Magnetic resonance elastography biomarkers for detection of histologic alterations in nonalcoholic fatty liver disease in the absence of fibrosis

• Published in: European radiology Vol. 31; no. 11; pp. 8408 - 8419
• Main Authors: Qu, Yali, Middleton, Michael S., Loomba, Rohit, Glaser, Kevin J., Chen, Jun, Hooker, Jonathan C., Wolfson, Tanya, Covarrubias, Yesenia, Valasek, Mark A., Fowler, Kathryn J., Zhang, Yingzhen N., Sy, Ethan, Gamst, Anthony C., Wang, Kang, Mamidipalli, Adrija, Schwimmer, Jeffrey B., Song, Bin, Reeder, Scott B., Yin, Meng, Ehman, Richard L., Sirlin, Claude B.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-11-2021; Springer Nature B.V
• Subjects: Adults; Age; Biomarkers; Biopsy; Damping ratio; Diagnostic Radiology; Elasticity Imaging Techniques; Fatty liver; Fibrosis; Histology; Humans; Imaging; Inflammation; Internal Medicine; Interventional Radiology; Liver; Liver - diagnostic imaging; Liver - pathology; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - pathology; Liver diseases; Loss modulus; Magnetic properties; Magnetic Resonance; Magnetic Resonance Imaging; Mechanical properties; Medicine; Medicine & Public Health; Neuroradiology; Non-alcoholic Fatty Liver Disease - diagnostic imaging; Non-alcoholic Fatty Liver Disease - pathology; Prospective Studies; Proton density (concentration); Radiology; Resonance; Retrospective Studies; Shear stiffness; Storage modulus; Ultrasound; Wave attenuation; Nonalcoholic fatty liver disease; Inflammation; Magnetic resonance imaging; Elasticity imaging techniques
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-021-07988-6

Objectives
To investigate associations between histology and hepatic mechanical properties measured using multiparametric magnetic resonance elastography (MRE) in adults with known or suspected nonalcoholic fatty liver disease (NAFLD) without histologic fibrosis.
Methods
This was a retrospective analysis of 88 adults who underwent 3T MR exams including hepatic MRE and MR imaging to estimate proton density fat fraction (MRI-PDFF) within 180 days of liver biopsy. Associations between MRE mechanical properties (mean shear stiffness (|
G
*|) by 2D and 3D MRE, and storage modulus (
G
′), loss modulus (
G
″), wave attenuation (
α
), and damping ratio (
ζ
) by 3D MRE) and histologic, demographic and anthropometric data were assessed.
Results
In univariate analyses, patients with lobular inflammation grade ≥ 2 had higher 2D |
G
*| and 3D
G
″ than those with grade ≤ 1 (
p
= 0.04). |
G
*| (both 2D and 3D),
G
′, and
G
″ increased with age (rho = 0.25 to 0.31;
p
≤ 0.03). In multivariable regression analyses, the association between inflammation grade ≥ 2 remained significant for 2D |
G
*| (
p
= 0.01) but not for 3D
G
″ (
p
= 0.06); age, sex, or BMI did not affect the MRE-inflammation relationship (
p
> 0.20).
Conclusions
2D |
G
*| and 3D
G
″ were weakly associated with moderate or severe lobular inflammation in patients with known or suspected NAFLD without fibrosis. With further validation and refinement, these properties might become useful biomarkers of inflammation. Age adjustment may help MRE interpretation, at least in patients with early-stage disease.
Key Points
• Moderate to severe lobular inflammation was associated with hepatic elevated shear stiffness and elevated loss modulus (p =0.04) in patients with known or suspected NAFLD without liver fibrosis; this suggests that with further technical refinement these MRE-assessed mechanical properties may permit detection of inflammation before the onset of fibrosis in NAFLD.
• Increasing age is associated with higher hepatic shear stiffness, and storage and loss moduli (rho = 0.25 to 0.31; p ≤ 0.03); this suggests that age adjustment may help interpret MRE results, at least in patients with early-stage NAFLD.