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Advanced MRI may be useful for evaluating treatment response in NASH

MRI-derived measures of liver fat and volume may be more responsive markers of treatment response than histology in nonalcoholic steatohepatitis, according to new research.

Investigators found that these advanced MRI-derived measures correlated well with each other, and reflected improvements in steatosis and fibrosis.

“New advanced MRI-derived measures of liver fat and volume are being explored for utility in randomized clinical trials,” Rohit Loomba, MD, MHSc, director of the NAFLD Research Center, UC San Diego Health, and professor of medicine at UC San Diego School of Medicine, and colleagues wrote. “This is of significance as changes in liver volume may be an important marker of disease progression or regression, as they are associated with metabolic syndrome. … However, no studies to date have examined the cross-sectional and longitudinal relationships of these advanced MRI-derived measures vs. histological features.”

Rohit Loomba

Loomba and colleagues therefore conducted a secondary analysis of the MOZART trial to compare the links between MRI proton-density fat fraction (MRI-PDFF), total liver volume (TLV), total liver fat index (TLFI) and histology. The trial was a 24-week double blind trial of 10 mg daily oral ezetimibe vs. placebo in 50 NASH patients (62% women; mean age, 49 years; mean BMI, 33.4), whose anthropometrics, biochemical profiling, MRI and biopsies were collected before and after treatment.

At baseline, mean PDFF strongly correlated with TLFI (P < .0001) and correlated with TLV (P < .0001), and mean TLV strongly correlated with TLFI (P < .0001).

“These findings remained consistently robust after 24 weeks of treatment,” Loomba and colleagues wrote.

After 24 weeks, PDFF continued to correlate strongly with TLFI (P < .0001), and remained correlated with TLV (P < .0004). Further, TLV continued to correlate strongly with TLFI (P < .0001).

The investigators also observed that patients with grade 1 steatosis had lower PDFF (P < .0001), TLV (P = .0003) and TLFI (P < .0001) compared with those who had grade 3 steatosis.

Finally, they performed regression analysis of changes in MRI-PDFF vs. TLV and found that a 10% decrease in MRI-PDFF was predictive of a 257 mL decrease in TLV.

“A reduction in liver fat by MRI [PDFF] is associated with improvement in hepatomegaly,” the investigators wrote. “These measures may provide additional noninvasive quantitative and qualitative information when utilized in NASH clinical trials, and may be more dynamic and responsive than histology.” – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.