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MRE accurate for diagnosing fibrosis in patients with NAFLD, obesity

Magnetic resonance elastography accurately diagnosed fibrosis in patients with biopsy-proven nonalcoholic fatty liver disease and obesity more often than acoustic radiation force impulse imaging, according to data published in Hepatology.

“Biopsy is currently the gold standard for diagnosing fibrosis in NAFLD patients, but is invasive, has high interobserver variability and is associated with various complications, including death,” the researchers wrote. “There is a need for noninvasive tests that can diagnose fibrosis in NAFLD patients.”

Jeffrey Y. Cui, fourth year medical student in the NAFLD Translational Research Unit at University of California San Diego School of Medicine, and colleagues, including Rohit Loomba, MD, MHSc, NAFLD Translational Research Unit, University of California San Diego, performed a cross-sectional analysis of 125 patients who underwent magnetic resonance elastography (MRE), acoustic radiation force impulse (ARFI) and liver biopsies scored via the Nonalcoholic Steatohepatitis Clinical Research Network histological scoring system. Performances of both techniques were assessed using the area under receiver operating characteristic curve (AUROC).

Rohit Loomba

The AUROC of MRE in determining any fibrosis was higher (0.799; 95% CI, 0.723-0.875) compared with the AUROC for ARFI (0.664; 95% CI, 0.568-0.76). MRE was also superior to ARFI for diagnosing any fibrosis in patients with obesity (P < .001). However, this was not true for nonobese patients (P = .722).

“In obese individuals, MRE should be considered for diagnosis of fibrosis in patients with NAFLD. However, in non-obese individuals, ARFI measurements may provide adequate diagnostic accuracy,” the researchers wrote. “These findings may have important clinical implications in noninvasive assessment of NAFLD and developing an optimal strategy for resource utilization.

“MRE had higher AUROCs than ARFI for discriminating dichotomized fibrosis stages at all dichotomization cut-points, but the AUROC differences decreased as the cut-points (fibrosis stages) increased,” they added.

"This head to head comparison of MRE vs. ARFI shows that MRE is better than ARFI especially among obese patients with NAFLD," Loomba told Healio.com/Hepatology. "Multi center validation studies are needed to develop an integrated approach to develop screening for fibrotic disease in NAFLD utilizing serum as well ultrasound and MR-based bio markets." – by Melinda Stevens

Disclosures: Cui and Loomba report no relevant financial disclosures. Please see the study for a full list of all other authors’ relevant financial disclosures.