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Magnetic Resonance Elastography vs Transient Elastography in Detection of Fibrosis and Noninvasive Measurement of Steatosis in Patients with Biopsy-proven Nonalcoholic Fatty Liver Disease
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Abstract
Background & Aims
Magnetic-resonance-imaging (MRI) techniques and ultrasound-based transient elastography (TE) can be used in noninvasive diagnosis of fibrosis and steatosis in patients with nonalcoholic fatty liver disease (NAFLD). We performed a prospective study to compare the performance of magnetic resonance elastography (MRE) vs TE for in diagnosis of fibrosis, and MRI-based proton density fat fraction (MRI-PDFF) analysis vs TE-based controlled attenuation parameter (CAP) for diagnosis of steatosis in patients undergoing biopsy to assess NAFLD.
Methods
We performed a cross-sectional study of 104 consecutive adults (56.7% female) who underwent MRE, TE, and liver biopsy analysis (using the histological scoring system for NAFLD from the nonalcoholic steatohepatitis clinical research network scoring system) from October 2011 through May 2016 at a tertiary medical center. All patients received a standard clinical evaluation, including collection of history, anthropometric examination, and biochemical tests. The primary outcomes were fibrosis and steatosis. Secondary outcomes included dichotomized stages of fibrosis and NASH vs no NASH. Receiver operating characteristic (ROC) curve analyses were used to compare performances of MRE vs TE in diagnosis of fibrosis (stages 1–4 vs 0) and MRI-PDFF vs CAP for diagnosis of steatosis (grades 1–3 vs 0) with respect to findings from biopsy analysis.
Results
MRE detected any fibrosis (stage 1 or more) with an area under the ROC (AUROC) of 0.82 (95% CI, 0.74–0.91), which was significantly higher than that of TE (AUROC, 0.67; 95% CI, 0.56–0.78). MRI-PDFF detected any steatosis with an AUROC of 0.99 (95% CI, 0.98–1.00), which was significantly higher that of CAP (AUROC, 0.85; 95% CI, 0.75–0.96). MRE detected fibrosis of stages 2, 3, or 4 with AUROC values of 0.89 (95% CI, 0.83–0.96), 0.87 (95% CI, 0.78–0.96), and 0.87 (95% CI, 0.71-1.00); TE detected fibrosis of stages 2, 3, or 4 with AUROC values of 0.86 (95% CI, 0.77–0.95), 0.80 (95% CI, 0.67–0.93), and 0.69 (95% CI, 0.45–0.94). MRI-PDFF identified steatosis of grades 2 or 3 with AUROC values of 0.90 (95% CI, 0.82–0.97) and 0.92 (95% CI, 0.84–0.99); CAP identified steatosis of grades 2 or 3 with AUROC values of 0.70 (95% CI, 0.58–0.82) and 0.73 (95% CI, 0.58–0.89).
Conclusions
In a prospective, cross-sectional study of more than 100 patients, we found MRE to be more accurate than TE in identification of liver fibrosis (stage 1 or more), using biopsy analysis as the standard. MRI-PDFF is more accurate than CAP in detecting all grades of steatosis in patients with NAFLD.