Abstract
PurposeAutoimmune hepatitis (AIH) is an immune-mediated chronic liver disease that leads to severe fibrosis and cirrhosis. The aim of this study was to determine the diagnostic value of T1 and T2 mapping as well as extracellular volume fraction (ECV) for non-invasive assessment of liver fibrosis in AIH patients.MethodsIn this prospective study, 27 patients (age range: 19–77 years) with AIH underwent liver MRI. T1 and T2 relaxation times as well as ECV were quantified by mapping techniques. The presence of significant fibrosis (≥ F2) was defined as magnetic resonance elastography (MRE)-based liver stiffness ≥ 3.66 kPa. MRE was used as reference standard, against which the diagnostic performance of MRI-derived mapping parameters was tested. Diagnostic performance was compared by utilizing receiver-operating characteristic (ROC) analysis.ResultsMRE-based liver stiffness correlated with both, hepatic native T1 (r = 0.69; P < 0.001) as well as ECV (r = 0.80; P < 0.001). For the assessment of significant fibrosis, ECV yielded a sensitivity of 85.7% (95% confidence interval (CI): 60.1–96.0%) and a specificity of 84.6% (CI 60.1–96.0%); hepatic native T1 yielded a sensitivity of 85.7% (CI 60.1–96.0%); and a specificity of 76.9% (CI 49.7–91.8%). Diagnostic performance of hepatic ECV (area under the curve (AUC): 0.885), native hepatic T1 (AUC: 0.846) for assessment of significant fibrosis was similar compared to clinical fibrosis scores (APRI (AUC: 0.852), FIB-4 (AUC: 0.758), and AAR (0.654) (P > 0.05 for each comparison)).ConclusionQuantitative mapping parameters such as T1 and ECV can identify significant fibrosis in AIH patients. Future studies are needed to explore the value of parametric mapping for the evaluation of different disease stages.
Highlights
Autoimmune hepatitis (AIH) is an immune-mediated chronic liver disease that may lead to severe liver fibrosis and cirrhosis
Non-invasive scoring systems based on laboratory tests for assessment of liver fibrosis (aspartate aminotransferase-to-platelet ratio index (ARPI), fibrosis index based on the 4 factor (FIB-4), and aspartate aminotransferase and alanine aminotransferase ratio (AST/ALT ratio) were calculated as previously described [26,27,28]
extracellular volume fraction (ECV) values were normalized for hematocrit and calculated with regions of interest from pre- and post-contrast T1 values using the following equation [32]: ECV = (1 − hematocrit)*(1/T1 parenchyma post-contrast − 1/T1 parenchyma pre-contrast)/ (1/T1 aortic post-contrast − 1/T1 aortic pre-contrast)
Summary
Autoimmune hepatitis (AIH) is an immune-mediated chronic liver disease that may lead to severe liver fibrosis and cirrhosis. AIH is relatively rare and predominantly affects females [1]. Liver biopsy is recommended in patients with AIH to establish diagnosis, evaluate the presence of fibrosis, and make further treatment decision [2]. Despite being considered the gold standard for diagnosis, liver biopsy in AIH patients. Abdominal Radiology (2021) 46:2458–2466 has clear disadvantages, which include high clinical expertise, high intra- and interobserver variability, risk of severe periprocedural complications, and high cost. Serial liver biopsies are not practical for long-term monitoring of a patient’s treatment response. As fibrosis detection and staging are important for treatment decisions and prognosis estimation reliably non-invasive measurements are needed, in these patients [1]
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