Abstract
ObjectivesHepatic steatosis is associated with an increased risk of developing serious liver disease and other clinical sequelae of the metabolic syndrome. However, visual estimates of steatosis from histological sections of biopsy samples are subjective and reliant on an invasive procedure with associated risks. The aim of this study was to test the ability of a rapid, routinely available, magnetic resonance imaging (MRI) method to diagnose clinically relevant grades of hepatic steatosis in a cohort of patients with diverse liver diseases.Materials and MethodsFifty-nine patients with a range of liver diseases underwent liver biopsy and MRI. Hepatic steatosis was quantified firstly using an opposed-phase, in-phase gradient echo, single breath-hold MRI methodology and secondly, using liver biopsy with visual estimation by a histopathologist and by computer-assisted morphometric image analysis. The area under the receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of the MRI method against the biopsy observations.ResultsThe MRI approach had high sensitivity and specificity at all hepatic steatosis thresholds. Areas under ROC curves were 0.962, 0.993, and 0.972 at thresholds of 5%, 33%, and 66% liver fat, respectively. MRI measurements were strongly associated with visual (r2 = 0.83) and computer-assisted morphometric (r2 = 0.84) estimates of hepatic steatosis from histological specimens.ConclusionsThis MRI approach, using a conventional, rapid, gradient echo method, has high sensitivity and specificity for diagnosing liver fat at all grades of steatosis in a cohort with a range of liver diseases.
Highlights
Fatty liver disease is associated with an increased risk of carcinoma, cardiovascular death, cirrhosis, reduced effectiveness of antiviral treatments, and is implicated in the development of diabetes [1]
magnetic resonance imaging (MRI) measurements were strongly associated with visual (r2 = 0.83) and computer-assisted morphometric (r2 = 0.84) estimates of hepatic steatosis from histological specimens
A visual estimate of the fat content in a liver biopsy specimen by a histopathologist is considered the gold standard for clinically assessing liver fat
Summary
Fatty liver disease is associated with an increased risk of carcinoma, cardiovascular death, cirrhosis, reduced effectiveness of antiviral treatments, and is implicated in the development of diabetes [1]. A visual estimate of the fat content in a liver biopsy specimen by a histopathologist is considered the gold standard for clinically assessing liver fat. Visual estimates of liver fat in biopsy samples are subjective, have poor reproducibility [3], are potentially unrepresentative of the whole liver and require an invasive procedure with associated risks to obtain the sample [4]. With obesity common in developed countries there is increased interest in non-invasive methods of quantifying liver fat content for research purposes, diagnosis, and monitoring intervention programs
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