Magnetic Resonance imaging analysis of liver fibrosis and inflammation: overwhelming gray zones restrict clinical use

Martí-Aguado, David; Rodríguez-Ortega, Alejandro; Martí‐Bonmatí, Luis

doi:10.1007/s00261-020-02713-1

Cited by 7 publications

(6 citation statements)

References 76 publications

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“…Conflicting results have been reported regarding the influence of inflammation on liver stiffness measurement-based liver fibrosis staging of chronic liver disease. 55 , 56 Whether such an association is present in patients with HCC remains unknown. Of note, our study did not observe the grade of liver inflammation as a possible indicator of liver fibrosis S stage by uni- and multivariate analyses in patients with HCC.…”

Section: Discussionmentioning

confidence: 99%

Rethinking Liver Fibrosis Staging in Patients with Hepatocellular Carcinoma: New Insights from a Large Two-Center Cohort Study

Xu¹,

Li²,

Yang³

et al. 2022

JHC

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Background Hepatocellular carcinoma (HCC) is a prevalent and aggressive malignancy closely related to background chronic liver disease. This study aimed to explore predictive factors associated with background liver fibrosis burden in patients with HCC and sought to construct a practical predictive model for clinical use. Methods This large two-center retrospective cohort study evaluated data from Chinese medical centers. Uni- and multivariate ordinal logistic regression analyses were performed to identify variables associated with liver fibrosis stages. Predictive models based on variables identified by multivariate analysis were established in the Derivation Cohort and subjected to internal and external validation. Model performance was evaluated for discriminative and calibration abilities. Results Multivariate ordinal logistic regression analysis identified liver fibrosis severity score (LFSS), portal hypertension (PH) severity, plateletcrit (PCT) and model for end-stage liver disease-sodium (MELD-Na) as independent predictors of liver fibrosis stage in HCC patients. Nomograms that integrated these factors disclosed that the area under receiver operating characteristic curves (AUROCs) to predict S1 in the Derivation and External Validation cohorts were 0.850 and 0.919, respectively. Internal validation disclosed C-indexes of 0.823 and 0.833 in the Derivation and External Validation cohorts, respectively, indicating that the nomogram had good and excellent performance for distinguishing between S1 and non-S1 patients. Nomogram performance in the Derivation and External Validation cohorts, respectively, was fair and good to predict stage S2 (AUROCs 0.726, 0.806; C-indexes 0.713, 0.791); poor for S3 (AUROCs 0.648, 0.698; C-indexes 0.616, 0.666); good for S4 (AUROCs 0.812, 0.824; C-indexes 0.804, 0.792); and good for S3+S4 (AUROCs 0.806, 0.840; C-indexes 0.795, 0.811). Conclusion We propose new predictive models for the staging of background liver fibrosis in patients with HCC that can be implemented into clinical practice as important complements to hepatic imaging to inform HCC management strategy.

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Section: Discussionmentioning

confidence: 99%

Rethinking Liver Fibrosis Staging in Patients with Hepatocellular Carcinoma: New Insights from a Large Two-Center Cohort Study

Xu¹,

Li²,

Yang³

et al. 2022

JHC

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“…58 Although magnetic resonance elastography has the best diagnostic accuracy for liver fibrosis detection, its' use is not widely available in clinical settings because it requires specific software and an external device. 59,60 A recent study carried out by Chen et al 61 has also identified some prognostic factors based on computed tomography radiomics (texture, liver surface nodularity and steatosis measurements) which were associated with reduced 90-day…”

Section: Non-invasive Diagnosismentioning

confidence: 98%

“…Additionally, a cut-off higher than 20 KPa carries prognostic information [ 58 ]. Although magnetic resonance elastography has the best diagnostic accuracy for liver fibrosis detection, its’ use is not widely available in clinical settings because it requires specific software and an external device [ 59 , 60 ].…”

Section: Subclinical Ash Vs Ah: Clinical Analytical and Histological ...mentioning

confidence: 99%

Subclinical versus advanced forms of alcohol-related liver disease: Need for early detection

Gómez-Medina¹,

Melo

Martí-Aguado

et al. 2023

Clin Mol Hepatol

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Alcohol-related liver disease (ALD) consists of a wide spectrum of clinical manifestations and pathological features, ranging from asymptomatic patients to decompensated cirrhosis and hepatocellular carcinoma. Patients with heavy alcohol intake and advanced fibrosis often develop a subacute form of liver failure called alcohol-induced hepatitis (AH). Globally, most patients with ALD are identified at late stages of the disease, limiting therapeutic interventions. Thus, there is a need for early detection of ALD patients, which is lacking in most countries. The identification of alcohol misuse is hampered by the existence of alcohol underreporting by many patients. There are useful biomarkers that can detect recent alcohol use. Moreover, there are several non-invasive techniques to assess the presence of advanced fibrosis among patients with alcohol misuse, which could identify patients at high risk of liver related events or early death. In this review, we discuss differences between early stages of ALD and AH as the cornerstone of advanced forms. A global overview of epidemiological, anthropometric, clinical, analytical, histological, and molecular differences is summarized in this article. We propose that campaigns aimed at identifying patients with subclinical forms can prevent the development of life-threatening forms.

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“…Currently, the most challenging aspect of MASLD to evaluate using MRI is assessing activity 39 . At present, no specific approach is designed for differentiating activity grades; instead, existing techniques for steatosis and fibrosis assessment are extended to encompass this aspect of the disease.…”

Section: Assessment Of Activitymentioning

confidence: 99%

This is what MASLD looks like: Potential of a multiparametric MRI protocol

Fischer,

Lechea,

Coxson

2024

Semin Liver Dis

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Metabolic dysfunction associated steatotic liver disease (MASLD) is a prevalent condition with a broad spectrum defined by liver biopsy. This gold standard method evaluates three features: steatosis, activity (ballooning and lobular inflammation) and fibrosis, attributing them to certain grades or stages using a semi-quantitative scoring system. However, liver biopsy is subject to numerous restrictions, creating an unmet need for a reliable and reproducible method for MASLD assessment, grading and staging. Non-invasive imaging modalities, such as magnetic resonance imaging (MRI), offer the potential to assess quantitative liver parameters. This review aims to provide an overview of the available MRI techniques for the three criteria evaluated individually by liver histology. Here, we discuss the possibility of combining multiple MRI parameters to replace liver biopsy with a holistic, multiparametric MRI protocol. In conclusion, the development and implementation of such an approach could significantly improve the diagnosis and management of MASLD, reducing the need for invasive procedures and paving the way for more personalized treatment strategies.

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Magnetic Resonance imaging analysis of liver fibrosis and inflammation: overwhelming gray zones restrict clinical use

Cited by 7 publications

References 76 publications

Rethinking Liver Fibrosis Staging in Patients with Hepatocellular Carcinoma: New Insights from a Large Two-Center Cohort Study

Rethinking Liver Fibrosis Staging in Patients with Hepatocellular Carcinoma: New Insights from a Large Two-Center Cohort Study

Subclinical versus advanced forms of alcohol-related liver disease: Need for early detection

This is what MASLD looks like: Potential of a multiparametric MRI protocol

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