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• W3192200357 abstract "Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming one of the most common causes of liver disease. The progressive subtype of NAFLD, nonalcoholic steatohepatitis (NASH), leads to cirrhosis, hepatocellular carcinoma, and mortality. Fibrosis is the strongest predictor for complications. Due to the invasive nature of liver biopsy, noninvasive testing methods have emerged to detect fibrosis and predict outcomes. Of these modalities, magnetic resonance elastography (MRE) has demonstrated the highest accuracy to detect fibrosis. In this review, we will focus on the emerging data regarding MRE and liver fibrosis, cirrhosis, and portal hypertension in NAFLD. Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming one of the most common causes of liver disease. The progressive subtype of NAFLD, nonalcoholic steatohepatitis (NASH), leads to cirrhosis, hepatocellular carcinoma, and mortality. Fibrosis is the strongest predictor for complications. Due to the invasive nature of liver biopsy, noninvasive testing methods have emerged to detect fibrosis and predict outcomes. Of these modalities, magnetic resonance elastography (MRE) has demonstrated the highest accuracy to detect fibrosis. In this review, we will focus on the emerging data regarding MRE and liver fibrosis, cirrhosis, and portal hypertension in NAFLD. Nonalcoholic fatty liver disease (NAFLD) is defined as the presence of hepatic steatosis on either imaging or histology in individuals who consume little or no alcohol and who do not have any secondary cause of hepatic steatosis such as medications, viral hepatitis, or human immunodeficiency virus infection.1Chalasani N. Younossi Z. Lavine J.E. et al.The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases.Hepatology. 2017; https://doi.org/10.1002/hep.29367Crossref Scopus (3010) Google Scholar,2Loomba R. Friedman S.L. Shulman G.I. Mechanisms and disease consequences of nonalcoholic fatty liver disease.Cell. 2021; 184: 2537-2564Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar NAFLD includes two subtypes: nonalcoholic fatty liver (NAFL) or nonalcoholic steatohepatitis (NASH). Steatosis, or increased fat content, is seen in both NAFL and NASH, but NASH also involves the presence of lobular inflammation and ballooning with or without perisinusoidal fibrosis.3Brunt E.M. Kleiner D.E. Carpenter D.H. et al.NAFLD: reporting histologic findings in clinical Practice.Hepatology. 2021; 73: 2028-2038Crossref PubMed Scopus (30) Google Scholar Patients with NAFL are generally thought to have a benign course, but the NASH subtype is associated with increased risk of progression to cirrhosis, hepatocellular carcinoma (HCC), cardiovascular, and liver-related mortality.1Chalasani N. Younossi Z. Lavine J.E. et al.The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases.Hepatology. 2017; https://doi.org/10.1002/hep.29367Crossref Scopus (3010) Google Scholar,4Dulai P.S. Singh S. Patel J. et al.Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis.Hepatology. 2017; 65: 1557-1565Crossref PubMed Scopus (884) Google Scholar,5Huang D.Q. El-Serag H.B. Loomba R. Global epidemiology of NAFLD-related HCC: trends, predictions, risk factors and prevention.Nat Rev Gastroenterol Hepatol. 2021; 18: 223-238Crossref PubMed Scopus (334) Google ScholarParalleling the obesity epidemic, the clinical burden of NAFLD has increased steadily since the 1980s, currently affecting 25% of the global population. Even though a small percentage of patients with NAFLD have NASH, this population is burgeoning as well. It is estimated to affect 3–5% of the general population; this translates to over 30 million people worldwide.6Younossi Z.M. Non-alcoholic fatty liver disease – a global public health perspective.J Hepatol. 2019; 70: 531-544Abstract Full Text Full Text PDF PubMed Scopus (839) Google Scholar The number of patients with NAFLD cirrhosis will likely double by the year 2030, leading to an estimated increase in 800,000 liver-related deaths.7Estes C. Razavi H. Loomba R. Younossi Z. Sanyal A.J. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease.Hepatology. 2018; 67: 123-133Crossref PubMed Scopus (876) Google Scholar NASH has become the number one indication in the United States for liver transplantation in women and patients older than 50.8Noureddin M. Vipani A. Bresee C. et al.NASH leading cause of liver transplant in women: updated analysis of indications for liver transplant and ethnic and gender variances.Am J Gastroenterol. 2018; 113: 1649-1659Crossref PubMed Scopus (250) Google ScholarThe presence of fibrosis strongly predicts mortality, rising dramatically with each stage greater than F2.4Dulai P.S. Singh S. Patel J. et al.Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis.Hepatology. 2017; 65: 1557-1565Crossref PubMed Scopus (884) Google Scholar Liver biopsy is considered the gold standard to differentiate between NASH/NAFL, as well as identify fibrosis. However, this procedure is limited by its invasive nature, risk of bleeding, and other complications, and interobserver variability.9Ratziu V. Charlotte F. Heurtier A. et al.Sampling variability of liver biopsy in nonalcoholic fatty liver disease.Gastroenterology. 2005; 128: 1898-1906Abstract Full Text Full Text PDF PubMed Scopus (1472) Google Scholar,10Merriman R.B. Ferrell L.D. Patti M.G. et al.Correlation of paired liver biopsies in morbidly obese patients with suspected nonalcoholic fatty liver disease.Hepatology. 2006; https://doi.org/10.1002/hep.21346Crossref PubMed Scopus (250) Google Scholar Noninvasive methods have been developed to detect fibrosis—these include serum calculators, genetic factors, and imaging modalities such as elastography.11Ajmera V. Liu A. Bettencourt R. Dhar D. Richards L. Loomba R. The impact of genetic risk on liver fibrosis in non-alcoholic fatty liver disease as assessed by magnetic resonance elastography.Aliment Pharmacol Ther. 2021; https://doi.org/10.1111/apt.16392Crossref PubMed Scopus (6) Google Scholar,12Loomba R. Adams L.A. Advances in non-invasive assessment of hepatic fibrosis.Gut. 2020; 69: 1343-1352Crossref PubMed Scopus (94) Google ScholarOf these modalities, MRE has emerged as the superior test to evaluate fibrosis. MRE differs from traditional MRI by utilizing an acoustic driver and a two-dimensional pulse sequence to generate shear waves within the liver. Unlike vibration-controlled transient elastography (VCTE), which evaluates shear waves at one location, MRE evaluates shear waves in four regional maps, called elastograms. These elastograms are interpreted in the context of the location of liver capsule, large blood vessels, and artifact. Liver stiffness is calculated in each region; an average of all four regions to determine mean 2D liver stiffness measurement (LSM).13Patel N.S. Hooker J. Gonzalez M. et al.Weight loss decreases magnetic resonance elastography estimated liver stiffness in nonalcoholic fatty liver disease.Clin Gastroenterol Hepatol. 2017; 15: 463-464Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar Of note, these measurements are not on the same scale as VCTE, even though both are measured in kilopascals (kPa). Three-dimensional MRE, which obtains elastograms in multiple dimensions, has also shown promise in the evaluation of fibrosis.14Loomba R. Cui J. Wolfson T. et al.Novel 3D magnetic resonance elastography for the noninvasive diagnosis of advanced fibrosis in NAFLD: a prospective study.Am J Gastroenterol. 2016; 111: 986-994Crossref PubMed Scopus (130) Google ScholarMRE has demonstrated superiority in diagnostic accuracy to other imaging modalities such as VCTE and 2-dimensional shear wave elastography (2D SWE) (Table 1).15Long M.T. Gandhi S. Loomba R. Advances in non-invasive biomarkers for the diagnosis and monitoring of non-alcoholic fatty liver disease.Metabolism. 2020; 111S: 154259Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar,16Xiao G. Zhu S. Xiao X. Yan L. Yang J. Wu G. Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: a meta-analysis.Hepatology. 2017; 66: 1486-1501Crossref PubMed Scopus (401) Google Scholar Although VCTE and 2D SWE can assess LSM at particular points, MRE can assess the stiffness of the entire liver. In addition, MRE performance is not affected by BMI, small ascites, and bowel gas. MRE is also less prone to operator error. Limitations of MRE include cost, access, and lack of portability. In this review, we will discuss MRE and its association with liver fibrosis, cirrhosis, and portal hypertension in patients with NAFLD. We refer the readers to other reviews that cover other aspects of noninvasive assessment.12Loomba R. Adams L.A. Advances in non-invasive assessment of hepatic fibrosis.Gut. 2020; 69: 1343-1352Crossref PubMed Scopus (94) Google Scholar,15Long M.T. Gandhi S. Loomba R. Advances in non-invasive biomarkers for the diagnosis and monitoring of non-alcoholic fatty liver disease.Metabolism. 2020; 111S: 154259Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar,17Ajmera V. Loomba R. Imaging biomarkers of NAFLD, NASH, and fibrosis.Mol Metab. 2021; 101167https://doi.org/10.1016/j.molmet.2021.101167Crossref Scopus (24) Google ScholarTable 1Diagnostic Accuracy, Advantages, and Disadvantages of Noninvasive Measurements of Fibrosis.Testing ModalityCutoffsAUROCAdvantagesDisadvantagesMRE≥F1—2.88 kPa≥F2—3.54 kPa≥F3—3.77 kPa≥F4—4.09 kPa0.860.870.900.91-Overall best performance-Performs well at high BMI-Can be easily performed with techniques to quantify liver fat-Largest area of the liver assessed-Performed in radiology-Performed at a limited number of centers-Quality control not integrated-Lack of portability-CostVCTE≥F2—4.8 to 8.2 (XL probe)≥F3—5.7 to 9.3 (M Probe)≥F3—7.6 to 8 (M Probe)0.800.880.85-Performed in liver clinic-Simultaneously quantify fat (CAP)-Integrated quality control-Larger area of liver assessed-No prior experience with ultrasound required-Failure if narrow rib spaces-Failure if large ascites-Only measures CAP and LSM-Less cost-effective if also need an ultrasound2-Dimensional Shear Wave Elastography≥F2—2.67 to 9.4≥F3—3.02 to 10.60.880.95-Low failure rate for experienced operators-Uses ultrasound probe-Failure/lower accuracy as BMI increases-Learning curve: higher interobserver variability with less experienced operatorsNAFLD Fibrosis Score≥F3—0.670.84-Easy to calculate-Clinical information for the score is often available-Large number of individuals fall in the indeterminate range-Different cut-off values needed for younger or older participants-Limited usefulness in the general populationFibrosis-4≥F2—0.37 to 3.25≥F3—2.670.730.84-Easy to calculate-Clinical information for the score is often available-Large number of individuals fall in the indeterminate range-Various cutoffs used in studies-Limited usefulness in the general populationAPRI≥F2—1.0≥F3—1.50.760.77-Easy to calculate-Clinical information for the score is often available-Large number of individuals fall in the indeterminate range-Various cutoffs used in studies-Limited usefulness in the general populationMRE, magnetic resonance; VCTE, vibration-controlled transient elastography; NAFLD, nonalcoholic fatty liver disease. Open table in a new tab Technical considerationsMRE can be performed on 1.5 T to 7 T MRI machines. Most patients are able to tolerate MRE, but they do need to be able to hold their breath for specific time periods. Liver stiffness is not affected by the presence of steatosis or increasing BMI.20Venkatesh S.K. Yin M. Ehman R.L. Magnetic resonance elastography of liver: technique, analysis, and clinical applications.J Magn Reson Imaging. 2013; 37: 544-555Crossref PubMed Scopus (431) Google Scholar, 18Singh S. Venkatesh S.K. Loomba R. et al.Magnetic resonance elastography for staging liver fibrosis in non-alcoholic fatty liver disease: a diagnostic accuracy systematic review and individual participant data pooled analysis.Eur Radiol. 2016; 26: 1431-1440Crossref PubMed Scopus (151) Google Scholar, 19Chen J. Yin M. Talwalkar J.A. et al.Diagnostic performance of MR elastography and vibration-controlled transient elastography in the detection of hepatic fibrosis in patients with severe to morbid obesity.Radiology. 2017; 283: 418-428Crossref PubMed Scopus (95) Google Scholar Performance was similar in both male and female patients and does not vary with magnet strength.18Singh S. Venkatesh S.K. Loomba R. et al.Magnetic resonance elastography for staging liver fibrosis in non-alcoholic fatty liver disease: a diagnostic accuracy systematic review and individual participant data pooled analysis.Eur Radiol. 2016; 26: 1431-1440Crossref PubMed Scopus (151) Google Scholar,21Hsu C. Caussy C. Imajo K. et al.Magnetic resonance vs transient elastography analysis of patients with nonalcoholic fatty liver disease: a systematic review and pooled analysis of individual participants.Clin Gastroenterol Hepatol. 2019; https://doi.org/10.1016/j.cgh.2018.05.059Abstract Full Text Full Text PDF Scopus (158) Google Scholar Liver stiffness may be overestimated in patients with iron overload, large ascites, congestive hepatopathy, or acute inflammation; MRE should be interpreted keeping the clinical context of use in mind, especially in these patient populations.22Wagner M. Corcuera-Solano I. Lo G. et al.Technical failure of MR elastography examinations of the liver: experience from a large single-center study.Radiology. 2017; 284: 401-412Crossref PubMed Scopus (99) Google ScholarMRE for assessment of fibrosisMRE has high diagnostic performance and a low failure rate for the assessment of fibrosis.23Singh S. Venkatesh S.K. Wang Z. et al.Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data.Clin Gastroenterol Hepatol. 2015; https://doi.org/10.1016/j.cgh.2014.09.046Abstract Full Text Full Text PDF Scopus (345) Google Scholar Interobserver variation is low and can be utilized on different types of MRI machines.18Singh S. Venkatesh S.K. Loomba R. et al.Magnetic resonance elastography for staging liver fibrosis in non-alcoholic fatty liver disease: a diagnostic accuracy systematic review and individual participant data pooled analysis.Eur Radiol. 2016; 26: 1431-1440Crossref PubMed Scopus (151) Google Scholar In a systematic review of 9 studies with 232 patients, MRE had a high AUROC for each stage of fibrosis: ≥F1—0.86 (cutoff: 2.88 kPa, sensitivity 0.75, specificity 0.77), ≥F2—0.87 (cutoff: 3.54 kPa, sensitivity 0.79, specificity 0.81), ≥F3—0.90 (cutoff: 3.77 kPa; sensitivity 0.83, specificity 0.86), ≥F4—0.91 (cutoff: 4.09 kPa; sensitivity 0.88, specificity 0.87).18Singh S. Venkatesh S.K. Loomba R. et al.Magnetic resonance elastography for staging liver fibrosis in non-alcoholic fatty liver disease: a diagnostic accuracy systematic review and individual participant data pooled analysis.Eur Radiol. 2016; 26: 1431-1440Crossref PubMed Scopus (151) Google Scholar These findings were confirmed in a 2019 systematic review and meta-analysis, which demonstrated higher diagnostic accuracy of MRE vs. VCTE at all stages of fibrosis.21Hsu C. Caussy C. Imajo K. et al.Magnetic resonance vs transient elastography analysis of patients with nonalcoholic fatty liver disease: a systematic review and pooled analysis of individual participants.Clin Gastroenterol Hepatol. 2019; https://doi.org/10.1016/j.cgh.2018.05.059Abstract Full Text Full Text PDF Scopus (158) Google Scholar There is a greater degree of discordance between VCTE and MRE measurements as BMI increases.24Caussy C. Chen J. Alquiraish M.H. et al.Association between obesity and discordance in fibrosis stage determination by magnetic resonance vs transient elastography in patients with nonalcoholic liver disease.Clin Gastroenterol Hepatol. 2018; 16 (e7): 1974-1982Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar Three-dimensional MRE at 40 Hz has an even higher detection of advanced fibrosis in NAFLD compared to 2D MRE (AUROC 0.98 vs. 0.92).14Loomba R. Cui J. Wolfson T. et al.Novel 3D magnetic resonance elastography for the noninvasive diagnosis of advanced fibrosis in NAFLD: a prospective study.Am J Gastroenterol. 2016; 111: 986-994Crossref PubMed Scopus (130) Google Scholar This modality is not yet widely available clinically.Longitudinal assessments of fibrosisChanges in liver stiffness over time may also provide prognostic value in NAFLD. A prospective study of 100 patients determined that a 15% increase in LSM is associated with a threefold to fourfold increased risk of any progression of fibrosis stage and a fivefold increased risk of progression to advanced fibrosis.25Ajmera V.H. Liu A. Singh S. et al.Clinical utility of an increase in magnetic resonance elastography in predicting fibrosis progression in nonalcoholic fatty liver disease.Hepatology. 2020; 71: 849-860Crossref PubMed Scopus (42) Google Scholar Similarly, Gidener et al., found that noncirrhotic patients that had a 1 kPa increase in LSM were threefold more likely to develop cirrhosis. In addition, cirrhotic patients that had a 1 kPa increase in LSM were prone to a fivefold increased risk of liver-related decompensation or mortality within 5 years.26Gidener T. Ahmed O.T. Larson J.J. et al.Liver stiffness by magnetic resonance elastography predicts future cirrhosis, decompensation, and death in NAFLD.Clin Gastroenterol Hepatol. 2020; https://doi.org/10.1016/j.cgh.2020.09.044Abstract Full Text Full Text PDF Scopus (29) Google Scholar Alternatively, weight loss is associated with a decrease in liver stiffness. Patients who had a 5% decrease in BMI experienced a ~16% decrease in liver stiffness.13Patel N.S. Hooker J. Gonzalez M. et al.Weight loss decreases magnetic resonance elastography estimated liver stiffness in nonalcoholic fatty liver disease.Clin Gastroenterol Hepatol. 2017; 15: 463-464Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar A secondary analysis of phase II trial data for selonsertib showed that improvement in LSM measured by MRE was associated with improvement in fibrosis (48% positive predictive value, 79% negative predictive value). This study was limited by a small sample size.27Jayakumar S. Middleton M.S. Lawitz E.J. et al.Longitudinal correlations between MRE, MRI-PDFF, and liver histology in patients with non-alcoholic steatohepatitis: analysis of data from a phase II trial of selonsertib.J Hepatol. 2019; https://doi.org/10.1016/j.jhep.2018.09.024Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar Further studies are needed to confirm these outcomes and determine optimal intervals and cutoffs for changes in elastography.In addition to elastography, changes in proton density fat fraction (PDFF) may be used to evaluate prognosis. PDFF is the MRI signal intensity ratio of fat to the sum of fat and water, reported as a percentage.28Mashhood A. Railkar R. Yokoo T. et al.Reproducibility of hepatic fat fraction measurement by magnetic resonance imaging.J Magn Reson Imaging. 2013; 37: 1359-1370Crossref PubMed Scopus (58) Google Scholar MRI-PDFF can assess regional variation of steatosis. Patients with high PDFF, defined as >15.7% had a sixfold to sevenfold increased risk of fibrosis progression on serial MRE (median time 1.4 years).29Ajmera V. Park C.C. Caussy C. et al.Magnetic resonance imaging proton density fat fraction associates with progression of fibrosis in patients with nonalcoholic fatty liver disease.Gastroenterology. 2018; 155 (e2): 307-310Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar Conversely, improvements in PDFF are an independent predictor for fibrosis regression. Patients with a decrease of ≥30% PDFF are sevenfold more likely to have histologic improvement and 5.5 more likely to have a resolution of NASH.30Stine J.G. Munaganuru N. Barnard A. et al.Change in MRI-PDFF and histologic response in patients with nonalcoholic steatohepatitis: a systematic review and meta-analysis.Clin Gastroenterol Hepatol. 2020; https://doi.org/10.1016/j.cgh.2020.08.061Abstract Full Text Full Text PDF Scopus (33) Google Scholar This marker also predicts >1 stage improvement in fibrosis.31Tamaki N. Munaganuru N. Jung J. et al.Clinical utility of 30% relative decline in MRI-PDFF in predicting fibrosis regression in non-alcoholic fatty liver disease.Gut. 2021; https://doi.org/10.1136/gutjnl-2021-324264Crossref PubMed Scopus (14) Google Scholar These data will need to be validated in future studies. Combining PDFF and MRE data may predict NASH (AUROC 0.87) and even estimate granular data previously only found on biopsy, such as NAFLD Activity Score (AUROC 0.85). The use of automated algorithms demonstrated high fidelity compared to expert radiologist interpretation.32Dzyubak B. Li J. Chen J. et al.Automated analysis of multiparametric magnetic resonance imaging/magnetic resonance elastography exams for prediction of nonalcoholic steatohepatitis.J Magn Reson Imaging. 2021; https://doi.org/10.1002/jmri.27549Crossref PubMed Scopus (8) Google Scholar These data are promising but need to be validated in larger multicenter studies.MRE can be combined with serum markers to increase predictive capability and identify candidates for pharmacologic therapy. Using a FIB4 ≥1.6 and MRE liver stiffness ≥3.3 kPa identified NAFLD patients with ≥F2 fibrosis with a positive predictive value (PPV) of 97.1% (P < 0.02). This combination, known as MEFIB, was validated in a separate international cohort.33Jung J. Loomba R.R. Imajo K. et al.MRE combined with FIB-4 (MEFIB) index in detection of candidates for pharmacological treatment of NASH-related fibrosis.Gut. 2020; https://doi.org/10.1136/gutjnl-2020-322976Crossref Scopus (29) Google Scholar Studies are ongoing to determine how performance compares to the Fibroscan-AST score (FAST).MRE for assessment of compensated cirrhosisMRE can be used to distinguish lower levels of fibrosis and cirrhosis. Studies evaluating the diagnostic performance of MRE for detection of cirrhosis have determined cutoffs of 3.35–6.7 kPa (AUROC 0.8–0.97).21Hsu C. Caussy C. Imajo K. et al.Magnetic resonance vs transient elastography analysis of patients with nonalcoholic fatty liver disease: a systematic review and pooled analysis of individual participants.Clin Gastroenterol Hepatol. 2019; https://doi.org/10.1016/j.cgh.2018.05.059Abstract Full Text Full Text PDF Scopus (158) Google Scholar,27Jayakumar S. Middleton M.S. Lawitz E.J. et al.Longitudinal correlations between MRE, MRI-PDFF, and liver histology in patients with non-alcoholic steatohepatitis: analysis of data from a phase II trial of selonsertib.J Hepatol. 2019; https://doi.org/10.1016/j.jhep.2018.09.024Abstract Full Text Full Text PDF PubMed Scopus (113) Google Scholar,34Han M.A.T. Vipani A. Noureddin N. et al.MR elastography-based liver fibrosis correlates with liver events in nonalcoholic fatty liver patients: a multicenter study.Liver Int. 2020; 40: 2242-2251Crossref PubMed Scopus (22) Google Scholar, 35Loomba R. Wolfson T. Ang B. et al.Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: a prospective study.Hepatology. 2014; https://doi.org/10.1002/hep.27362Crossref Scopus (320) Google Scholar, 36Park C.C. Nguyen P. Hernandez C. et al.Magnetic resonance elastography vs transient elastography in detection of fibrosis and noninvasive measurement of steatosis in patients with biopsy-proven nonalcoholic fatty liver disease.Gastroenterology. 2017; https://doi.org/10.1053/j.gastro.2016.10.026Abstract Full Text Full Text PDF Scopus (368) Google Scholar, 37Wong G.L.H. Hui A.Y. Wong V.W.S. Chan F.K.L. Sung J.J.Y. Chan H.L.Y. A retrospective study on clinical features and prognostic factors of biopsy-proven primary biliary cirrhosis in Chinese patients.Am J Gastroenterol. 2005; 100: 2205-2211Crossref PubMed Scopus (29) Google Scholar, 38Hui J.M. Kench J.G. Chitturi S. et al.Long-term outcomes of cirrhosis in nonalcoholic steatohepatitis compared with hepatitis C.Hepatology. 2003; 38: 420-427Crossref PubMed Scopus (390) Google Scholar Difference in findings can be accounted for by study population (single center vs. multicenter, Japan vs. western population). Based on a pooled analysis of individual participant data by Hsu, et al., we consider liver stiffness ≥4.67 to be indicative of cirrhosis. To increase ease of use in clinical care, this can be rounded to 5 kPa.21Hsu C. Caussy C. Imajo K. et al.Magnetic resonance vs transient elastography analysis of patients with nonalcoholic fatty liver disease: a systematic review and pooled analysis of individual participants.Clin Gastroenterol Hepatol. 2019; https://doi.org/10.1016/j.cgh.2018.05.059Abstract Full Text Full Text PDF Scopus (158) Google ScholarMRE for assessment of decompensated cirrhosis and portal hypertensionIncreased levels of liver stiffness may be predictive of decompensated cirrhosis, portal hypertension, and liver-related outcomes. Baseline liver stiffness has been shown to be predictive of decompensated disease in a cohort of all etiologies.39Asrani S.K. Talwalkar J.A. Kamath P.S. et al.Role of magnetic resonance elastography in compensated and decompensated liver disease.J Hepatol. 2014; 60: 934-939Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Within a NAFLD cohort, the use of MRE to measure LSM with a cutoff of 6.48 kPa (AUROC 0.71) has been shown to differentiate between compensated and decompensated cirrhosis.34Han M.A.T. Vipani A. Noureddin N. et al.MR elastography-based liver fibrosis correlates with liver events in nonalcoholic fatty liver patients: a multicenter study.Liver Int. 2020; 40: 2242-2251Crossref PubMed Scopus (22) Google Scholar Evaluation of a NAFLD cohort at the Mayo demonstrated increasing LSM showed an increased risk of decompensation; a cutoff of 8 kPa is associated with a 20% risk of decompensation.26Gidener T. Ahmed O.T. Larson J.J. et al.Liver stiffness by magnetic resonance elastography predicts future cirrhosis, decompensation, and death in NAFLD.Clin Gastroenterol Hepatol. 2020; https://doi.org/10.1016/j.cgh.2020.09.044Abstract Full Text Full Text PDF Scopus (29) Google Scholar As noted above, a 1 kPa increase in liver stiffness confers a fivefold increased risk of mortality and liver-related events.26Gidener T. Ahmed O.T. Larson J.J. et al.Liver stiffness by magnetic resonance elastography predicts future cirrhosis, decompensation, and death in NAFLD.Clin Gastroenterol Hepatol. 2020; https://doi.org/10.1016/j.cgh.2020.09.044Abstract Full Text Full Text PDF Scopus (29) Google Scholar Baseline LSM by MRE has been shown to predict HCC and death in a cohort of patients with all types of chronic liver disease; these findings need to be specifically evaluated in NAFLD.40Ichikawa S. Motosugi U. Enomoto N. Onishi H. Magnetic resonance elastography can predict development of hepatocellular carcinoma with longitudinally acquired two-point data.Eur Radiol. 2019; 29: 1013-1021Crossref PubMed Scopus (18) Google ScholarSimilarly, MRE may be used to rule out portal hypertension, minimizing the need for screening upper endoscopy for varices. One cross-sectional study of 627 patients using MRE cutoff 4.2 kPa and platelets >180,000 had a negative predictive value of 1.0.41Matsui N. Imajo K. Yoneda M. et al.Magnetic resonance elastography increases usefulness and safety of non-invasive screening for esophageal varices.J Gastroenterol Hepatol. 2018; 33: 2022-2028Crossref PubMed Scopus (16) Google Scholar This needs to be validated in prospective studies. MRE can be used to assess splenic stiffness in addition to liver stiffness. A 2021 meta-analysis found that splenic stiffness assessed by MRE had a sensitivity, specificity, and AUC values for spleen stiffness on MRE were 79% (95% CI 61–90%), 90% (95% CI 80–95%), and 92% (95% CI 89–94%), respectively (PMID: 32282542).42Singh R. Wilson M.P. Katlariwala P. Murad M.H. McInnes M.D.F. Low G. Accuracy of liver and spleen stiffness on magnetic resonance elastography for detecting portal hypertension: a systematic review and meta-analysis.Eur J Gastroenterol Hepatol. 2021; 32: 237-245Crossref PubMed Scopus (15) Google Scholar When evaluating specific manifestations of portal hypertension such as varices and ascites, liver stiffness has been used alone or in combination with spleen stiffness/spleen size in small series to predict the presence of esophageal varices.43Sun H.Y. Lee J.M. Han J.K. Choi B.I. Usefulness of MR elastography for predicting esophageal varices in cirrhotic patients.J Magn Reson Imaging. 2014; 39: 559-566Crossref PubMed Scopus (27) Google Scholar, 44Abe H. Midorikawa Y. Matsumoto N. et al.Prediction of esophageal varices by liver and spleen MR elastography.Eur Radiol. 2019; 29: 6611-6619Crossref PubMed Scopus (15) Google Scholar, 45Hoffman D.H. Ayoola A. Nickel D. et al.MR elastography, T1 and T2 relaxometry of liver: role in noninvasive assessment of liver function and portal hypertension.Abdom. Radiol. (New York). 2020; 45: 2680-2687Crossref PubMed Scopus (11) Google Scholar, 46Shin S.U. Lee J.-M. Yu M.H. et al.Prediction of esophageal varices in patients with cirrhosis: usefulness of three-dimensional MR elastography with echo-planar imaging technique.Radiology. 2014; 272: 143-153Crossref PubMed Scopus (82) Google Scholar, 47Morisaka H. Motosugi U. Ichikawa S. Sano K. Ichikawa T. Enomoto N. Associa" @default.
• W3192200357 created "2021-08-16" @default.
• W3192200357 creator A5037638631 @default.
• W3192200357 creator A5052059601 @default.
• W3192200357 date "2022-01-01" @default.
• W3192200357 modified "2023-10-03" @default.
• W3192200357 title "Magnetic Resonance Elastography for the Clinical Risk Assessment of Fibrosis, Cirrhosis, and Portal Hypertension in Patients With NAFLD" @default.
• W3192200357 cites W1482508651 @default.
• W3192200357 cites W1511319319 @default.
• W3192200357 cites W1917816261 @default.
• W3192200357 cites W1982702940 @default.
• W3192200357 cites W2003518626 @default.
• W3192200357 cites W2026020092 @default.
• W3192200357 cites W2039618459 @default.
• W3192200357 cites W2056488785 @default.
• W3192200357 cites W2076858432 @default.
• W3192200357 cites W2086719465 @default.
• W3192200357 cites W2112097563 @default.
• W3192200357 cites W2117827638 @default.
• W3192200357 cites W2156792510 @default.
• W3192200357 cites W2314336137 @default.
• W3192200357 cites W2529595671 @default.
• W3192200357 cites W2546306361 @default.
• W3192200357 cites W2554642866 @default.
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