A study of T1 relaxation time as a measure of liver fibrosis and the influence of confounding histological factors. (24th April 2015)

• Record Type: Journal Article
• Authors: Hoad, Caroline L.; Palaniyappan, Naaventhan; Kaye, Philip; Chernova, Yulia; James, Martin W.; Costigan, Carolyn; Austin, Andrew; Marciani, Luca; Gowland, Penny A.; Guha, Indra N.; Francis, Susan T.; Aithal, Guruprasad P.
• Is Part Of: NMR in biomedicine. Volume 28:Number 6(2015:Jun.)
• Page Start: 706
• Page End: 714
• Publication Date: 2015-04-24
• Subjects: Nuclear magnetic resonance -- Periodicals; Magnetic Resonance Spectroscopy -- Periodicals; 574
• DOI: 10.1002/nbm.3299
• Languages: English
• ISSNs: 0952-3480

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <p>Liver biopsy is the standard test for the assessment of fibrosis in liver tissue of patients with chronic liver disease. Recent studies have used a non‐invasive measure of <italic>T</italic><sub>1</sub> relaxation time to estimate the degree of fibrosis in a single slice of the liver. Here, we extend this work to measure <italic>T</italic><sub>1</sub> of the whole liver and investigate the effects of additional histological factors such as steatosis, inflammation and iron accumulation on the relationship between liver <italic>T</italic><sub>1</sub> and fibrosis. We prospectively enrolled patients who had previously undergone liver biopsy to have MR scans. A non‐breath‐holding, fast scanning protocol was used to acquire MR relaxation time data (<italic>T</italic><sub>1</sub> and <italic>T</italic><sub>2</sub>*), and blood serum was used to determine the enhanced liver fibrosis (ELF) score. Areas under the receiver operator curves (AUROCs) for <italic>T</italic><sub>1</sub> to detect advanced fibrosis and cirrhosis were derived in a training cohort and then validated in a second cohort. Combining the cohorts, the influence of various histology factors on liver <italic>T</italic><sub>1</sub> relaxation time was investigated. The AUROCs (95% confidence interval (CI)) for detecting advanced fibrosis (<italic>F</italic> ≥ 3) and cirrhosis (<italic>F</italic> = 4) for the training cohort were 0.81 (0.65–0.96) and 0.92 (0.81–1.0) respectively (<italic>p</italic> < 0.01). Inflammation and iron accumulation were shown to significantly alter <italic>T</italic><sub>1</sub> in opposing directions in the absence of advanced fibrosis; inflammation increasing <italic>T</italic><sub>1</sub> and iron decreasing <italic>T</italic><sub>1</sub>. A decision tree model was developed to allow the assessment of early liver disease based on relaxation times and ELF, and to screen for the need for biopsy. <italic>T</italic><sub>1</sub> relaxation time increases with advanced fibrosis in liver patients, but is also influenced by iron accumulation and inflammation. Together with ELF, relaxation time measures provide a marker to stratify patients with suspected liver disease for biopsy. Copyright © 2015 John Wiley & Sons, Ltd.</p> </abstract>