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Clinical Utility of an Increase in Magnetic Resonance Elastography in Predicting Fibrosis Progression in Nonalcoholic Fatty Liver Disease
Author(s) -
Ajmera Veeral H.,
Liu Amy,
Singh Seema,
Yachoa Georg,
Ramey Matthew,
Bhargava Meera,
Zamani Ava,
Lopez Scarlett,
Mangla Neeraj,
Bettencourt Ricki,
Rizo Emily,
Valasek Mark,
Behling Cynthia,
Richards Lisa,
Sirlin Claude,
Loomba Rohit
Publication year - 2020
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.30974
Subject(s) - nonalcoholic fatty liver disease , medicine , interquartile range , odds ratio , liver biopsy , magnetic resonance elastography , transient elastography , prospective cohort study , fibrosis , gastroenterology , body mass index , fatty liver , confidence interval , biopsy , elastography , pathology , radiology , disease , ultrasound
Background and Aims Cross‐sectional studies have shown that magnetic resonance elastography (MRE) is accurate in the noninvasive detection of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD). However, there are limited data on the longitudinal association between an increase in liver stiffness on MRE and fibrosis progression in NAFLD. Therefore, using a well‐characterized prospective cohort of patients with biopsy‐proven NAFLD, we aimed to examine the longitudinal association between a 15% increase in liver stiffness on MRE and fibrosis progression in NAFLD. Approach and Results This prospective cohort study included 102 patients (62.7% women) with biopsy‐proven NAFLD who underwent contemporaneous MRE and liver biopsy at baseline followed by a repeat paired liver biopsy and MRE assessment. The primary outcome was odds of fibrosis progression by one or more stage as assessed by the Nonalcoholic Steatohepatitis Clinical Research Network histologic scoring system. The mean (±SD) of age and body mass index (BMI) were 52 (±14) years and 32.6 (±5.3) kg/m 2 , respectively. The median time interval between the two paired assessments was 1.4 years (interquartile range 2.15 years). The number of patients with fibrosis stages 0, 1, 2, 3, and 4 was 27, 36, 12, 17, and 10, respectively. In unadjusted analysis, a 15% increase in MRE was associated with increased odds of histologic fibrosis progression (odds ratio [OR], 3.56; 95% confidence interval [CI], 1.17‐10.76; P = 0.0248). These findings remained clinically and statistically significant even after multivariable adjustment for age, sex, and BMI (adjusted OR, 3.36; 95% CI, 1.10‐10.31; P = 0.0339). A 15% increase in MRE was the strongest predictor of progression to advanced fibrosis (OR, 4.90; 95% CI, 1.35‐17.84; P = 0.0159). Conclusions A 15% increase in liver stiffness on MRE may be associated with histologic fibrosis progression and progression from early fibrosis to advanced fibrosis.