MR elastography‐based liver fibrosis correlates with liver events in nonalcoholic fatty liver patients: A multicenter study

Abstract

Background & Aims Liver fibrosis assessed by liver biopsy is predictive of clinical liver events in patients with nonalcoholic fatty liver disease (NAFLD). Magnetic resonance elastography (MRE) correlates with liver biopsy in assessing liver fibrosis. However, data assessing the relationship between MRE and clinical liver events are lacking. We investigated the association between MRE and clinical liver events/death and identified the cut‐off to predict clinical liver events in NAFLD patients. Methods We conducted a multicenter retrospective study of NAFLD patients who underwent MRE between 2016 and 2019. Clinical liver events were defined as decompensation events and death. We categorized patients into noncirrhosis, compensated cirrhosis and decompensated cirrhosis. Fisher's exact test was used to test association strength. Receiver operative curve methods were used to determine the optimal cut‐off of MRE liver stiffness and to maximize the accuracy for classifying noncirrhosis, compensated cirrhosis and decompensated cirrhosis. Logistic regression modelling was used to predict decompensation. Results The study included 320 NAFLD patients who underwent MRE. The best threshold for distinguishing cirrhosis from noncirrhosis was 4.39 kPa (AUROC 0.92) and from decompensated cirrhosis was 6.48 kPa (AUROC 0.71). Odds of decompensation increased as liver stiffness increased (OR 3.28) (P < .001). Increased liver stiffness was associated with ascites, hepatic encephalopathy, oesophageal variceal bleeding and mortality (median 7.10, 10.15 and 10.15 kPa respectively). Conclusion In NAFLD patients, liver stiffness measured by MRE with a cut‐off of ≥6.48 kPa is associated with decompensation and mortality, and specific MRE cut‐offs are predictive of individual clinical liver events.

Usefulness of Different Imaging Modalities in Evaluation of Patients with Non-Alcoholic Fatty Liver Disease

“…Subgroup analysis from the same study performed by Petta et al additionally provided evidence for the prognostic significance of the changes in liver stiffness measurement on TE by at least 20% with respect to those clinical outcomes and, furthermore, overall patient survival. Similarly, MRE-assessed liver stiffness exceeding 6.48 kPa was found to be predictive for the occurrence of liver function decompensation, with higher liver stiffness values also observed in patients with ascites, encephalopathy, and esophageal variceal bleeding [ 107 ].…”

Magnetic Resonance Elastography for the Clinical Risk Assessment of Fibrosis, Cirrhosis, and Portal Hypertension in Patients With NAFLD

“…Studies evaluating the diagnostic performance of MRE for detection of cirrhosis have determined cutoffs of 3.35-6.7 kPa (AUROC 0.8-0.97). 22,28,[35][36][37][38][39] Difference in findings can be accounted for by study population (single center vs multi-center, Japan vs western population). Based on pooled analysis of individual participant data by Hsu, et al, we consider liver stiffness  4.67 to be indicative of cirrhosis.…”

Noninvasive Tests (NITs) for Hepatic Fibrosis in Fatty Liver Syndrome

“…[ 56 ] Another analysis from a phase II trial of Selonsertib from 23 sites in the US and Canada demonstrated MRE cut-offs of 4.7 kPa and 5.5 kPa to detect advanced fibrosis (F ≥ 3) and cirrhosis (F4), respectively, with an AUROC of 0.8 [ 57 ]. In a recent multi-center study of patients with NAFLD, a cut-off of 4.39 kPa was shown to detect cirrhosis (F4) with an AUROC of 0.92 [ 58 ].…”

“…The cut-off for the liver stiffness value to predict hepatic decompensation was 6.48 kPa, with an AUROC of 0.707, 66.7% sensitivity, 80.8% specificity, and 73.7% accuracy. This study also defined the median cut-offs for individual decompensation events: 7.1 kPa for the occurrence of ascites, 8.85 kPa for hepatic encephalopathy, and 10.1 kPa for esophageal variceal bleeding and mortality [ 58 ].…”