Abstract
Non-alcoholic steatohepatitis (NASH) is a complex disease consisting of various components including steatosis, lobular inflammation, and ballooning degeneration, with or without fibrosis. Therefore, it is difficult to diagnose NASH with only one imaging modality. This study was aimed to evaluate the feasibility of magnetic resonance imaging (MRI) for predicting NASH and to develop a non-invasive multiparametric MR index for the detection of NASH in non-alcoholic fatty liver disease (NAFLD) patients. This prospective study included 47 NAFLD patients who were scheduled to undergo or underwent ultrasound-guided liver biopsy within 2 months. Biopsy specimens were graded as NASH or non-NASH. All patients underwent non-enhanced MRI including MR spectroscopy (MRS), MR elastography (MRE), and T1 mapping. Diagnostic performances of MRS, MRE, and T1 mapping for grading steatosis, activity, and fibrosis were evaluated. A multiparametric MR index combining fat fraction (FF), liver stiffness (LS) value, and T1 relaxation time was developed using linear regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the newly devised MR index. Twenty NASH patients and 27 non-NASH patients were included. Using MRS, MRE, and T1 mapping, the mean areas under the curve (AUCs) for grading steatosis, fibrosis, and activity were 0.870, 0.951, and 0.664, respectively. The multiparametric MR index was determined as 0.037 × FF (%) + 1.4 × LS value (kPa) + 0.004 × T1 relaxation time (msec) −3.819. ROC curve analysis of the MR index revealed an AUC of 0.883. The cut-off value of 6 had a sensitivity of 80.0% and specificity of 85.2%. The multiparametric MR index combining FF, LS value, and T1 relaxation time showed high diagnostic performance for detecting NASH in NAFLD patients.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease with increasing prevalence worldwide[1]
Patients were classified into the Non-alcoholic steatohepatitis (NASH) (n = 20) or non-NASH (n = 27) group based on the Steatosis, Activity, Fibrosis (SAF) scoring system
MR spectroscopy (MRS) and MR elastography (MRE) showed high diagnostic performance for staging steatosis and fibrosis in non-alcoholic fatty liver disease (NAFLD) patients, respectively. These results are in good agreement with those of previous studies in which MRS and MRE showed strong correlations with hepatic fat fraction (FF) and hepatic fibrosis, respectively[8,13,14,15]
Summary
Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease with increasing prevalence worldwide[1]. NAFLD encompasses a wide spectrum of diseases, ranging from simple steatosis and non-alcoholic steatohepatitis (NASH) to liver cirrhosis. It has been shown that T1 mapping can be used to differentiate patients with liver fibrosis and cirrhosis[11] and to predict clinical outcomes in patients with chronic liver disease[12]. We postulated that a non-invasive multiparametric MR index combining MRS, MRE, and T1 mapping may help diagnose NASH in NAFLD patients, thereby potentially reducing the need for liver biopsy. The purpose of this study was to evaluate the feasibility of MRI for predicting NASH and to develop a non-invasive multiparametric MR index for the detection of NASH in NAFLD patients
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