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Assessment of treatment response in non‐alcoholic steatohepatitis using advanced magnetic resonance imaging
Author(s) -
Lin S. C.,
Heba E.,
Bettencourt R.,
Lin G. Y.,
Valasek M. A.,
Lunde O.,
Hamilton G.,
Sirlin C. B.,
Loomba R.
Publication year - 2017
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13951
Subject(s) - medicine , steatohepatitis , magnetic resonance imaging , steatosis , liver biopsy , placebo , fatty liver , gastroenterology , nuclear medicine , biopsy , pathology , radiology , alternative medicine , disease
Summary Background Magnetic resonance imaging‐derived measures of liver fat and volume are emerging as accurate, non‐invasive imaging biomarkers in non‐alcoholic steatohepatitis ( NASH ). Little is known about these measures in relation to histology longitudinally. Aim To examine any relationship between MRI ‐derived proton‐density fat‐fraction ( PDFF ), total liver volume ( TLV ), total liver fat index ( TLFI ), vs. histology in a NASH trial. Methods This is a secondary analysis of a 24‐week randomised, double‐blind, placebo‐controlled trial of 50 patients with biopsy‐proven NASH randomised to oral ezetimibe 10 mg daily ( n = 25) vs. placebo ( n = 25). Baseline and post‐treatment anthropometrics, biochemical profiling, MRI and biopsies were obtained. Results Baseline mean PDFF correlated strongly with TLFI (Spearman's ρ = 0.94, n = 45, P < 0.0001) and had good correlation with TLV ( ρ = 0.57, n = 45, P < 0.0001). Mean TLV correlated strongly with TLFI ( ρ = 0.78, n = 45, P < 0.0001). After 24 weeks, PDFF remained strongly correlated with TLFI ( ρ = 0.94, n = 45, P < 0.0001), maintaining good correlation with TLV ( ρ = 0.51, n = 45, P = 0.0004). TLV remained strongly correlated with TLFI ( ρ = 0.74, n = 45, P < 0.0001). Patients with Grade 1 vs. 3 steatosis had lower PDFF , TLV , and TLFI ( P < 0.0001, P = 0.0003, P < 0.0001 respectively). Regression analysis of changes in MRI ‐ PDFF vs. TLV indicates that 10% reduction in MRI ‐ PDFF predicts 257 mL reduction in TLV . Conclusions The MRI ‐ PDFF and TLV strongly correlated with TLFI . Decreases in steatosis were associated with an improvement in hepatomegaly. Lower values of these measures reflect lower histologic steatosis grades. MRI ‐derived measures of liver fat and volume may be used as dynamic and more responsive imaging biomarkers in a NASH trial, than histology.