Role of Magnetic Resonance Elastography in Assessment of Liver Fibrosis in Patients With Non-cirrhotic Portal Fibrosis

Abstract

Background and Aim: Non-cirrhotic portal fibrosis (NCPF) is diagnosed by liver biopsy, which is invasive, has potential complications and limited by sampling error and inter-observer variability. MR Elastography (MRE) is validated to assess liver fibrosis. We did this study to assess MRE findings in patients with NCPF. Methods: Patients with biopsy proven NCPF (n = 28, age 33.9[10.6] years; 16 women), Cirrhosis with portal hypertension (n = 14, age 31.9[10.3] years; 5 women) and healthy controls (n = 14, age 45.1[13.5] years; 5 women) underwent MRE (3 Tesla, HD Discovery 750, GE Healthcare, Milwaukee, MRE sequence—4-slice, 4-phase-offset, 2-D, gradient-echo in 4, 16-second expiration breath holds). Additionally liver texture, contour and surface nodularity were evaluated. Results: The mean (SD) liver stiffness values (kPa) of patients with NCPF, cirrhosis and healthy controls were 3.43(0.89), 2.31(0.30) and 9.10(2.21), respectively; P < 0.001. Liver stiffness > 2.95 kPa has a sensitivity and specificity of 75% (95% CI 55.1–89.3) and 92.8% (95% CI 66.1–98.2), respectively to distinguish NCPF from controls. Liver stiffness > 5.6 kPa has a sensitivity and specificity of 100% (95% CI 76.8–100) and 100% (95% CI 87–100) respectively to distinguish NCPF from cirrhosis. The mean (SD) spleen size (cm) of patients with NCPF, cirrhosis and controls were 18.45(3.20), 13.17(1.90) and 9.4(0.74), respectively; P < 0.001. The AUC of liver stiffness and spleen size between NCPF and cirrhosis was 1.00 and 0.932(95% CI, 0.846–1) respectively. The AUC of liver stiffness and spleen size between NCPF and controls was 0.899(95% CI, 0.807–0.991) and 0.987(95% CI, 0.96–1) respectively. In patients with NCPF, periportal cuffing was present in 11(39.28%). Mean (SD) right and left portal venous cuffing was 3.16(2.34) and 3.2(2.2) mm, respectively. Minimal ascites was present in 2(7%) and collaterals in 27 (96.4%). Right posterior and peripheral regions of liver showed highest stiffness. Conclusion: MRE reliably distinguishes NCPF from cirrhosis of liver (Figure 1). The authors have none to declare.