Utility and cost evaluation of multiparametric magnetic resonance imaging for the assessment of non‐alcoholic fatty liver disease. Issue 5 (22nd December 2017)

• Record Type: Journal Article
• Authors: Eddowes, P. J.; McDonald, N.; Davies, N.; Semple, S. I. K.; Kendall, T. J.; Hodson, J.; Newsome, P. N.; Flintham, R. B.; Wesolowski, R.; Blake, L.; Duarte, R. V.; Kelly, C. J.; Herlihy, A. H.; Kelly, M. D.; Olliff, S. P.; Hübscher, S. G.; Fallowfield, J. A.; Hirschfield, G. M.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 47:Issue 5(2018)
• Page Start: 631
• Page End: 644
• Publication Date: 2017-12-22
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.14469
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background: Validated diagnostic tools that are accurate, cost effective and acceptable to patients are required for disease stratification and monitoring in NAFLD. Aims: To investigate the performance and cost of multiparametric MRI alongside existing biomarkers in the assessment of NAFLD. Methods: Adult patients undergoing standard of care liver biopsy for NAFLD were prospectively recruited at two UK liver centres and underwent multiparametric MRI, blood sampling and transient elastography withing 2 weeks of liver biopsy. Non‐invasive markers were compared to histology as the gold standard. Results: Data were obtained in 50 patients and 6 healthy volunteers. Corrected T1 (cT1) correlated with NAFLD activity score (ρ = 0.514, P < .001). cT1, enhanced liver fibrosis (ELF) test and liver stiffness differentiated patients with simple steatosis and NASH with AUROC (95% CI) of 0.69 (0.50‐0.88), 0.87 (0.77‐0.79) and 0.82 (0.70‐0.94) respectively and healthy volunteers from patients with AUROC (95% CI) of 0.93 (0.86‐1.00), 0.81 (0.69‐0.92) and 0.89 (0.77‐1.00) respectively. For the risk stratification of NAFLD, multiparametric MRI could save £150, 218 per 1000 patients compared to biopsy. Multiparametric MRI did not discriminate between individual histological fibrosis stages in this population ( P = .068). Conclusions: Multiparametric MRI accurately identified patients with steatosis, stratifies those with NASH or simple steatosis and reliably excludes clinically significant liver disease with superior negative predictive value (83.3%) to liver stiffness (42.9%) and ELF (57.1%). For the risk stratification of NAFLD, multiparametric MRI was cost effective and, combined with transient elastography, had the lowest cost per correct diagnosis. Linked content: This article is linked to Ferraioli paper. To view this article visithttps://doi.org/10.1111/apt.14501 .