Assessment of Hepatic Fibrosis With Magnetic Resonance Elastography

doi:10.1016/j.cgh.2007.06.012

Clinical Gastroenterology and Hepatology

Volume 5, Issue 10, October 2007, Pages 1207-1213.e2

https://doi.org/10.1016/j.cgh.2007.06.012 Get rights and content

Background & Aims: Accurate detection of hepatic fibrosis is crucial for assessing prognosis and candidacy for treatment in patients with chronic liver disease. Magnetic resonance (MR) elastography, a technique for quantitatively assessing the mechanical properties of soft tissues, has been shown previously to have potential for noninvasively detecting liver fibrosis. The goal of this work was to obtain preliminary estimates of the sensitivity and specificity of the technique in diagnosing liver fibrosis, and to assess its potential for identifying patients who potentially can avoid a biopsy procedure. Methods: MR elastography was performed in 35 normal volunteers and 50 patients with chronic liver disease. MR imaging measurements of hepatic fat to water ratios were obtained to assess the potential for fat infiltration to affect stiffness-based detection of fibrosis. Results: Liver stiffness increased systematically with fibrosis stage. Receiver operating curve analysis showed that, with a shear stiffness cut-off value of 2.93 kilopascals, the predicted sensitivity and specificity for detecting all grades of liver fibrosis is 98% and 99%, respectively. Receiver operating curve analysis also provided evidence that MR elastography can discriminate between patients with moderate and severe fibrosis (grades 2–4) and those with mild fibrosis (sensitivity, 86%; specificity, 85%). Hepatic stiffness does not appear to be influenced by the degree of steatosis. Conclusions: MR elastography is a safe, noninvasive technique with excellent diagnostic accuracy for assessing hepatic fibrosis. Based on the high negative predictive value of MR elastography, an initial clinical application may be to triage patients who are under consideration for biopsy examination to assess possible hepatic fibrosis.

Section snippets

Patient Population

Subjects undergoing clinical evaluation and management for chronic liver disease at the Mayo Clinic (Rochester, MN) between August 4, 2005, and March 10, 2007, were eligible for study participation. Inclusion criteria were as follows: (1) age 18 years or older, (2) percutaneous liver biopsy performed within 1 year of study enrollment (average time interval, 6.5 ± 3.9 mo; range, 0–12 mo), and/or (3) a diagnosis of compensated cirrhosis supported by liver histology or compatible clinical and

Patient and Volunteer Demographics and Diagnoses

Thirty-five volunteers (28% women; mean age, 37.2 ± 17.8 y; range, 19–82 y; mean body mass index, 23.6 ± 3.8 kg/m²; body mass index range, 17.9–34.8 kg/m²) with no history of liver disease and 50 patients (54% women; mean age, 55.3 ± 11.2 y; range, 21–76 y) with chronic liver disease consented to undergo MR elastography. Among patients, the major causes of chronic liver disease included chronic hepatitis C (33%), nonalcoholic fatty liver disease (20%), autoimmune hepatitis (7%), primary biliary

Discussion

The results of this study support the hypothesis that MR elastography is effective for distinguishing normal from fibrotic livers with a very high negative predictive value of 97%. It appears to be very good at differentiating normal from mild fibrosis (F0–2), and mild fibrosis (F0–2) from severe fibrosis (F3–4). The presence of steatosis does not appear to affect shear stiffness measurements.

Liver stiffness assessed by MR elastography was highly consistent among normal individuals with a mean

Conclusions

The detection of hepatic fibrosis by MR elastography appears safe and feasible in human subjects with chronic liver disease. Furthermore, this method is highly sensitive and specific for detecting intermediate stages of hepatic fibrosis based on the information available from this investigation. The presence of hepatic steatosis had no apparent effect on the liver stiffness measurements. Overall, these results provide continued motivation for further evaluation of hepatic MR elastography in

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: Supported by National Institutes of Health grant EB001981. P.J.R. and R.L.E. and their institution hold patents related to this technology and have a potential financial interest in this research.

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Original article—liver, pancreas, and biliary tractAssessment of Hepatic Fibrosis With Magnetic Resonance Elastography

Section snippets

Patient Population

Patient and Volunteer Demographics and Diagnoses

Discussion

Conclusions

Hepatology

Liver Transpl

Clin Gastroenterol Hepatol

J Radiol

Ultrasound Med Biol

J Surg Res

Gastroenterology

Ultrasound Med Biol

Magn Reson Imaging

Magn Reson Imaging

Med Image Anal

Am J Gastroenterol

Hepatology

Med Image Anal

The burden of gastrointestinal and liver diseases, 2006

Am J Gastroenterol

An appraisal of the histopathological assessment of liver fibrosis

Gut

Liver biopsy

N Engl J Med

Reversal of hepatic fibrosis—fact or fantasy?

Hepatology

Magnetization transfer contrast imaging of liver cirrhosis

Hepatogastroenterology

Significance of intraoperative measurement of liver consistency prior to hepatic resection

Hepatogastroenterology

Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C

Hepatology

Increased hepatic resistance: a new target in the pharmacologic therapy of portal hypertension

J Clin Gastroenterol

Original article—liver, pancreas, and biliary tract
Assessment of Hepatic Fibrosis With Magnetic Resonance Elastography