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MRE-based NASH score for diagnosis of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease

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Abstract

Background and aims

As the prevalence of nonalcoholic fatty liver disease (NAFLD) is approximately 30% in the general population, it is important to develop a non-invasive biomarker for the diagnosis of nonalcoholic steatohepatitis (NASH). This prospective cross-sectional study aimed to develop a scoring system for NASH diagnosis through multiparametric magnetic resonance (MR) and clinical indicators.

Methods

Medical history, laboratory tests, and MR parameters of patients with NAFLD were assessed. A scoring system was developed using a logistic regression model. In total, 127 patients (58 with nonalcoholic fatty liver [NAFL] and 69 with NASH) were enrolled. After evaluating 23 clinical characteristics of the patients (4 categorical and 19 numeric variables) for the NASH diagnostic model, an equation for MR elastography (MRE)-based NASH score was obtained using 3 demographic factors, 2 laboratory variables, and MRE.

Results

The MRE-based NASH score showed a satisfactory accuracy for NASH diagnosis (c-statistics, 0.841; 95% CI 0.772–0.910). At a cut-off MRE-based NASH score of 0.68 for NASH diagnosis, its sensitivity was 0.68 and specificity was 0.91. When an MRE-based NASH score of 0.37 was used as a cut-off for NASH exclusion, the sensitivity was 0.91 and specificity was 0.55. Overall, 35% (44/127) of patients were in the gray zone (between 0.37 and 0.68). Internal validation via bootstrapping also indicated the satisfactory accuracy of NASH diagnosis (optimism-corrected statistics, 0.811).

Conclusion

MRE-based NASH score is a useful and accurate non-invasive biomarker for diagnosis of NASH in patients with NAFLD.

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Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate transaminase

AUC:

Area under the ROC curve

BMI:

Body Mass Index

CAP:

Controlled attenuation parameter

CK18:

Cytokeratin 18

FAST:

FibroScan-AST

FLASH:

Fast low-angle shot

IFG:

Impaired fasting glucose

kPa:

Kilopascal

MR:

Magnetic resonance

MRE:

Magnetic resonance elastography

MRI:

Magnetic resonance imaging

MRS:

Magnetic resonance spectroscopy

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

PDFF:

Proton density fat fraction

PT:

Prothrombin time

ROI:

Regions-of-interest

TE:

Transient elastography

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Funding

This study was supported by a National Research Foundation of Korea grant from the Korean government (the Ministry of Education, Science and Technology 2021R1C1C1009445 and 2018R1A2B2006183).

Author information

Author notes

  1. Young-Sun Lee and Ji Eun Lee authors contributed equally to this work.

  2. Jong Eun Yeon and Juneyoung Lee share correspondence equally for this work.

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea

    Young-Sun Lee, Young Kul Jung, Ji Hoon Kim, Yeon Seok Seo, Hyung Joon Yim, Jong Eun Yeon, Soon Ho Um & Kwan Soo Byun

  2. Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea

    Ji Eun Lee & Juneyoung Lee

  3. Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon, 35015, Republic of Korea

    Hyon-Seung Yi

  4. Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Republic of Korea

    Dae Won Jun

  5. Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea

    Baek-hui Kim

  6. Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea

    Jeong Woo Kim & Chang Hee Lee

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  1. Young-Sun Lee
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Correspondence to Jong Eun Yeon or Juneyoung Lee.

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This study had been approved by the institutional review board from Korea University Guro Hospital (2016GR0302).

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Lee, YS., Lee, J.E., Yi, HS. et al. MRE-based NASH score for diagnosis of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease. Hepatol Int 16, 316–324 (2022). https://doi.org/10.1007/s12072-022-10300-3

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