination, and biochemical tests. The primary outcomes were fibrosis and steatosis. Secondary outcomes included dichotomized stages of fibrosis and nonalcoholic steatohepatitis vs no nonalcoholic steatohepatitis. Receiver operating characteristic curve analyses were used to compare performances of MRE vs TE in diagnosis of fibrosis (stages 1-4 vs 0) and MRI-PDFF vs CAP for diagnosis of steatosis (grades 1-3 vs 0) with respect to findings from biopsy analysis.
  
  
  
  MRE detected any fibrosis (stage 1 or more) with an area under the receiver operating characteristic curve (AUROC) of 0.82 (95% confidence interval [CI], 0.74-0.91), which was significantly higher than that of TE (AUROC, 0.67; 95% CI, 0.56-0.78). MRI-PDFF detected any steatosis with an AUROC of 0.99 (95% CI, 0.98-1.00), which was significantly higher than that of CAP (AUROC, 0.85; 95% CI, 0.75-0.96). MRE detected fibrosis of stages 2, 3, or 4 with AUROC values of 0.89 (95% CI, 0.83-0.96), 0.87 (95% CI, 0.78-0.96), and 0.87 (95% CI, 0.71-1.00); TE detected fibrosis of stages 2, 3, or 4 with AUROC values of 0.86 (95% CI, 0.77-0.95), 0.80 (95% CI, 0.67-0.93), and 0.69 (95% CI, 0.45-0.94). MRI-PDFF identified steatosis of grades 2 or 3 with AUROC values of 0.90 (95% CI, 0.82-0.97) and 0.92 (95% CI, 0.84-0.99); CAP identified steatosis of grades 2 or 3 with AUROC values of 0.70 (95% CI, 0.58-0.82) and 0.73 (95% CI, 0.58-0.89).
  
  
  
  In a prospective, cross-sectional study of more than 100 patients, we found MRE to be more accurate than TE in identification of liver fibrosis (stage 1 or more), using biopsy analysis as the standard. MRI-PDFF is more accurate than CAP in detecting all grades of steatosis in patients with NAFLD.
authors.affiliation: Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California at San Diego, La Jolla, California.
authors.forename: Charlie C
authors.initials: CC
authors.lastname: Park
authors.affiliation: Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California at San Diego, La Jolla, California.
authors.forename: Phirum
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California at San Diego, La Jolla, California.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Hernandez
authors.affiliation: Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California at San Diego, La Jolla, California.
authors.forename: Ricki
authors.initials: R
authors.lastname: Bettencourt
authors.affiliation: Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California at San Diego, La Jolla, California.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Ramirez
authors.affiliation: Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California at San Diego, La Jolla, California.
authors.forename: Lynda
authors.initials: L
authors.lastname: Fortney
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, California.
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.
authors.forename: Ethan
authors.initials: E
authors.lastname: Sy
authors.affiliation: Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California at San Diego, La Jolla, California.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Savides
authors.affiliation: Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California at San Diego, La Jolla, California.
authors.forename: Mosab H
authors.initials: MH
authors.lastname: Alquiraish
authors.affiliation: Department of Pathology, University of California at San Diego, La Jolla, California.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Valasek
authors.affiliation: Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California at San Diego, La Jolla, California.
authors.forename: Emily
authors.initials: E
authors.lastname: Rizo
authors.affiliation: Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California at San Diego, La Jolla, California.
authors.forename: Lisa
authors.initials: L
authors.lastname: Richards
authors.affiliation: Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California at San Diego, La Jolla, California; Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, California.
authors.forename: David
authors.initials: D
authors.lastname: Brenner
authors.affiliation: Liver Imaging Group, Department of Radiology, University of California at San Diego, La Jolla, California.
authors.forename: Claude B
authors.initials: CB
authors.lastname: Sirlin
authors.affiliation: Nonalcoholic Fatty Liver Disease Research Center, Department of Medicine, University of California at San Diego, La Jolla, California; Division of Gastroenterology, Department of Medicine, University of California at San Diego, La Jolla, California; Division of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, California. Electronic address: roloomba@ucsd.edu.
authors.forename: Rohit
authors.initials: R
authors.lastname: Loomba
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001706:Biopsy; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D011446:Prospective Studies; D012372:ROC Curve; D014463:Ultrasonography
keywords: Assessment; Biomarker; Comparative; Noninvasive