Incorporation of Noninvasive Measures of Liver Fibrosis Into Clinical Practice: Diagnosis and Prognosis

Asrani, Sumeet K.

doi:10.1016/j.cgh.2015.07.030

Cited by 46 publications

(41 citation statements)

References 130 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…13, 14, 22 Thus, the precision with which MRI-based PDFF assessments quantify hepatic steatosis, and the reproducibility of these estimates across observations, is significant. Negrete et al 60 demonstrated that MRI-based PDFF assessments showed excellent inter-examination precision for each hepatic segment (ICC ≥ 0.992; SD ≤ 0.66%; range ≤ 1.24%), each hepatic lobe (ICC ≥ 0.998; SD ≤ 0.34%; range ≤ 0.64%), and the whole liver (ICC = 0.999; SD ≤ 0.24%; range ≤ 0.45%).…”

Section: Mri-based Assessment Of Hepatic Steatosismentioning

confidence: 99%

“…102, 103 Among shear wave technologies the most widely studied and compared to MRE are transient elastrography (TE), and point wave shear elastography utilizing acoustic radiation force impulse imaging (ARFI). 14 Similar to their application for assessing hepatic steatosis, ultrasound-based techniques have a lower diagnostic accuracy as compared to MRE for assessing hepatic fibrosis (TE: AUC 0.82; ARFI: AUC 0.85) or cirrhosis (TE: AUC 0.92; ARFI: AUC 0.93). 88, 104–107 Direct comparison studies in heterogenous study populations have also shown that MRE-based assessments have higher completion rates, and they provide significantly more reliable measurements of liver stiffness.…”

Section: Mre Based Assessment Of Hepatic Fibrosismentioning

confidence: 99%

“…14, 23, 24 Significant advances have now been made in magnetic resonance technology, and magnetic resonance imaging (MRI) and elastrography (MRE) have been demonstrated to be highly accurate diagnostic tools for non-invasive quantitative assessment of hepatic steatosis and fibrosis. 25–30 Thus, they may be suitable alternatives to liver biopsy for diagnosing NALFD, for identifying at risk populations (NASH and those with hepatic fibrosis), and for assessing response to therapeutic interventions.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

MRI and MRE for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: Clinical trials to clinical practice

Dulai

Sirlin

Loomba

2016

Journal of Hepatology

289

262

View full text Add to dashboard Cite

Nonalcoholic fatty liver disease (NAFLD) represents one of the most common causes of chronic liver disease, and its prevalence is rising worldwide. The occurrence of nonalcoholic steatohepatitis (NASH) is associated with a substantial increase in disease related morbidity and mortality. Accordingly, there has been a surge of innovation surrounding drug development in an effort to off-set the natural progression and long-term risks of this disease. Disease assessment within clinical trials and clinical practice for NAFLD is currently done with liver biopsies. Liver biopsy-based assessments, however, remain imprecise and are not without cost or risk. This carries significant implications for the feasibility and costs of bringing therapeutic interventions to market. A need therefore arises for reliable and highly accurate surrogate end-points that can be used in phase 2 and 3 clinical trials to reduce trial size requirements and costs, while improving feasibility and ease of implementation in clinical practice. Significant advances have now been made in magnetic resonance technology, and magnetic resonance imaging (MRI) and elastrography (MRE) have been demonstrated to be highly accurate diagnostic tools for the detection of hepatic steatosis and fibrosis. In this review article, we will summarize the currently available evidence regarding the use of MRI and MRE among NAFLD patients, and the evolving role these surrogate biomarkers will play in the rapidly advancing arena of clinical trials in NASH and hepatic fibrosis. Furthermore, we will highlight how these tools can be readily applied to routine clinical practice, where the growing burden of NAFLD will need to be met with enhanced monitoring algorithms.

show abstract

Section: Mri-based Assessment Of Hepatic Steatosismentioning

confidence: 99%

Section: Mre Based Assessment Of Hepatic Fibrosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

MRI and MRE for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: Clinical trials to clinical practice

Dulai

Sirlin

Loomba

2016

Journal of Hepatology

289

262

View full text Add to dashboard Cite

show abstract

“…These markers are classified as direct markers that reflect the pathophysiology of liver fibrogenesis and represent components of the extracellular matrix; indirect markers use routine laboratory data and reflect the consequences of liver damage. [15,25] However, liver biochemistry and platelet counts could change over time in patients with deteriorating advanced HCC, and non-invasive serum markers, such as the AAR, the APRI, the FIB-4 or the Lok index, may be inadequate for assessing liver fibrosis in such patients.…”

Section: Discussionmentioning

confidence: 99%

Attenuation of liver stiffness in sorafenib-treated patients with advanced hepatocellular carcinoma

Hung¹,

Liu²,

Wu³

et al. 2017

View full text Add to dashboard Cite

Aim: Sorafenib is a multi-tyrosine kinase inhibitor and the standard therapy for advanced hepatocellular carcinoma (HCC). This retrospective study aimed to observe the anti-fibrotic effect of sorafenib in patients with advanced HCC. Methods: Seventeen patients with advanced HCC were recruited. Shear wave velocity (SWV) using acoustic radiation force impulse elastography and non-invasive serum markers for liver fibrosis, such as the aspartate aminotransferase (AST) to alanine aminotransferase ratio (AAR), the AST to platelet ratio index, the fibrosis-4 index and the Lok index, were recorded at the beginning of sorafenib treatment and 3-6 months after sorafenib treatment in 2014-2015. Results: Nine (52.9%) patients achieved disease control status and 8 had progressive disease after a mean duration of 11.1 months with sorafenib treatment. The mean SWV decreased from 2.37 m/s at the beginning to 1.90 m/s after sorafenib treatment (P < 0.01). This trend was observed in patients with and without liver cirrhosis (from 2.49 to 2.06 m/s, P = 0.06, and from 2.32 to 1.69 m/s, P < 0.05, respectively). Among the non-invasive serum markers, no statistically significant differences were observed except for the AAR in the cirrhotic group. Conclusion: Sorafenib has potential antif-ibrotic effects in patients with advanced HCC. Key words:Sorafenib, liver stiffness, attenuation, advanced hepatocellular carcinoma ABSTRACTArticle history:

show abstract

“…As pointed out by the investigators, the cost-eff ectiveness of MRE compared to liver biopsy has not been shown. If economics and access to an MRI-based technique is an issue, sequential testing may play a role ( 16 ). One may envision a scenario whereby well-validated non-invasive serum markers (e.g., NAFLD fi brosis score, Fib-4, or BARD score) with high NPVs may be used to rule out advanced fi brosis, and among the subset with equivocal scores, MRE is pursued.…”

mentioning

confidence: 99%

Editorial: Magnetic Resonance Elastography and Non-Alcoholic Fatty Liver Disease: Time for an Upgrade?

Flores

Asrani

2016

American Journal of Gastroenterology

View full text Add to dashboard Cite

Elastography techniques, such as two-dimensional magnetic resonance elastography (2D-MRE) are increasingly used for the non-invasive assessment of liver fibrosis in patients with nonalchoholic fatty liver disease (NAFLD). Loomba et al. demonstrate that 3D-MRE (shear wave frequency 40 Hz) had even greater diagnostic accuracy than the commercially available 2D-MRE (shear wave frequency 60 Hz) in diagnosing advanced fibrosis (area under the receiver operator curve, AUROC 0.981 vs. 0.921, P<0. 05) using liver biopsy as reference standard. Despite limitations, MRE serves as an important tool in risk stratification for patients with NAFLD.

show abstract

Incorporation of Noninvasive Measures of Liver Fibrosis Into Clinical Practice: Diagnosis and Prognosis

Cited by 46 publications

References 130 publications

MRI and MRE for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: Clinical trials to clinical practice

MRI and MRE for non-invasive quantitative assessment of hepatic steatosis and fibrosis in NAFLD and NASH: Clinical trials to clinical practice

Attenuation of liver stiffness in sorafenib-treated patients with advanced hepatocellular carcinoma

Editorial: Magnetic Resonance Elastography and Non-Alcoholic Fatty Liver Disease: Time for an Upgrade?

Contact Info

Product

Resources

About