Change in serial liver stiffness measurement by magnetic resonance elastography and outcomes in NAFLD

Gidener, Tolga; Dierkhising, Ross A.; Mara, Kristin C.; Terry, Therneau M.; Venkatesh, Sudhakar K.; Ehman, Richard L.; Yin, Min-Jean; Allen, Alina M.

doi:10.1002/hep.32594

Cited by 31 publications

(18 citation statements)

References 19 publications

(32 reference statements)

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“…[336,344] Changes in liver stiffness may also be useful in identifying disease progression, such that an increase in liver stiffness of 20% on either VCTE or MRE may be associated with disease progression and long-term clinical outcomes. [345,346] In identifying patients with cirrhosis, a sequential approach with a FIB-4 > 3.48 and LSM by VCTE ≥ 20 kPa had a specificity of 90%. [4] However, such an approach will likely miss some patients with cirrhosis due to low sensitivity of these cut points.…”

Section: Elastographymentioning

confidence: 99%

AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease

et al. 2023

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The study of NAFLD has intensified significantly, with more than 1400 publications since 2018, when the last American Association for the Study of Liver Diseases (AASLD) Guidance document was published. [1] This new AASLD Guidance document reflects many advances in the field pertinent to any practitioner caring for patients with NAFLD and emphasizes advances in noninvasive risk stratification and therapeutics. A separate guideline focused on the management of patients with NAFLD in the context of diabetes has been written jointly by the American Association of Clinical Endocrinology and AASLD. [2] Given the significant growth in pediatric NAFLD, it will not be covered here to allow for a more robust discussion of the diagnosis and management of pediatric NAFLD in the upcoming AASLD Pediatric NAFLD Guidance. A "Guidance" differs from a "Guideline" in that it is not bound by the Grading of Recommendations, Assessment Development and Evaluation system. Thus, actionable statements rather than formal recommendations are provided herein. The highest available level of evidence was used to develop these statements, and, where high-level evidence was not available, expert opinion was used to develop guidance statements to inform clinical practice. Key points highlight important concepts relevant to understanding the disease and its management.The most profound advances in NAFLD relevant to clinical practice are in biomarkers and therapeutics. Biomarkers and noninvasive tests (NITs) can be used

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Section: Elastographymentioning

confidence: 99%

AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease

et al. 2023

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“…To date, there are limited data on the association between change in MRE and change in liver histology in cohorts of 50–100 patients 23,41 . A recent study evaluated the impact of change in MRE on liver-related outcomes and demonstrated that progression in LS on MRE in 29 patients with compensated cirrhosis was associated with hepatic decompensation or death 42 . Future studies may evaluate if serial MRE measurements over time can refine the prediction of future liver-related events, although the clinical value of accurate risk prediction with a single MRE value remains significant.…”

Section: Discussionmentioning

confidence: 99%

“…[23,41] A recent study evaluated the impact of change in MRE on liver-related outcomes and demonstrated that progression in LS on MRE in 29 patients with compensated cirrhosis was associated with hepatic decompensation or death. [42] Future studies may evaluate if serial MRE measurements over time can refine the prediction of future liver-related events, although the clinical value of accurate risk prediction with a single MRE value remains significant. Second, primarily because MRE has become available in the clinical practice more recently compared with other noninvasive tests, for example, VCTE or other blood-based markers, our study has a relatively short median follow-up duration.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Magnetic resonance elastography-based prediction model for hepatic decompensation in NAFLD: A multicenter cohort study

et al. 2023

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Background and Aims: Magnetic resonance elastography (MRE) is an accurate, continuous biomarker of liver fibrosis; however, the optimal combination with clinical factors to predict the risk of incident hepatic decompensation is unknown. Therefore, we aimed to develop and validate an MRE-based prediction model for hepatic decompensation for patients with NAFLD. Approach and Results: This international multicenter cohort study included participants with NAFLD undergoing MRE from 6 hospitals. A total of 1254 participants were randomly assigned as training (n = 627) and validation (n = 627) cohorts. The primary end point was hepatic decompensation, defined as the first occurrence of variceal hemorrhage, ascites, or HE. Covariates associated with hepatic decompensation on Cox-regression were combined with MRE to construct a risk prediction model in the training cohort and then tested in the validation cohort. The median (IQR) age and MRE values were 61 (18) years and 3.5 (2.5) kPa in the training cohort and 60 (20) years and 3.4 (2.5) kPa in the validation cohort, respectively. The MRE-based multivariable model that included age, MRE, albumin, aspartate aminotransferase, and platelets had excellent discrimination for the 3- and 5-year risk of hepatic decompensation (c-statistic 0.912 and 0.891, respectively) in the training cohort. The diagnostic accuracy remained consistent in the validation cohort with a c-statistic of 0.871 and 0.876 for hepatic decompensation at 3 and 5 years, respectively, and was superior to Fibrosis-4 in both cohorts (p < 0.05). Conclusions: An MRE-based prediction model allows for accurate prediction of hepatic decompensation and assists in the risk stratification of patients with NAFLD.

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“…A 15% increase in the LS value measured by MRE was associated with histologic fibrosis progression and progression from early to advanced liver fibrosis. A retrospective study of 128 patients with NAFLD who underwent at least two serial MRE examinations showed a significantly higher risk of the development of cirrhosis and decompensation or death in patients with a ≥19% increase in LS value from baseline than in those without [ 80 ].…”

Section: Role Of Noninvasive Tests In Disease Monitoringmentioning

confidence: 99%

Noninvasive imaging biomarkers for liver fibrosis in nonalcoholic fatty liver disease: current and future

Yu¹,

Lee²,

Kim³

2023

Clin Mol Hepatol

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Nonalcoholic fatty liver disease (NAFLD) is increasingly prevalent worldwide and becoming a major cause of liver disease-related morbidity and mortality. The presence of liver fibrosis in patients with NAFLD is closely related to prognosis, including the development of hepatocellular carcinoma and other complications of cirrhosis. Therefore, assessment of the presence of significant or advanced liver fibrosis is crucial. Although liver biopsy has been considered the "gold standard" method for evaluating the degree of liver fibrosis, it is not suitable for extensive use in all patients with NAFLD owing to its invasiveness and high cost.Therefore, noninvasive biochemical and imaging biomarkers have been developed to overcome the limitations of liver biopsy. Imaging biomarkers for the stratification of liver fibrosis have been evaluated in patients with NAFLD using different imaging techniques, such as transient elastography, shear wave elastography, and magnetic resonance elastography. Furthermore, artificial intelligence and deep learning methods are increasingly being applied to improve the diagnostic accuracy of imaging techniques and overcome the pitfalls of existing imaging biomarkers. In this review, we describe the usefulness and future prospects of noninvasive imaging biomarkers that have been studied and used to evaluate the degree of liver fibrosis in patients with NAFLD.

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Change in serial liver stiffness measurement by magnetic resonance elastography and outcomes in NAFLD

Cited by 31 publications

References 19 publications

AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease

AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease

Magnetic resonance elastography-based prediction model for hepatic decompensation in NAFLD: A multicenter cohort study

Noninvasive imaging biomarkers for liver fibrosis in nonalcoholic fatty liver disease: current and future

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