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Richard L Ehman - One of the best experts on this subject based on the ideXlab platform.

  • Magnetic Resonance Elastography in primary sclerosing cholangitis interobserver agreement for liver stiffness measurement with manual and automated methods
    Academic Radiology, 2019
    Co-Authors: Safa Hoodeshenas, Richard L Ehman, John E Eaton, Bogdan Dzyubak, Christopher L Welle, Patrick J Navin, Sudhakar K Venkatesh
    Abstract:

    Rationale and Objective Primary sclerosing cholangitis, a chronic liver disease causes heterogeneous parenchymal changes and fibrosis. Liver stiffness measurement (LSM) with Magnetic Resonance Elastography (MRE) may be affected by this heterogeneous distribution. We evaluated interobserver agreement of LSM in primary sclerosing cholangitis (PSC) with manual and automated methods to study the influence of heterogeneous changes. Materials and Methods A total of 79 consecutive patients with PSC who had a liver MRI and MRE formed the study group. Three readers with 1–3 years’ experience in MRE and a MRE expert (11 years’ experience) independently performed LSM. Each reader manually drew free hand (fROI) and average (aROI) on stiffness maps. Automatic liver elasticity calculation (ALEC) was used to generate automated LSM. The expert fROI was the reference standard. Correlation analysis and absolute intra-class correlation coefficient (ICC) analysis was performed. Results LSM data of 79 livers and 315 sections were evaluated. There was excellent ICC between expert and reader fROIs (0.989, 95% confidence interval, and 0.985–0.993) and aROIs (0.971, 95% confidence interval, and 0.953–0.983) and ALEC (0.972, 0.957–0.982) with fROI performing better. The areas measured with fROIs and ALEC had moderate ICC with Expert fROI (0.64 and 0.56, respectively) whereas aROI area had a poor ICC of 0.12. Comparison of multiple methods showed significant differences in LSM between expert fROI and aROI of two readers and no significant differences for fROIs of all three readers. Conclusion LSM with MRE in PSC patients shows excellent interobserver agreement with both fROI and aROI methods with better performance with fROI. fROI may therefore be preferred for LSM measurements in PSC.

  • Magnetic Resonance Elastography of Liver in Light Chain Amyloidosis
    'MDPI AG', 2019
    Co-Authors: Sudhakar K Venkatesh, Safa Hoodeshenas, Sandeep H. Venkatesh, Angela Dispenzieri, Morie A. Gertz, Michael S. Torbenson, Richard L Ehman
    Abstract:

    In this paper, we present our preliminary findings regarding Magnetic Resonance Elastography (MRE) on the livers of 10 patients with systemic amyloidosis. Mean liver stiffness measurements (LSM) and spleen stiffness measurements (SSM) were obtained. Magnetic Resonance imaging (MRI) images were analyzed for the distribution pattern of amyloid deposition. Pearson correlation analysis was performed in order to study the correlation between LSM, SSM, liver span, liver volume, spleen span, spleen volume, serum alkaline phosphatase (ALP), N-terminal pro b-type natriuretic peptide (NT pro BNP), and the kappa and lambda free light chains. An increase in mean LSM was seen in all patients. Pearson correlation analysis showed a statistically significant correlation between LSM and liver volume (r = 0.78, p = 0.007) and kappa chain level (r = 0.65, p = 0.04). Interestingly, LSM did not correlate significantly with SSM (r = 0.45, p = 0.18), liver span (r = 0.57, p = 0.08), or serum ALP (r = 0.60, p = 0.07). However, LSM correlated significantly with serum ALP when corrected for liver volume (partial correlation, r = 0.71, p = 0.03) and NT pro BNP levels (partial correlation, r = 0.68, p = 0.04). MRI review revealed that amyloid deposition in the liver can be diffuse, lobar, or focal. MRE is useful for the evaluation of hepatic amyloidosis and shows increased stiffness in hepatic amyloidosis. MRE has the potential to be a non-invasive quantitative imaging marker for hepatic amyloidosis

  • quantitative 3d Magnetic Resonance Elastography comparison with dynamic mechanical analysis
    Magnetic Resonance in Medicine, 2017
    Co-Authors: Shivaram P Arunachalam, Arvin Arani, Kiaran P. Mcgee, Kevin J Glaser, Armando Manduca, Phillip J Rossman, Richard L Ehman, David S Lake, Joshua D Trzasko, Philip A Araoz
    Abstract:

    Magnetic Resonance Elastography (MRE) is a rapidly growing noninvasive imaging technique for measuring tissue mechanical properties in vivo. Previous studies have compared two-dimensional MRE measurements with material properties from dynamic mechanical analysis (DMA) devices that were limited in frequency range. Advanced DMA technology now allows broad frequency range testing, and three-dimensional (3D) MRE is increasingly common. The purpose of this study was to compare 3D MRE stiffness measurements with those of DMA over a wide range of frequencies and shear stiffnesses.3D MRE and DMA were performed on eight different polyvinyl chloride samples over 20-205 Hz with stiffness between 3 and 23 kPa. Driving frequencies were chosen to create 1.1, 2.2, 3.3, 4.4, 5.5, and 6.6 effective wavelengths across the diameter of the cylindrical phantoms. Wave images were analyzed using direct inversion and local frequency estimation algorithm with the curl operator and compared with DMA measurements at each corresponding frequency. Samples with sufficient spatial resolution and with an octahedral shear strain signal-to-noise ratio > 3 were compared.Consistency between the two techniques was measured with the intraclass correlation coefficient (ICC) and was excellent with an overall ICC of 0.99.3D MRE and DMA showed excellent consistency over a wide range of frequencies and stiffnesses. Magn Reson Med 77:1184-1192, 2017. © 2016 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

  • Magnetic Resonance Elastography of the liver qualitative and quantitative comparison of gradient echo and spin echo echoplanar imaging sequences
    Investigative Radiology, 2016
    Co-Authors: Mathilde Wagner, T K Yasar, Richard L Ehman, Cecilia Besa, Jad Bou Ayache, Octavia Bane, Maggie Fung, Bachir Taouli
    Abstract:

    OBJECTIVE The aim of this study was to compare 2-dimensional (2D) gradient recalled echo (GRE) and 2D spin echo echoplanar imaging (SE-EPI) Magnetic Resonance Elastography (MRE) sequences of the liver in terms of image quality and quantitative liver stiffness (LS) measurement. MATERIALS AND METHODS This prospective study involved 50 consecutive subjects (male/female, 33/17; mean age, 58 years) who underwent liver Magnetic Resonance imaging at 3.0 T including 2 MRE sequences, 2D GRE, and 2D SE-EPI (acquisition time 56 vs 16 seconds, respectively). Image quality scores were assessed by 2 independent observers based on wave propagation and organ coverage on the confidence map (range, 0-15). A third observer measured LS on stiffness maps (in kilopascal). Mean LS values, regions of interest size (based on confidence map), and image quality scores between SE-EPI and GRE-MRE were compared using paired nonparametric Wilcoxon test. Reproducibility of LS values between the 2 sequences was assessed using intraclass coefficient correlation, coefficient of variation, and Bland-Altman limits of agreement. T2* effect on image quality was assessed using partial Spearman correlation. RESULTS There were 4 cases of failure with GRE-MRE and none with SE-EPI-MRE. Image quality scores and region of interest size were significantly higher using SE-EPI-MRE versus GRE-MRE (P < 0.0001 for both measurements and observers). Liver stiffness measurements were not significantly different between the 2 sequences (3.75 ± 1.87 kPa vs 3.55 ± 1.51 kPa, P = 0.062), were significantly correlated (intraclass coefficient correlation, 0.909), and had excellent reproducibility (coefficient of variation, 10.2%; bias, 0.023; Bland-Altman limits of agreement, -1.19; 1.66 kPa). Image quality scores using GRE-MRE were significantly correlated with T2* while there was no correlation for SE-EPI-MRE. CONCLUSIONS Our data suggest that SE-EPI-MRE may be a better alternative to GRE-MRE. The diagnostic performance of SE-EPI-MRE for detection of liver fibrosis needs to be assessed in a future study.

  • performance of Magnetic Resonance Elastography in primary sclerosing cholangitis
    Journal of Gastroenterology and Hepatology, 2016
    Co-Authors: John E Eaton, Richard L Ehman, Bogdan Dzyubak, Sudhakar K Venkatesh, Thomas C Smyrk, Gregory J Gores, Nicholas F Larusso, Andrea A Gossard, Konstantinos N Lazaridis
    Abstract:

    Background and Aim: Liver stiffness (LS) measured by Magnetic Resonance Elastography (MRE) is emerging as an important biomarker in chronic liver diseases. We examined the diagnostic performance of MRE, factors associated with an increased LS and the prognostic value of LS as measured by MRE among patients with primary sclerosing cholangitis (PSC). Methods: We performed a retrospective review of 266 patients with PSC to examine whether LS was associated with the primary endpoint of hepatic decompensation (ascites, variceal hemorrhage and hepatic encephalopathy). The ability of MRE to differentiate stages of fibrosis was examined in a subset of patients who underwent a liver biopsy (n = 20). Results: An LS of 4.93 kPa was the optimal point to detected F4 fibrosis (sensitivity, 1.00; 95% confidence interval (CI), 0.40–1.00; specificity, 0.94; 95%CI, 0.68–1.00). While a serum alkaline phosphatase 6.0 kPa (respectively). Conclusion: Magnetic Resonance Elastography is able to detect cirrhosis with high specificity and an alkaline phosphatase <1.5 times the upper limit of normal makes the presence of advanced LS unlikely. Moreover, LS obtained by MRE is predictive of hepatic decompensation in PSC.

Rohit Loomba - One of the best experts on this subject based on the ideXlab platform.

  • Magnetic Resonance Elastography is superior to acoustic radiation force impulse for the diagnosis of fibrosis in patients with biopsy proven nonalcoholic fatty liver disease a prospective study
    Hepatology, 2016
    Co-Authors: Jeffrey Cui, William Haufe, Mark A Valasek, H Aryafar, Claude B Sirlin, Jonathan Hooker, Elhamy Heba, Carolyn Hernandez, Michael P Andre, Rohit Loomba
    Abstract:

    Magnetic Resonance Elastography (MRE), an advanced Magnetic Resonance–based imaging technique, and acoustic radiation force impulse (ARFI), an ultrasound-based imaging technique, are accurate for diagnosing nonalcoholic fatty liver disease (NAFLD) fibrosis. However, no head-to-head comparisons between MRE and ARFI for diagnosing NAFLD fibrosis have been performed. We compared MRE versus ARFI head-to-head for diagnosing fibrosis in well-characterized patients with biopsy-proven NAFLD. This cross-sectional analysis of a prospective cohort involved 125 patients (54.4% female) who underwent MRE, ARFI, and contemporaneous liver biopsies scored using the Nonalcoholic Steatohepatitis Clinical Research Network histological scoring system. The performances of MRE versus ARFI for diagnosing fibrosis were evaluated using area under the receiver operating characteristic curves (AUROCs). The mean (± standard deviation) age and body mass index were 48.9 (±15.4) years and 31.8 (±7.0) kg/m2, respectively. For diagnosing any fibrosis (≥ stage 1), the MRE AUROC was 0.799 (95% confidence interval [CI] 0.723-0.875), significantly (P = 0.012) higher than the ARFI AUROC of 0.664 (95% CI 0.568-0.760). In stratified analysis by presence or absence of obesity, MRE was superior to ARFI for diagnosing any fibrosis in obese patients (P < 0.001) but not in nonobese patients (P = 0.722). The MRE AUROCs for diagnosing ≥stages 2, 3, and 4 fibrosis were 0.885 (95% CI 0.816-0.953), 0.934 (95% CI 0.863-1.000), and 0.882 (95% CI 0.729-1.000); and the ARFI AUROCs were 0.848 (95% CI 0.776-0.921), 0.896 (95% CI 0.824-0.968), and 0.862 (95% CI 0.721-1.000). MRE had higher AUROCs than ARFI for discriminating dichotomized fibrosis stages at all dichotomization cutoff points, but the AUROC differences decreased as the cutoff points (fibrosis stages) increased. Conclusion: MRE is more accurate than ARFI for diagnosing any fibrosis in NAFLD patients, especially those who are obese. (Hepatology 2016;63:453–461)

  • Magnetic Resonance Elastography is superior to acoustic radiation force impulse for the diagnosis of fibrosis in patients with biopsy proven nonalcoholic fatty liver disease a prospective study
    Hepatology, 2016
    Co-Authors: Elhamy Heba, William Haufe, Mark A Valasek, H Aryafar, Claude B Sirlin, Jonathan Hooker, Carolyn Hernandez, Michael P Andre, Rohit Loomba
    Abstract:

    Magnetic Resonance Elastography (MRE), an advanced Magnetic Resonance-based imaging technique, and acoustic radiation force impulse (ARFI), an ultrasound-based imaging technique, are accurate for diagnosing nonalcoholic fatty liver disease (NAFLD) fibrosis. However, no head-to-head comparisons between MRE and ARFI for diagnosing NAFLD fibrosis have been performed. We compared MRE versus ARFI head-to-head for diagnosing fibrosis in well-characterized patients with biopsy-proven NAFLD. This cross-sectional analysis of a prospective cohort involved 125 patients (54.4% female) who underwent MRE, ARFI, and contemporaneous liver biopsies scored using the Nonalcoholic Steatohepatitis Clinical Research Network histological scoring system. The performances of MRE versus ARFI for diagnosing fibrosis were evaluated using area under the receiver operating characteristic curves (AUROCs). The mean (± standard deviation) age and body mass index were 48.9 (±15.4) years and 31.8 (±7.0) kg/m(2) , respectively. For diagnosing any fibrosis (≥ stage 1), the MRE AUROC was 0.799 (95% confidence interval [CI] 0.723-0.875), significantly (P = 0.012) higher than the ARFI AUROC of 0.664 (95% CI 0.568-0.760). In stratified analysis by presence or absence of obesity, MRE was superior to ARFI for diagnosing any fibrosis in obese patients (P < 0.001) but not in nonobese patients (P = 0.722). The MRE AUROCs for diagnosing ≥stages 2, 3, and 4 fibrosis were 0.885 (95% CI 0.816-0.953), 0.934 (95% CI 0.863-1.000), and 0.882 (95% CI 0.729-1.000); and the ARFI AUROCs were 0.848 (95% CI 0.776-0.921), 0.896 (95% CI 0.824-0.968), and 0.862 (95% CI 0.721-1.000). MRE had higher AUROCs than ARFI for discriminating dichotomized fibrosis stages at all dichotomization cutoff points, but the AUROC differences decreased as the cutoff points (fibrosis stages) increased.MRE is more accurate than ARFI for diagnosing any fibrosis in NAFLD patients, especially those who are obese.

  • comparative diagnostic accuracy of Magnetic Resonance Elastography vs eight clinical prediction rules for non invasive diagnosis of advanced fibrosis in biopsy proven non alcoholic fatty liver disease a prospective study
    Alimentary Pharmacology & Therapeutics, 2015
    Co-Authors: Jeffrey Cui, William Haufe, Claude B Sirlin, Brandon Ang, Carolyn Hernandez, Elizabeth C Verna, Rohit Loomba
    Abstract:

    Author(s): Cui, J; Ang, B; Haufe, W; Hernandez, C; Verna, EC; Sirlin, CB; Loomba, R | Abstract: BackgroundTwo-dimensional Magnetic Resonance Elastography (2D-MRE) is an advanced Magnetic Resonance method with high diagnostic accuracy for predicting advanced fibrosis in non-alcoholic fatty liver disease (NAFLD) patients. However, no prospective, head-to-head comparisons between 2D-MRE and clinical prediction rules (CPRs) have been performed in patients with biopsy-proven NAFLD.AimTo compare the diagnostic utility of 2D-MRE against that of eight CPRs (AST:ALT ratio, APRI, BARD, FIB-4, NAFLD Fibrosis Score, Bonacini cirrhosis discriminant score, Lok Index and NASH CRN model) for predicting advanced fibrosis in a prospective cohort with paired liver biopsy as the gold standard.MethodsThis is a cross-sectional analysis of a prospective study of 102 patients (58.8% women) with biopsy-proven NAFLD, 2D-MRE and clinical research assessment within 90 days of biopsy. Receiver operating characteristic (ROC) analysis was performed to assess the performance of 2D-MRE and CPRs for predicting advanced fibrosis.ResultsThe mean (±s.d.) age and BMI were 51.3 (±14.0) years and 31.7 (±5.5) kg/m(2) respectively. 48, 26, 9, 13 and 6 patients had stage 0, 1, 2, 3 and 4 fibrosis respectively. The area under ROC curve (AUROC) was 0.957 for 2D-MRE and between 0.796 and 0.861 for the CPRs. FIB-4 was the best-performing CPR at predicting advanced fibrosis with AUROC of 0.861. In head-to-head comparisons using the DeLong test, 2D-MRE had significantly better AUROC (P l 0.05) than each CPR for predicting advanced fibrosis.ConclusionCompared to clinical prediction rules, 2D-MRE provides significantly higher accuracy for the diagnosis of advanced fibrosis in NAFLD patients.

  • comparative diagnostic accuracy of Magnetic Resonance Elastography vs eight clinical prediction rules for non invasive diagnosis of advanced fibrosis in biopsy proven non alcoholic fatty liver disease a prospective study
    Alimentary Pharmacology & Therapeutics, 2015
    Co-Authors: Jeffrey Cui, William Haufe, Claude B Sirlin, Brandon Ang, Carolyn Hernandez, Elizabeth C Verna, Rohit Loomba
    Abstract:

    Author(s): Cui, J; Ang, B; Haufe, W; Hernandez, C; Verna, EC; Sirlin, CB; Loomba, R | Abstract: Two-dimensional Magnetic Resonance Elastography (2D-MRE) is an advanced Magnetic Resonance method with high diagnostic accuracy for predicting advanced fibrosis in non-alcoholic fatty liver disease (NAFLD) patients. However, no prospective, head-to-head comparisons between 2D-MRE and clinical prediction rules (CPRs) have been performed in patients with biopsy-proven NAFLD.To compare the diagnostic utility of 2D-MRE against that of eight CPRs (AST:ALT ratio, APRI, BARD, FIB-4, NAFLD Fibrosis Score, Bonacini cirrhosis discriminant score, Lok Index and NASH CRN model) for predicting advanced fibrosis in a prospective cohort with paired liver biopsy as the gold standard.This is a cross-sectional analysis of a prospective study of 102 patients (58.8% women) with biopsy-proven NAFLD, 2D-MRE and clinical research assessment within 90 days of biopsy. Receiver operating characteristic (ROC) analysis was performed to assess the performance of 2D-MRE and CPRs for predicting advanced fibrosis.The mean (±s.d.) age and BMI were 51.3 (±14.0) years and 31.7 (±5.5) kg/m(2) respectively. 48, 26, 9, 13 and 6 patients had stage 0, 1, 2, 3 and 4 fibrosis respectively. The area under ROC curve (AUROC) was 0.957 for 2D-MRE and between 0.796 and 0.861 for the CPRs. FIB-4 was the best-performing CPR at predicting advanced fibrosis with AUROC of 0.861. In head-to-head comparisons using the DeLong test, 2D-MRE had significantly better AUROC (P l 0.05) than each CPR for predicting advanced fibrosis.Compared to clinical prediction rules, 2D-MRE provides significantly higher accuracy for the diagnosis of advanced fibrosis in NAFLD patients.

  • ezetimibe for the treatment of nonalcoholic steatohepatitis assessment by novel Magnetic Resonance imaging and Magnetic Resonance Elastography in a randomized trial mozart trial
    Hepatology, 2015
    Co-Authors: Rohit Loomba, Ricki Bettencourt, Claude B Sirlin, Brandon Ang, Rashmi Jain, Joanie Salotti, Linda Soaft, Jonathan Hooker, Yuko Kono, Archana Bhatt
    Abstract:

    Ezetimibe inhibits intestinal cholesterol absorption and lowers low-density lipoprotein cholesterol. Uncontrolled studies have suggested that it reduces liver fat as estimated by ultrasound in nonalcoholic steatohepatitis (NASH). Therefore, we aimed to examine the efficacy of ezetimibe versus placebo in reducing liver fat by the Magnetic Resonance imaging-derived proton density-fat fraction (MRI-PDFF) and liver histology in patients with biopsy-proven NASH. In this randomized, double-blind, placebo-controlled trial, 50 patients with biopsy-proven NASH were randomized to either ezetimibe 10 mg orally daily or placebo for 24 weeks. The primary outcome was a change in liver fat as measured by MRI-PDFF in colocalized regions of interest within each of the nine liver segments. Novel assessment by two-dimensional and three-dimensional Magnetic Resonance Elastography was also performed. Ezetimibe was not significantly better than placebo at reducing liver fat as measured by MRI-PDFF (mean difference between the ezetimibe and placebo arms -1.3%, P = 0.4). Compared to baseline, however, end-of-treatment MRI-PDFF was significantly lower in the ezetimibe arm (15%-11.6%, P < 0.016) but not in the placebo arm (18.5%-16.4%, P = 0.15). There were no significant differences in histologic response rates, serum alanine aminotransferase and aspartate aminotransferase levels, or longitudinal changes in two-dimensional and three-dimensional Magnetic Resonance Elastography-derived liver stiffness between the ezetimibe and placebo arms. Compared to histologic nonresponders (25/35), histologic responders (10/35) had a significantly greater reduction in MRI-PDFF (-4.35 ± 4.9% versus -0.30 ± 4.1%, P < 0.019). Conclusions: Ezetimibe did not significantly reduce liver fat in NASH. This trial demonstrates the application of colocalization of MRI-PDFF-derived fat maps and Magnetic Resonance Elastography-derived stiffness maps of the liver before and after treatment to noninvasively assess treatment response in NASH. (Hepatology 2015;61:1239–1250)

Sudhakar K Venkatesh - One of the best experts on this subject based on the ideXlab platform.

  • changes in liver stiffness measured by Magnetic Resonance Elastography associated with hepatic decompensation in patients with primary sclerosing cholangitis
    Clinical Gastroenterology and Hepatology, 2020
    Co-Authors: John E Eaton, Gregory J Gores, Nicholas F Larusso, Andrea A Gossard, Konstantinos N Lazaridis, Safa Hoodeshenas, Aditi Sen, Cathy D Schleck, William S Harmsen, Sudhakar K Venkatesh
    Abstract:

    Background & Aims Single measurements of liver stiffness (LS) by Magnetic Resonance Elastography (MRE) have been associated with outcomes of patients with primary sclerosing cholangitis (PSC), but the significance of changes in LS over time are unclear. We investigated associations between changes in LS measurement and progression of PSC. Methods We performed a retrospective review of 204 patients with patients who underwent 2 MREs at a single center between January 1, 2007 and December 31, 2018. We collected laboratory data and information on revised Mayo PSC risk and model for end-stage liver disease scores, the PSC risk estimate tool, and levels of aspartate transferase at the time of each MRE. The ΔLS/time was determined by the change in LS between the second MRE compared to the first MRE divided by the time between examinations. The primary endpoint was development of hepatic decompensation (ascites, variceal hemorrhage or hepatic encephalopathy). Results The median LS measurement was 2.72 kPa (interquartile range, 2.32–3.44 kPa) and the overall change in LS was 0.05 kPa/y. However, ΔLS/y was 10-fold higher in patients anticipated to have cirrhosis (0.31 kPa/y) compared to patients with no fibrosis (0.03 kPa/y). The median LS increased over time in patients who ultimately developed hepatic decompensation (0.60 kPa/y; interquartile range, 0.21–1.26 kPa/y) vs but remained static in patients who did not (reduction of 0.04/y; interquartile range, reductions of 0.26 to 0.17 kPa/y) (P Conclusions A single LS measurement and changes in LS over time are independently associated with hepatic decompensation in patients with PSC. However, changes in LS occur slowly in patients without advanced fibrosis or hepatic decompensation.

  • Magnetic Resonance Elastography in primary sclerosing cholangitis interobserver agreement for liver stiffness measurement with manual and automated methods
    Academic Radiology, 2019
    Co-Authors: Safa Hoodeshenas, Richard L Ehman, John E Eaton, Bogdan Dzyubak, Christopher L Welle, Patrick J Navin, Sudhakar K Venkatesh
    Abstract:

    Rationale and Objective Primary sclerosing cholangitis, a chronic liver disease causes heterogeneous parenchymal changes and fibrosis. Liver stiffness measurement (LSM) with Magnetic Resonance Elastography (MRE) may be affected by this heterogeneous distribution. We evaluated interobserver agreement of LSM in primary sclerosing cholangitis (PSC) with manual and automated methods to study the influence of heterogeneous changes. Materials and Methods A total of 79 consecutive patients with PSC who had a liver MRI and MRE formed the study group. Three readers with 1–3 years’ experience in MRE and a MRE expert (11 years’ experience) independently performed LSM. Each reader manually drew free hand (fROI) and average (aROI) on stiffness maps. Automatic liver elasticity calculation (ALEC) was used to generate automated LSM. The expert fROI was the reference standard. Correlation analysis and absolute intra-class correlation coefficient (ICC) analysis was performed. Results LSM data of 79 livers and 315 sections were evaluated. There was excellent ICC between expert and reader fROIs (0.989, 95% confidence interval, and 0.985–0.993) and aROIs (0.971, 95% confidence interval, and 0.953–0.983) and ALEC (0.972, 0.957–0.982) with fROI performing better. The areas measured with fROIs and ALEC had moderate ICC with Expert fROI (0.64 and 0.56, respectively) whereas aROI area had a poor ICC of 0.12. Comparison of multiple methods showed significant differences in LSM between expert fROI and aROI of two readers and no significant differences for fROIs of all three readers. Conclusion LSM with MRE in PSC patients shows excellent interobserver agreement with both fROI and aROI methods with better performance with fROI. fROI may therefore be preferred for LSM measurements in PSC.

  • Magnetic Resonance Elastography of Liver in Light Chain Amyloidosis
    'MDPI AG', 2019
    Co-Authors: Sudhakar K Venkatesh, Safa Hoodeshenas, Sandeep H. Venkatesh, Angela Dispenzieri, Morie A. Gertz, Michael S. Torbenson, Richard L Ehman
    Abstract:

    In this paper, we present our preliminary findings regarding Magnetic Resonance Elastography (MRE) on the livers of 10 patients with systemic amyloidosis. Mean liver stiffness measurements (LSM) and spleen stiffness measurements (SSM) were obtained. Magnetic Resonance imaging (MRI) images were analyzed for the distribution pattern of amyloid deposition. Pearson correlation analysis was performed in order to study the correlation between LSM, SSM, liver span, liver volume, spleen span, spleen volume, serum alkaline phosphatase (ALP), N-terminal pro b-type natriuretic peptide (NT pro BNP), and the kappa and lambda free light chains. An increase in mean LSM was seen in all patients. Pearson correlation analysis showed a statistically significant correlation between LSM and liver volume (r = 0.78, p = 0.007) and kappa chain level (r = 0.65, p = 0.04). Interestingly, LSM did not correlate significantly with SSM (r = 0.45, p = 0.18), liver span (r = 0.57, p = 0.08), or serum ALP (r = 0.60, p = 0.07). However, LSM correlated significantly with serum ALP when corrected for liver volume (partial correlation, r = 0.71, p = 0.03) and NT pro BNP levels (partial correlation, r = 0.68, p = 0.04). MRI review revealed that amyloid deposition in the liver can be diffuse, lobar, or focal. MRE is useful for the evaluation of hepatic amyloidosis and shows increased stiffness in hepatic amyloidosis. MRE has the potential to be a non-invasive quantitative imaging marker for hepatic amyloidosis

  • temporal changes in liver stiffness after fontan operation results of serial Magnetic Resonance Elastography
    International Journal of Cardiology, 2018
    Co-Authors: Alexander C Egbe, Sudhakar K Venkatesh, Patrick S Kamath, William R Miranda, Heidi M Connolly, Arooj R Khan, Mohamad Alotaibi, Douglas A Simonetto, Carole A Warnes
    Abstract:

    Abstract Background The relationship between temporal progression of Magnetic Resonance Elastography derived liver stiffness (MRE-LS) and progression of Fontan associated liver disease (FALD) is unknown. To assess this relationship, we hypothesized that progression of MRE-LS correlated with progression FALD severity and clinical outcomes. Methods Retrospective review of Fontan patients who had >1 liver MRE, 2010–2016. Annual change in MRE-LS was the quotient of the difference between baseline and subsequent MRE-LS, and the interval between scans. Results 22 patients were enrolled; median age 29(19–38) years, 14 (64%) males and 10 (46%) with atriopulmonary Fontan. Baseline and subsequent MRE-LS values were 5.4 ± 1.1 kPa and 5.8 ± 0.9 kPa" for clarity, interval between scans was 25 ± 5 months, and annual change in MRE-LS was 0.3 ± 0.2 kPa. Temporal change in MRE-LS correlated with temporal changes in model for end-stage liver disease (MELD) score ( r  = 0.84, p r  = 0.75, p  = 0.001). The study cohort was divided into 2 groups using the mean annual change in MRE-LS as the cut point. Groups A and B comprised of patients with annual increase in MRE-LS ≥0.3 kPa ( n  = 6) and n  = 16) respectively. Composite adverse event endpoint (death, heart–liver transplant listing, palliative care, hospitalization, paracentesis) was more common in Group A (4 of 6, 67%) compared to Group B (3 of 16, 19%), p  = 0.13 although this did not reach statistical significance due to small sample size. Conclusions Progression of MRE-LS correlated with clinical deterioration as measured by worsening liver disease severity scores and the occurrence of adverse events.

  • correlation of hepatic fractional extracellular space using gadolinium enhanced mri with liver stiffness using Magnetic Resonance Elastography
    Abdominal Radiology, 2017
    Co-Authors: Michael L Wells, Rickey E Carter, Michael R Moynagh, Robert Childs, Cameron E Leitch, Joel G Fletcher, Benjamin M Yeh, Sudhakar K Venkatesh
    Abstract:

    Purpose To compare MR hepatic fractional extracellular space (fECS) to liver stiffness (LS) with Magnetic Resonance Elastography (MRE) for evaluation of liver fibrosis.

Claude B Sirlin - One of the best experts on this subject based on the ideXlab platform.

  • Magnetic Resonance Elastography is superior to acoustic radiation force impulse for the diagnosis of fibrosis in patients with biopsy proven nonalcoholic fatty liver disease a prospective study
    Hepatology, 2016
    Co-Authors: Jeffrey Cui, William Haufe, Mark A Valasek, H Aryafar, Claude B Sirlin, Jonathan Hooker, Elhamy Heba, Carolyn Hernandez, Michael P Andre, Rohit Loomba
    Abstract:

    Magnetic Resonance Elastography (MRE), an advanced Magnetic Resonance–based imaging technique, and acoustic radiation force impulse (ARFI), an ultrasound-based imaging technique, are accurate for diagnosing nonalcoholic fatty liver disease (NAFLD) fibrosis. However, no head-to-head comparisons between MRE and ARFI for diagnosing NAFLD fibrosis have been performed. We compared MRE versus ARFI head-to-head for diagnosing fibrosis in well-characterized patients with biopsy-proven NAFLD. This cross-sectional analysis of a prospective cohort involved 125 patients (54.4% female) who underwent MRE, ARFI, and contemporaneous liver biopsies scored using the Nonalcoholic Steatohepatitis Clinical Research Network histological scoring system. The performances of MRE versus ARFI for diagnosing fibrosis were evaluated using area under the receiver operating characteristic curves (AUROCs). The mean (± standard deviation) age and body mass index were 48.9 (±15.4) years and 31.8 (±7.0) kg/m2, respectively. For diagnosing any fibrosis (≥ stage 1), the MRE AUROC was 0.799 (95% confidence interval [CI] 0.723-0.875), significantly (P = 0.012) higher than the ARFI AUROC of 0.664 (95% CI 0.568-0.760). In stratified analysis by presence or absence of obesity, MRE was superior to ARFI for diagnosing any fibrosis in obese patients (P < 0.001) but not in nonobese patients (P = 0.722). The MRE AUROCs for diagnosing ≥stages 2, 3, and 4 fibrosis were 0.885 (95% CI 0.816-0.953), 0.934 (95% CI 0.863-1.000), and 0.882 (95% CI 0.729-1.000); and the ARFI AUROCs were 0.848 (95% CI 0.776-0.921), 0.896 (95% CI 0.824-0.968), and 0.862 (95% CI 0.721-1.000). MRE had higher AUROCs than ARFI for discriminating dichotomized fibrosis stages at all dichotomization cutoff points, but the AUROC differences decreased as the cutoff points (fibrosis stages) increased. Conclusion: MRE is more accurate than ARFI for diagnosing any fibrosis in NAFLD patients, especially those who are obese. (Hepatology 2016;63:453–461)

  • Magnetic Resonance Elastography is superior to acoustic radiation force impulse for the diagnosis of fibrosis in patients with biopsy proven nonalcoholic fatty liver disease a prospective study
    Hepatology, 2016
    Co-Authors: Elhamy Heba, William Haufe, Mark A Valasek, H Aryafar, Claude B Sirlin, Jonathan Hooker, Carolyn Hernandez, Michael P Andre, Rohit Loomba
    Abstract:

    Magnetic Resonance Elastography (MRE), an advanced Magnetic Resonance-based imaging technique, and acoustic radiation force impulse (ARFI), an ultrasound-based imaging technique, are accurate for diagnosing nonalcoholic fatty liver disease (NAFLD) fibrosis. However, no head-to-head comparisons between MRE and ARFI for diagnosing NAFLD fibrosis have been performed. We compared MRE versus ARFI head-to-head for diagnosing fibrosis in well-characterized patients with biopsy-proven NAFLD. This cross-sectional analysis of a prospective cohort involved 125 patients (54.4% female) who underwent MRE, ARFI, and contemporaneous liver biopsies scored using the Nonalcoholic Steatohepatitis Clinical Research Network histological scoring system. The performances of MRE versus ARFI for diagnosing fibrosis were evaluated using area under the receiver operating characteristic curves (AUROCs). The mean (± standard deviation) age and body mass index were 48.9 (±15.4) years and 31.8 (±7.0) kg/m(2) , respectively. For diagnosing any fibrosis (≥ stage 1), the MRE AUROC was 0.799 (95% confidence interval [CI] 0.723-0.875), significantly (P = 0.012) higher than the ARFI AUROC of 0.664 (95% CI 0.568-0.760). In stratified analysis by presence or absence of obesity, MRE was superior to ARFI for diagnosing any fibrosis in obese patients (P < 0.001) but not in nonobese patients (P = 0.722). The MRE AUROCs for diagnosing ≥stages 2, 3, and 4 fibrosis were 0.885 (95% CI 0.816-0.953), 0.934 (95% CI 0.863-1.000), and 0.882 (95% CI 0.729-1.000); and the ARFI AUROCs were 0.848 (95% CI 0.776-0.921), 0.896 (95% CI 0.824-0.968), and 0.862 (95% CI 0.721-1.000). MRE had higher AUROCs than ARFI for discriminating dichotomized fibrosis stages at all dichotomization cutoff points, but the AUROC differences decreased as the cutoff points (fibrosis stages) increased.MRE is more accurate than ARFI for diagnosing any fibrosis in NAFLD patients, especially those who are obese.

  • comparative diagnostic accuracy of Magnetic Resonance Elastography vs eight clinical prediction rules for non invasive diagnosis of advanced fibrosis in biopsy proven non alcoholic fatty liver disease a prospective study
    Alimentary Pharmacology & Therapeutics, 2015
    Co-Authors: Jeffrey Cui, William Haufe, Claude B Sirlin, Brandon Ang, Carolyn Hernandez, Elizabeth C Verna, Rohit Loomba
    Abstract:

    Author(s): Cui, J; Ang, B; Haufe, W; Hernandez, C; Verna, EC; Sirlin, CB; Loomba, R | Abstract: BackgroundTwo-dimensional Magnetic Resonance Elastography (2D-MRE) is an advanced Magnetic Resonance method with high diagnostic accuracy for predicting advanced fibrosis in non-alcoholic fatty liver disease (NAFLD) patients. However, no prospective, head-to-head comparisons between 2D-MRE and clinical prediction rules (CPRs) have been performed in patients with biopsy-proven NAFLD.AimTo compare the diagnostic utility of 2D-MRE against that of eight CPRs (AST:ALT ratio, APRI, BARD, FIB-4, NAFLD Fibrosis Score, Bonacini cirrhosis discriminant score, Lok Index and NASH CRN model) for predicting advanced fibrosis in a prospective cohort with paired liver biopsy as the gold standard.MethodsThis is a cross-sectional analysis of a prospective study of 102 patients (58.8% women) with biopsy-proven NAFLD, 2D-MRE and clinical research assessment within 90 days of biopsy. Receiver operating characteristic (ROC) analysis was performed to assess the performance of 2D-MRE and CPRs for predicting advanced fibrosis.ResultsThe mean (±s.d.) age and BMI were 51.3 (±14.0) years and 31.7 (±5.5) kg/m(2) respectively. 48, 26, 9, 13 and 6 patients had stage 0, 1, 2, 3 and 4 fibrosis respectively. The area under ROC curve (AUROC) was 0.957 for 2D-MRE and between 0.796 and 0.861 for the CPRs. FIB-4 was the best-performing CPR at predicting advanced fibrosis with AUROC of 0.861. In head-to-head comparisons using the DeLong test, 2D-MRE had significantly better AUROC (P l 0.05) than each CPR for predicting advanced fibrosis.ConclusionCompared to clinical prediction rules, 2D-MRE provides significantly higher accuracy for the diagnosis of advanced fibrosis in NAFLD patients.

  • comparative diagnostic accuracy of Magnetic Resonance Elastography vs eight clinical prediction rules for non invasive diagnosis of advanced fibrosis in biopsy proven non alcoholic fatty liver disease a prospective study
    Alimentary Pharmacology & Therapeutics, 2015
    Co-Authors: Jeffrey Cui, William Haufe, Claude B Sirlin, Brandon Ang, Carolyn Hernandez, Elizabeth C Verna, Rohit Loomba
    Abstract:

    Author(s): Cui, J; Ang, B; Haufe, W; Hernandez, C; Verna, EC; Sirlin, CB; Loomba, R | Abstract: Two-dimensional Magnetic Resonance Elastography (2D-MRE) is an advanced Magnetic Resonance method with high diagnostic accuracy for predicting advanced fibrosis in non-alcoholic fatty liver disease (NAFLD) patients. However, no prospective, head-to-head comparisons between 2D-MRE and clinical prediction rules (CPRs) have been performed in patients with biopsy-proven NAFLD.To compare the diagnostic utility of 2D-MRE against that of eight CPRs (AST:ALT ratio, APRI, BARD, FIB-4, NAFLD Fibrosis Score, Bonacini cirrhosis discriminant score, Lok Index and NASH CRN model) for predicting advanced fibrosis in a prospective cohort with paired liver biopsy as the gold standard.This is a cross-sectional analysis of a prospective study of 102 patients (58.8% women) with biopsy-proven NAFLD, 2D-MRE and clinical research assessment within 90 days of biopsy. Receiver operating characteristic (ROC) analysis was performed to assess the performance of 2D-MRE and CPRs for predicting advanced fibrosis.The mean (±s.d.) age and BMI were 51.3 (±14.0) years and 31.7 (±5.5) kg/m(2) respectively. 48, 26, 9, 13 and 6 patients had stage 0, 1, 2, 3 and 4 fibrosis respectively. The area under ROC curve (AUROC) was 0.957 for 2D-MRE and between 0.796 and 0.861 for the CPRs. FIB-4 was the best-performing CPR at predicting advanced fibrosis with AUROC of 0.861. In head-to-head comparisons using the DeLong test, 2D-MRE had significantly better AUROC (P l 0.05) than each CPR for predicting advanced fibrosis.Compared to clinical prediction rules, 2D-MRE provides significantly higher accuracy for the diagnosis of advanced fibrosis in NAFLD patients.

  • ezetimibe for the treatment of nonalcoholic steatohepatitis assessment by novel Magnetic Resonance imaging and Magnetic Resonance Elastography in a randomized trial mozart trial
    Hepatology, 2015
    Co-Authors: Rohit Loomba, Ricki Bettencourt, Claude B Sirlin, Brandon Ang, Rashmi Jain, Joanie Salotti, Linda Soaft, Jonathan Hooker, Yuko Kono, Archana Bhatt
    Abstract:

    Ezetimibe inhibits intestinal cholesterol absorption and lowers low-density lipoprotein cholesterol. Uncontrolled studies have suggested that it reduces liver fat as estimated by ultrasound in nonalcoholic steatohepatitis (NASH). Therefore, we aimed to examine the efficacy of ezetimibe versus placebo in reducing liver fat by the Magnetic Resonance imaging-derived proton density-fat fraction (MRI-PDFF) and liver histology in patients with biopsy-proven NASH. In this randomized, double-blind, placebo-controlled trial, 50 patients with biopsy-proven NASH were randomized to either ezetimibe 10 mg orally daily or placebo for 24 weeks. The primary outcome was a change in liver fat as measured by MRI-PDFF in colocalized regions of interest within each of the nine liver segments. Novel assessment by two-dimensional and three-dimensional Magnetic Resonance Elastography was also performed. Ezetimibe was not significantly better than placebo at reducing liver fat as measured by MRI-PDFF (mean difference between the ezetimibe and placebo arms -1.3%, P = 0.4). Compared to baseline, however, end-of-treatment MRI-PDFF was significantly lower in the ezetimibe arm (15%-11.6%, P < 0.016) but not in the placebo arm (18.5%-16.4%, P = 0.15). There were no significant differences in histologic response rates, serum alanine aminotransferase and aspartate aminotransferase levels, or longitudinal changes in two-dimensional and three-dimensional Magnetic Resonance Elastography-derived liver stiffness between the ezetimibe and placebo arms. Compared to histologic nonresponders (25/35), histologic responders (10/35) had a significantly greater reduction in MRI-PDFF (-4.35 ± 4.9% versus -0.30 ± 4.1%, P < 0.019). Conclusions: Ezetimibe did not significantly reduce liver fat in NASH. This trial demonstrates the application of colocalization of MRI-PDFF-derived fat maps and Magnetic Resonance Elastography-derived stiffness maps of the liver before and after treatment to noninvasively assess treatment response in NASH. (Hepatology 2015;61:1239–1250)

William Haufe - One of the best experts on this subject based on the ideXlab platform.

  • Magnetic Resonance Elastography identifies fibrosis in adults with alpha 1 antitrypsin deficiency liver disease a prospective study
    Alimentary Pharmacology & Therapeutics, 2016
    Co-Authors: Rebecca G Kim, Phirum Nguyen, Ricki Bettencourt, Parambir S Dulai, William Haufe, Jacob M Hooker, Jeet Minocha, Mark A Valasek, H Aryafar, David A Brenner
    Abstract:

    Author(s): Kim, RG; Nguyen, P; Bettencourt, R; Dulai, PS; Haufe, W; Hooker, J; Minocha, J; Valasek, MA; Aryafar, H; Brenner, DA; Sirlin, CB; Loomba, R | Abstract: BACKGROUND:Limited data exist on the clinical presentation and non-invasive detection of liver fibrosis in adults with homozygous Z genotype alpha-1 antitrypsin (AAT) deficiency. AIMS:To compare demographic, biochemical, histological and imaging data of AAT deficient patients to normal-control and biopsy-proven non-alcoholic fatty liver disease (NAFLD) patients, and to assess the diagnostic accuracy of Magnetic Resonance Elastography (MRE) in detecting fibrosis in AAT deficiency. METHODS:Study includes 33 participants, 11 per group, who underwent clinical research evaluation, liver biopsy (AAT and NAFLD groups), and MRE. Histological fibrosis was quantified using a modified Ishak 6-point scale and liver stiffness by MRE. Diagnostic performance of MRE in detecting fibrosis was assessed by receiver operating characteristic (ROC) analysis. RESULTS:Mean (±s.d.) of age and BMI of normal-control, AAT and NAFLD groups was 57 (±19), 57 (±18), and 57 (±13) years, and 22.7 (±2.5), 24.8 (±4.0) and 31.0 (±5.1) kg/m(2) respectively. Serum ALT [mean ± s.d.] was similar within normal-control [16.4 ± 4.0] and AAT groups [23.5 ± 10.8], but was significantly lower in AAT than NAFLD even after adjustment for stage of fibrosis (P l 0.05, P = 0.0172). For fibrosis detection, MRE-estimated stiffness had an area under the ROC curve of 0.90 (P l 0.0001); an MRE threshold of ≥3.0 kPa provided 88.9% accuracy, with 80% sensitivity and 100% specificity to detect presence of any fibrosis (stage ≥1). CONCLUSIONS:This pilot prospective study suggests Magnetic Resonance Elastography may be accurate for identifying fibrosis in patients with alpha-1 antitrypsin deficiency. Larger validation studies are warranted.

  • Magnetic Resonance Elastography is superior to acoustic radiation force impulse for the diagnosis of fibrosis in patients with biopsy proven nonalcoholic fatty liver disease a prospective study
    Hepatology, 2016
    Co-Authors: Elhamy Heba, William Haufe, Mark A Valasek, H Aryafar, Claude B Sirlin, Jonathan Hooker, Carolyn Hernandez, Michael P Andre, Rohit Loomba
    Abstract:

    Magnetic Resonance Elastography (MRE), an advanced Magnetic Resonance-based imaging technique, and acoustic radiation force impulse (ARFI), an ultrasound-based imaging technique, are accurate for diagnosing nonalcoholic fatty liver disease (NAFLD) fibrosis. However, no head-to-head comparisons between MRE and ARFI for diagnosing NAFLD fibrosis have been performed. We compared MRE versus ARFI head-to-head for diagnosing fibrosis in well-characterized patients with biopsy-proven NAFLD. This cross-sectional analysis of a prospective cohort involved 125 patients (54.4% female) who underwent MRE, ARFI, and contemporaneous liver biopsies scored using the Nonalcoholic Steatohepatitis Clinical Research Network histological scoring system. The performances of MRE versus ARFI for diagnosing fibrosis were evaluated using area under the receiver operating characteristic curves (AUROCs). The mean (± standard deviation) age and body mass index were 48.9 (±15.4) years and 31.8 (±7.0) kg/m(2) , respectively. For diagnosing any fibrosis (≥ stage 1), the MRE AUROC was 0.799 (95% confidence interval [CI] 0.723-0.875), significantly (P = 0.012) higher than the ARFI AUROC of 0.664 (95% CI 0.568-0.760). In stratified analysis by presence or absence of obesity, MRE was superior to ARFI for diagnosing any fibrosis in obese patients (P < 0.001) but not in nonobese patients (P = 0.722). The MRE AUROCs for diagnosing ≥stages 2, 3, and 4 fibrosis were 0.885 (95% CI 0.816-0.953), 0.934 (95% CI 0.863-1.000), and 0.882 (95% CI 0.729-1.000); and the ARFI AUROCs were 0.848 (95% CI 0.776-0.921), 0.896 (95% CI 0.824-0.968), and 0.862 (95% CI 0.721-1.000). MRE had higher AUROCs than ARFI for discriminating dichotomized fibrosis stages at all dichotomization cutoff points, but the AUROC differences decreased as the cutoff points (fibrosis stages) increased.MRE is more accurate than ARFI for diagnosing any fibrosis in NAFLD patients, especially those who are obese.

  • Magnetic Resonance Elastography is superior to acoustic radiation force impulse for the diagnosis of fibrosis in patients with biopsy proven nonalcoholic fatty liver disease a prospective study
    Hepatology, 2016
    Co-Authors: Jeffrey Cui, William Haufe, Mark A Valasek, H Aryafar, Claude B Sirlin, Jonathan Hooker, Elhamy Heba, Carolyn Hernandez, Michael P Andre, Rohit Loomba
    Abstract:

    Magnetic Resonance Elastography (MRE), an advanced Magnetic Resonance–based imaging technique, and acoustic radiation force impulse (ARFI), an ultrasound-based imaging technique, are accurate for diagnosing nonalcoholic fatty liver disease (NAFLD) fibrosis. However, no head-to-head comparisons between MRE and ARFI for diagnosing NAFLD fibrosis have been performed. We compared MRE versus ARFI head-to-head for diagnosing fibrosis in well-characterized patients with biopsy-proven NAFLD. This cross-sectional analysis of a prospective cohort involved 125 patients (54.4% female) who underwent MRE, ARFI, and contemporaneous liver biopsies scored using the Nonalcoholic Steatohepatitis Clinical Research Network histological scoring system. The performances of MRE versus ARFI for diagnosing fibrosis were evaluated using area under the receiver operating characteristic curves (AUROCs). The mean (± standard deviation) age and body mass index were 48.9 (±15.4) years and 31.8 (±7.0) kg/m2, respectively. For diagnosing any fibrosis (≥ stage 1), the MRE AUROC was 0.799 (95% confidence interval [CI] 0.723-0.875), significantly (P = 0.012) higher than the ARFI AUROC of 0.664 (95% CI 0.568-0.760). In stratified analysis by presence or absence of obesity, MRE was superior to ARFI for diagnosing any fibrosis in obese patients (P < 0.001) but not in nonobese patients (P = 0.722). The MRE AUROCs for diagnosing ≥stages 2, 3, and 4 fibrosis were 0.885 (95% CI 0.816-0.953), 0.934 (95% CI 0.863-1.000), and 0.882 (95% CI 0.729-1.000); and the ARFI AUROCs were 0.848 (95% CI 0.776-0.921), 0.896 (95% CI 0.824-0.968), and 0.862 (95% CI 0.721-1.000). MRE had higher AUROCs than ARFI for discriminating dichotomized fibrosis stages at all dichotomization cutoff points, but the AUROC differences decreased as the cutoff points (fibrosis stages) increased. Conclusion: MRE is more accurate than ARFI for diagnosing any fibrosis in NAFLD patients, especially those who are obese. (Hepatology 2016;63:453–461)

  • comparative diagnostic accuracy of Magnetic Resonance Elastography vs eight clinical prediction rules for non invasive diagnosis of advanced fibrosis in biopsy proven non alcoholic fatty liver disease a prospective study
    Alimentary Pharmacology & Therapeutics, 2015
    Co-Authors: Jeffrey Cui, William Haufe, Claude B Sirlin, Brandon Ang, Carolyn Hernandez, Elizabeth C Verna, Rohit Loomba
    Abstract:

    Author(s): Cui, J; Ang, B; Haufe, W; Hernandez, C; Verna, EC; Sirlin, CB; Loomba, R | Abstract: BackgroundTwo-dimensional Magnetic Resonance Elastography (2D-MRE) is an advanced Magnetic Resonance method with high diagnostic accuracy for predicting advanced fibrosis in non-alcoholic fatty liver disease (NAFLD) patients. However, no prospective, head-to-head comparisons between 2D-MRE and clinical prediction rules (CPRs) have been performed in patients with biopsy-proven NAFLD.AimTo compare the diagnostic utility of 2D-MRE against that of eight CPRs (AST:ALT ratio, APRI, BARD, FIB-4, NAFLD Fibrosis Score, Bonacini cirrhosis discriminant score, Lok Index and NASH CRN model) for predicting advanced fibrosis in a prospective cohort with paired liver biopsy as the gold standard.MethodsThis is a cross-sectional analysis of a prospective study of 102 patients (58.8% women) with biopsy-proven NAFLD, 2D-MRE and clinical research assessment within 90 days of biopsy. Receiver operating characteristic (ROC) analysis was performed to assess the performance of 2D-MRE and CPRs for predicting advanced fibrosis.ResultsThe mean (±s.d.) age and BMI were 51.3 (±14.0) years and 31.7 (±5.5) kg/m(2) respectively. 48, 26, 9, 13 and 6 patients had stage 0, 1, 2, 3 and 4 fibrosis respectively. The area under ROC curve (AUROC) was 0.957 for 2D-MRE and between 0.796 and 0.861 for the CPRs. FIB-4 was the best-performing CPR at predicting advanced fibrosis with AUROC of 0.861. In head-to-head comparisons using the DeLong test, 2D-MRE had significantly better AUROC (P l 0.05) than each CPR for predicting advanced fibrosis.ConclusionCompared to clinical prediction rules, 2D-MRE provides significantly higher accuracy for the diagnosis of advanced fibrosis in NAFLD patients.

  • comparative diagnostic accuracy of Magnetic Resonance Elastography vs eight clinical prediction rules for non invasive diagnosis of advanced fibrosis in biopsy proven non alcoholic fatty liver disease a prospective study
    Alimentary Pharmacology & Therapeutics, 2015
    Co-Authors: Jeffrey Cui, William Haufe, Claude B Sirlin, Brandon Ang, Carolyn Hernandez, Elizabeth C Verna, Rohit Loomba
    Abstract:

    Author(s): Cui, J; Ang, B; Haufe, W; Hernandez, C; Verna, EC; Sirlin, CB; Loomba, R | Abstract: Two-dimensional Magnetic Resonance Elastography (2D-MRE) is an advanced Magnetic Resonance method with high diagnostic accuracy for predicting advanced fibrosis in non-alcoholic fatty liver disease (NAFLD) patients. However, no prospective, head-to-head comparisons between 2D-MRE and clinical prediction rules (CPRs) have been performed in patients with biopsy-proven NAFLD.To compare the diagnostic utility of 2D-MRE against that of eight CPRs (AST:ALT ratio, APRI, BARD, FIB-4, NAFLD Fibrosis Score, Bonacini cirrhosis discriminant score, Lok Index and NASH CRN model) for predicting advanced fibrosis in a prospective cohort with paired liver biopsy as the gold standard.This is a cross-sectional analysis of a prospective study of 102 patients (58.8% women) with biopsy-proven NAFLD, 2D-MRE and clinical research assessment within 90 days of biopsy. Receiver operating characteristic (ROC) analysis was performed to assess the performance of 2D-MRE and CPRs for predicting advanced fibrosis.The mean (±s.d.) age and BMI were 51.3 (±14.0) years and 31.7 (±5.5) kg/m(2) respectively. 48, 26, 9, 13 and 6 patients had stage 0, 1, 2, 3 and 4 fibrosis respectively. The area under ROC curve (AUROC) was 0.957 for 2D-MRE and between 0.796 and 0.861 for the CPRs. FIB-4 was the best-performing CPR at predicting advanced fibrosis with AUROC of 0.861. In head-to-head comparisons using the DeLong test, 2D-MRE had significantly better AUROC (P l 0.05) than each CPR for predicting advanced fibrosis.Compared to clinical prediction rules, 2D-MRE provides significantly higher accuracy for the diagnosis of advanced fibrosis in NAFLD patients.