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Abstract
There is a need, in NAFLD management, to develop non-invasive methods to detect steatohepatitis (NASH) and to predict advanced fibrosis stages. We evaluated a tool based on optical analysis of liver magnetic resonance images (MRI) as biomarkers for NASH and fibrosis detection by investigating patients with biopsy-proven NAFLD who underwent magnetic resonance (MR) protocols using 1.5T General Electric (GE) or Philips devices. Two imaging biomarkers (NASHMRI and FibroMRI) were developed, standardised and validated using area under the receiver operating characteristic curve (AUROC) analysis. The results indicated NASHMRI diagnostic accuracy for steatohepatitis detection was 0.83 (95% CI: 0.73–0.93) and FibroMRI diagnostic accuracy for significant fibrosis determination was 0.85 (95% CI: 0.77–0.94). These findings were independent of the MR system used. We conclude that optical analysis of MRI has high potential to define non-invasive imaging biomarkers for the detection of steatohepatitis (NASHMRI) and the prediction of significant fibrosis (FibroMRI) in NAFLD patients.
Highlights
Unmet needs in Non-alcoholic fatty liver disease (NAFLD) management include: a) non-alcoholic steatohepatitis (NASH) detection that could help exclude patients not at risk of disease progression; b) Prediction of significant fibrosis to select patients with poorer prognosis and survival[8]
Model coefficients associated with each one of these independent variables were β1 = 0.079 (OR: 1.08, 95% CI: 1.02–1.15; p = 0.015) and β2 = 0.127 (OR: 1.14, 95% CI: 1.03–1.26; p = 0.015). The influence of these estimators on the predictive equation to obtain the probability of suffering steatohepatitis was developed on estimation cohort and is given by: NASHMRI = 1/1 + e1.654−0.079∗E3 (SSFSE−T2) –0.127∗E57 (DYNAMIC) ∗E73 (FAST−STIR)
Mean NASHMRI discriminated between simple steatosis and steatohepatitis, with high sensitivity (Se) and specificity (Sp)
Summary
Unmet needs in NAFLD management include: a) NASH detection that could help exclude patients not at risk of disease progression; b) Prediction of significant fibrosis to select patients with poorer prognosis and survival[8]. The development of a definitive non-invasive test would be desirable. Several imaging tests have emerged to help diagnosis These include transient elastography[15], acoustic radiation force impulse[16], and magnetic resonance elastography[17]. Serum biomarkers have been demonstrated to be moderately useful These include cytokeratin-18 (CK-18), fibroblast grown factor 21 (FGF21)[18,19] and NAFLD fibrosis score, in combination with non-invasive methods developed in the hepatitis C setting e.g. the Sydney Index. The main aim was to develop, standardise and validate imaging biomarkers defined by optical processing methods applied to conventional non-enhanced contrast magnetic resonance images (MRI) in order to predict, using non-invasive tools, steatohepatitis and fibrosis stages in NAFLD patients. The secondary objective was to compare these imaging biomarkers with currently available non-invasive markers
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