Recent evidence highlighted that the accurate assessment of liver fibrosis is important for evaluating the progression of chronic liver disease. During the past decade, many non-invasive methods have been developed to reduce the need for core-needle biopsy in fibrosis staging and to overcome its limitations, such as invasiveness, high cost, low reproducibility, and poor patient consent. The diagnostic performance of magnetic resonance elastography (MRE) is promising for use in clinical practice to evaluate not only liver fibrosis, but also survival and major clinical end-points such as liver decompensation, portal hypertension, development of hepatocellular carcinoma, and surgical outcomes. Together with other clinical markers, MRE can be used to better categorize patients with advanced fibrosis and cirrhosis, and assign them to different classes of risk for significant clinical outcomes. This review discusses clinical applications of MRE in the management strategy of patients with chronic liver disease.
Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF), respectively, occur in patients with normal liver and patients with chronic liver diseases, including cirrhosis [...]
We aimed to assess liver and splenic volumetry (LV and SV), extracellular-volume (ECV) on dual-layer-spectral-detector CT (DLCT) and scoring-systems identifying liver fibrosis (LF). In 45 patients with pathologically staged LF, ECV measured on CT value (HU-ECV), iodine-density (ID-ECV), atomic-number (Zeff-ECV), and electron-density (ED-ECV) were calculated by two-readers. LV or SV/body-surface-area (BSA), albumin-bilirubin-grade (ALBI), model-for-end-stage-liver-disease-score (MELD), aspartate-aminotransferase-platelet-ratio-index (APRI), and fibrosis-index-based-on-the-four-factors (FIB-4) were also recorded. ALBI was weakly associated with LF (p = 0.451), while MELD (p < 0.001), APRI (p = 0.010), and FIB-4 (p = 0.010) were significantly associated with LF. SV/BSA had a higher AUC than MELD, APRI, and FIB-4 for estimating > F4 (AUC = 0.815,95%-CI = 0.63–0.999), but MELD (AUC = 0.799,95%-CI = 0.634–0.965), APRI (AUC = 0.722,95%-CI = 0.561–0.883), and FIB-4 (AUC = 0.741,95%-CI = 0.582–0.899) had higher AUCs than SV/BSA. SV/BSA significantly contributed to differentiation between F0–3 and F4; the odds ratio (OR) was 1.304 (Reader1;R1) and 1.353 (Reader2;R2), whereas MELD significantly contributed to the differentiation between F0–2 and F3–4; the OR was 1.528 (R1) and 1.509 (R2). AUC for SV/BSA and MELD combined was 0.877 (95%-CI = 0.748–1.000). In conclusion, SV/BSA allows for higher estimation of liver-cirrhosis (≥ F4). MELD is more suitable for assessing severe LF (≥ F3-4). The combination of SV/BSA and MELD had a higher AUC than SV/BSA alone for liver-cirrhosis (≥ F4).
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