Hepatology. 2023 Apr 24. doi: 10.1097/HEP.0000000000000417. Online ahead of print.
ABSTRACT
BACKGROUND AIMS: The presence of at-risk nonalcoholic steatohepatitis (NASH) is associated with an increased risk of cirrhosis and complications. Therefore, noninvasive identification of at-risk NASH with an accurate biomarker is a critical need for pharmacologic therapy. We aim to explore the performance of several magnetic resonance (MR)-based imaging parameters in diagnosing at-risk NASH.
APPROACH RESULTS: This prospective clinical trial (NCT02565446) includes 104 paired MR exams and liver biopsies performed in patients with suspected or diagnosed nonalcoholic fatty liver disease. MR Elastography (MRE)-assessed liver stiffness (LS), 6-point Dixon-derived proton density fat fraction (PDFF), single-point saturation-recovery acquisition-calculated T1 relaxation time were explored. Among all predictors, LS showed the significantly highest accuracy in diagnosing at-risk NASH (AUCLS: 0.89 [0.82, 0.95], AUCPDFF: 0.70 [0.58, 0.81], AUCT1: 0.72 [0.61, 0.82], z-score test z > 1.96 for LS vs. any of others). The optimal cut-off value of LS to identify at-risk NASH patients was 3.3kPa (sensitivity 79%, specificity 82%, NPV 91%), while the optimal cut-off value of T1 was 850ms (sensitivity 75%, specificity 63%, and NPV 87%). PDFF had the highest performance in diagnosing NASH with any fibrosis stage (AUCPDFF: 0.82 [0.72, 0.91], AUCLS: 0.73 [0.63, 0.84], AUCT1: 0.72 [0.61, 0.83], |z| < 1.96 for all).
CONCLUSIONS: MRE-assessed liver stiffness alone outperformed PDFF, and T1 in identifying patients with at-risk NASH for therapeutic trials.
PMID:37080558 | DOI:10.1097/HEP.0000000000000417
