Assessment of Imaging Modalities Against Liver Biopsy in Nonalcoholic Fatty Liver Disease: The Amsterdam NAFLD‐NASH Cohort

Background Noninvasive diagnostic methods are urgently required in disease stratification and monitoring in nonalcoholic fatty liver disease (NAFLD). Multiparametric magnetic resonance imaging (MRI) is a promising technique to assess hepatic steatosis, inflammation, and fibrosis, potentially enablin...

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Published in:Journal of magnetic resonance imaging Vol. 54; no. 6; pp. 1937 - 1949
Main Authors: Troelstra, Marian A., Witjes, Julia J., Dijk, Anne‐Marieke, Mak, Anne L., Gurney‐Champion, Oliver, Runge, Jurgen H., Zwirs, Diona, Stols‐Gonçalves, Daniela, Zwinderman, Aelko H., Wolde, Marije, Monajemi, Houshang, Ramsoekh, Sandjai, Sinkus, Ralph, Delden, Otto M., Beuers, Ulrich H., Verheij, Joanne, Nieuwdorp, Max, Nederveen, Aart J., Holleboom, Adriaan G.
Format: Journal Article
Language:English
Published: Hoboken, USA John Wiley & Sons, Inc 01.12.2021
Wiley Subscription Services, Inc
Wiley-Blackwell
Subjects:
Attenuation
Bioengineering
Biomechanics
Biopsy
Correlation
Diagnostic systems
Diffusion
Engineering Sciences
Fatty liver
Fibrosis
Field strength
Human health and pathology
Hépatology and Gastroenterology
Imaging
Life Sciences
Liver
liver biopsy
Liver diseases
Magnetic resonance imaging
Mechanics
Medical imaging
multiparametric
nonalcoholic fatty liver disease
nonalcoholic steatohepatitis
Parameters
Perfusion
Population studies
Proton density (concentration)
Rank tests
Resonance
Spectroscopy
Statistical analysis
Statistical tests
Steatosis
Stiffness
nonalcoholic steatohepatitis
magnetic resonance imaging
nonalcoholic fatty liver disease
liver biopsy
multiparametric
ISSN:1053-1807, 1522-2586, 1522-2586
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Summary:Background Noninvasive diagnostic methods are urgently required in disease stratification and monitoring in nonalcoholic fatty liver disease (NAFLD). Multiparametric magnetic resonance imaging (MRI) is a promising technique to assess hepatic steatosis, inflammation, and fibrosis, potentially enabling noninvasive identification of individuals with active and advanced stages of NAFLD. Purpose To examine the diagnostic performance of multiparametric MRI for the assessment of disease severity along the NAFLD disease spectrum with comparison to histological scores. Study Type Prospective, cohort. Population Thirty‐seven patients with NAFLD. Field Strength/Sequence Multiparametric MRI at 3.0 T consisted of magnetic resonance (MR) spectroscopy (MRS) with multi‐echo stimulated‐echo acquisition mode, magnitude‐based and three‐point Dixon using a two‐dimensional multi‐echo gradient echo, MR elastography (MRE) using a generalized multishot gradient‐recalled echo sequence and intravoxel incoherent motion (IVIM) using a multislice diffusion weighted single‐shot echo‐planar sequence. Assessment Histological steatosis grades were compared to proton density fat fraction measured by MRS (PDFFMRS), magnitude‐based MRI (PDFFMRI‐M), and three‐point Dixon (PDFFDixon), as well as FibroScan® controlled attenuation parameter (CAP). Fibrosis and disease activity were compared to IVIM and MRE. FibroScan® liver stiffness measurements were compared to fibrosis levels. Diagnostic performance of all imaging parameters was determined for distinction between simple steatosis and nonalcoholic steatohepatitis (NASH). Statistical Tests Spearman's rank test, Kruskal–Wallis test, Dunn's post‐hoc test with Holm‐Bonferroni P‐value adjustment, receiver operating characteristic curve analysis. A P‐value <0.05 was considered statistically significant. Results Histological steatosis grade correlated significantly with PDFFMRS (rs = 0.66, P < 0.001), PDFFMRI‐M (rs = 0.68, P < 0.001), and PDFFDixon (rs = 0.67, P < 0.001), whereas no correlation was found with CAP. MRE and IVIM diffusion and perfusion significantly correlated with disease activity (rs = 0.55, P < 0.001, rs = −0.40, P = 0.016, rs = −0.37, P = 0.027, respectively) and fibrosis (rs = 0.55, P < 0.001, rs = −0.46, P = 0.0051; rs = −0.53, P < 0.001, respectively). MRE and IVIM diffusion had the highest area‐under‐the‐curve for distinction between simple steatosis and NASH (0.79 and 0.73, respectively). Data Conclusion Multiparametric MRI is a promising method for noninvasive, accurate, and sensitive distinction between simple hepatic steatosis and NASH, as well as for the assessment of steatosis and fibrosis severity. Level of Evidence 2 Technical Efficacy 2
Bibliography:Marian A. Troelstra and Julia J. Witjes are shared first authors.
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ISSN:1053-1807
1522-2586
1522-2586
DOI:10.1002/jmri.27703