Abstract
ObjectivesTo assess whole-liver texture analysis on T1 maps for risk stratification of advanced fibrosis in patients with suspected nonalcoholic fatty liver disease (NAFLD).MethodsThis retrospective study included 53 patients. Histogram and texture parameters (volume, mean, SD, median, 5th percentile, 95th percentile, skewness, kurtosis, diff-entropy, diff-variance, contrast, and entropy) of T1 maps were calculated based on the semi-automatically segmented whole-liver volume. A two-step approach combining the Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS) and Fibrosis-4 Index (FIB-4) with the liver stiffness measurement (LSM) for the risk stratification was used. Univariate analysis was performed to identify significant parameters. Logistic regression models were then run on the significant features. Diagnostic performance was evaluated with receiver operating characteristic (ROC) analysis.ResultsIn total, 33 (62%) subjects had a low risk and 20 (38%) subjects had an intermediate-to-high risk of advanced fibrosis. The following significantly different parameters with the best performance were diff-entropy, entropy, and diff-variance, with AUROC 0.837 (95% CI 0.73–0.95), 0.821 (95% CI 0.71–0.94), and 0.807 (95% CI 0.69–0.93). The optimal combination of median, 5th percentile, and diff-entropy as a multivariate model improved the diagnostic performance to diagnose an intermediate-to-high risk of advanced fibrosis with AUROC 0.902(95% CI 0.79–0.97).ConclusionsParameters obtained by histogram and texture analysis of T1 maps may be a noninvasive analytical approach for stratifying the risk of advanced fibrosis in NAFLD.Key Points• Variable flip angle (VFA) T1 mapping can be used to acquire 3D T1 maps within a clinically acceptable duration.• Whole-liver histogram and texture parameters on T1 maps in patients with NAFLD can distinguish those with an intermediate-to-high risk of advanced fibrosis.• The multivariate model of combination of texture parameters improved the diagnostic performance for a high risk of advanced fibrosis and clinical parameters offer no added value to the multivariate model.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease and is estimated to affect 25% of the general population in the Asia-Pacific region [1]
The multivariate model of combination of texture parameters improved the diagnostic performance for a high risk of advanced fibrosis and clinical parameters offer no added value to the multivariate model
We assessed the potential of whole-liver histogram and texture analysis of T1 map in stratifying the risk of advanced fibrosis in the fatty liver
Summary
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease and is estimated to affect 25% of the general population in the Asia-Pacific region [1]. The presence of fibrosis, advanced fibrosis, is the most important prognostic factor in NAFLD and is correlated with liver-related outcomes and mortality [2, 3]. Monitoring fibrosis progression and recognizing those individuals at high risk of advanced fibrosis is important because those patients might benefit from a tailored therapeutic strategy [4]. Biopsy is invasive and problematic for frequent monitoring. Its interpretation is in part subjective [5]. For these reasons, noninvasive and objective techniques are under investigation, including fibrosis-specific serum markers, ultrasound elastography, magnetic resonance (MR) elastography, and diffusion-weighted MR imaging [6]
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