Abstract
ObjectivesTo assess reproducibility and fibrosis classification accuracy of magnetic resonance elastography (MRE)–determined liver stiffness measured manually at two different centers, and by automated analysis software in adults with nonalcoholic fatty liver disease (NAFLD), using histopathology as a reference standard.MethodsThis retrospective, cross-sectional study included 91 adults with NAFLD who underwent liver MRE and biopsy. MRE-determined liver stiffness was measured independently for this analysis by an image analyst at each of two centers using standardized manual analysis methodology, and separately by an automated analysis. Reproducibility was assessed pairwise by intraclass correlation coefficient (ICC) and Bland-Altman analysis. Diagnostic accuracy was assessed by receiver operating characteristic (ROC) analyses.ResultsICC of liver stiffness measurements was 0.95 (95% CI: 0.93, 0.97) between center 1 and center 2 analysts, 0.96 (95% CI: 0.94, 0.97) between the center 1 analyst and automated analysis, and 0.94 (95% CI: 0.91, 0.96) between the center 2 analyst and automated analysis. Mean bias and 95% limits of agreement were 0.06 ± 0.38 kPa between center 1 and center 2 analysts, 0.05 ± 0.32 kPa between the center 1 analyst and automated analysis, and 0.11 ± 0.41 kPa between the center 2 analyst and automated analysis. The area under the ROC curves for the center 1 analyst, center 2 analyst, and automated analysis were 0.834, 0.833, and 0.847 for distinguishing fibrosis stage 0 vs. ≥ 1, and 0.939, 0.947, and 0.940 for distinguishing fibrosis stage ≤ 2 vs. ≥ 3.ConclusionMRE-determined liver stiffness can be measured with high reproducibility and fibrosis classification accuracy at different centers and by an automated analysis.Key Points• Reproducibility of MRE liver stiffness measurements in adults with nonalcoholic fatty liver disease is high between two experienced centers and between manual and automated analysis methods.• Analysts at two centers had similar high diagnostic accuracy for distinguishing dichotomized fibrosis stages.• Automated analysis provides similar diagnostic accuracy as manual analysis for advanced fibrosis.
Highlights
Magnetic resonance elastography (MRE) of the liver is increasingly used to noninvasively assess hepatic fibrosis in chronic liver disease [1, 2]
Classification accuracy of MRE-determined liver stiffness measured by each of the three MRE analysis methods was assessed for distinguishing fibrosis stage 0 vs. 1–4 and for distinguishing fibrosis stages ≤ 2 vs. ≥ 3
These thresholds were selected in part by their importance, and in part by our data distribution
Summary
Magnetic resonance elastography (MRE) of the liver is increasingly used to noninvasively assess hepatic fibrosis in chronic liver disease [1, 2]. Assessing reproducibility is essential for determining whether liver stiffness changes assessed at different centers or by different analysis methods can be attributed confidently to true change, rather than to measurement or analysis variability. Prior studies have examined inter-analyst reproducibility [7, 9] of MRE-determined liver stiffness measurements at the same center, but there is limited data on the reproducibility of measurements between centers. Such data is needed because agreement within any one analysis center may not generalize to agreement across other centers due to variability in training, experience, or other factors
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