Non‐invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE

Abstract

SUMMARY Background Current guidelines do not recommend screening for nonalcoholic fatty liver disease (NAFLD) or advanced fibrosis. Patients with type 2 diabetes mellitus (T2DM) are known to be at increased risk for NAFLD and advanced fibrosis. Aim We aimed to assess the feasibility in diabetics in a primary care setting of screening for NAFLD and advanced fibrosis by using non-invasive magnetic resonance imaging (MRI) to estimate the hepatic proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE) to estimate hepatic stiffness. Methods We performed a cross-sectional analysis of a prospective study that included 100 (53% men) consecutively enrolled diabetics who did not have any other etiology of liver disease. All patients underwent a standardized research visit, laboratory tests, MRI-PDFF, and MRE. Results Mean (± SD) age and BMI was 59.7 (±11.2) years and 30.8 (±6.5) kg/m2, respectively. The prevalence of NAFLD (defined as MRI-PDFF ≥ 5%) and advanced fibrosis (defined as MRE ≥ 3.6 kPa) was 65% and 7.1%, respectively. One patient with advanced fibrosis had definite hepatocellular carcinoma. When compared to those without NAFLD, patients with NAFLD were younger (p=0.028) and had higher mean BMI (p=0.0008), waist circumference (p<0.0001) and prevalence of metabolic syndrome (84.6% vs. 40.0%, p<0.0001). Only 26% of those with NAFLD had elevated ALT. Conclusions This proof-of-concept study demonstrates that T2DM has significant rates of both NAFLD and advanced fibrosis. Concomitant screening for NAFLD and advanced fibrosis by using MRI-PDFF and MRE in T2DM is feasible and may be considered after validation in a larger cohort.

Diagnosis of non-alcoholic fatty liver disease (NAFLD)

“…Using this technique and criterion, the prevalence of NAFLD in type 2 diabetic patients has been reported to be 50% [14] and 60% [15]. A study diagnosing NAFLD by MRIestimated proton density fat fraction ≥5% found NAFLD in 65% [16] and studies using ultrasound diagnosed NAFLD in 74% [17], 57% [18] and 70% [19] of patients with type 2 diabetes. Half of patients with type 2 diabetes have NAFLD despite having normal alanine aminotransferase (ALT) levels [14].…”

“…In a biopsy study, 22% of type 2 diabetic patients attending an outpatient clinic were found to have NASH [17]. Advanced fibrosis, as measured by magnetic resonance elastography, was found in 7% of type 2 diabetic patients [16].…”

Mean Platelet Volume in Non-Alcoholic Fatty Liver Disease in Type 2 Diabetes Mellitus - A Marker of Cardiovascular Risk

“…[6] Past studies of NAFLD were based on abdominal ultrasound, magnetic resonance spectroscopy and liver biopsies. [7] Screening of NAFLD in not recommended routinely due to lack of accurate non-invasive methods of diagnosis. [8] There is an association between NAFLD and increased mean platelet volume (MPV) which is a marker of platelet function.…”

949 Sitagliptin Versus Placebo in the Treatment of Nonalcoholic Fatty Liver Disease: A Randomized Controlled Trial

“…MR Elastography-MRE has been shown to be a robust, accurate biomarker for the quantitative, noninvasive evaluation of liver stiffness as a surrogate for liver fibrosis 26,27,44,45 and may also be helpful for the early NASH detection. 46 MRE acquisitions was obtained using previously published parameters.…”