Abstract
Objective
To evaluate the usefulness of longitudinal observation of liver stiffness measured using magnetic resonance elastography (MRE) to stratify the risk of hepatocellular carcinoma (HCC) in patients with chronic liver disease.
Materials and methods
We retrospectively reviewed data for 161 patients with chronic liver disease using the following inclusion criteria: two MRE examinations separated by at least a 12-month interval, no history of HCC, no development of HCC between the two examinations and availability of laboratory results. Liver stiffness was classified as low (< 3 kPa), moderate (3–4.7 kPa) or high (> 4.7 kPa). The patients were divided into three groups according to sequential changes in liver stiffness as follows: high on the first MRE (group A, n = 60), low on both MRE examinations (group C, n = 36) and other combinations (group B, n = 65). Cox analyses and Kaplan-Meier methods were used to determine the risk of developing HCC.
Results
Forty-seven patients (29.2%) developed HCC during follow-up (46.7% [28/60] in group A, 26.2% [17/65] in group B, and 5.6% [2/36] in group C). There was a significant difference in the rate of development of HCC between groups A (45.1%), B (26.1%) and C (12.4%) at 3 years (p = 0.0002). The independent risk factors for development of HCC were group A classification, age and a high alanine aminotransferase level (risk ratio 1.018–6.030; p = 0.0028–0.0268).
Conclusion
Longitudinal observation of liver stiffness using MRE can stratify the risk of HCC during follow-up of chronic liver disease.
Key Points
• The results of MRE can stratify the risk for development of HCC during follow-up in patients with chronic liver disease.
• Patients with chronic liver disease and high liver stiffness (> 4.7 kPa) on a previous MRE examination are at high risk for developing HCC, regardless of current liver stiffness.
• Management of patients with chronic liver disease becomes more appropriate using longitudinally acquired two-point MRE data.
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Abbreviations
- ALT:
-
Alanine aminotransferase
- DAA:
-
Direct-acting antiviral
- MRE:
-
Magnetic resonance elastography
- PIVKA-II:
-
Protein induced by vitamin K absence or antagonists-II
- SVR:
-
Sustained virological response
References
Wong VW, Janssen HL (2015) Can we use HCC risk scores to individualize surveillance in chronic hepatitis B infection? J Hepatol 63:722–732
Sugino Y, Yamakado K, Yamanaka T et al (2017) Role of curative treatment in patients with intermediate-stage hepatocellular carcinoma. Jpn J Radiol 35:254–261
Takyar V, Etzion O, Heller T et al (2017) Complications of percutaneous liver biopsy with Klatskin needles: a 36-year single-centre experience. Aliment Pharmacol Ther 45:744–753
Chindamo MC, Nunes-Pannain VL, Araújo-Neto JM et al (2015) Intermediate fibrosis staging in hepatitis C: a problem not overcome by optimal samples or pathologists' expertise. Ann Hepatol 14:652–657
Huang Z, Zheng W, Zhang YJ et al (2017) Assessing hepatic fibrosis using 2-D shear wave elastography in patients with liver tumors: a prospective single-center study. Ultrasound Med Biol 43:2522–2529
Wang T, Shao C, Zhang G, Xu Y (2017) Real-time elastography (RTE): a valuable sonography-based non-invasive method for the assessment of liver fibrosis in chronic hepatitis B. Abdom Radiol (NY) 42:2632–2638
Masuzaki R, Tateishi R, Yoshida H et al (2008) Risk assessment of hepatocellular carcinoma in chronic hepatitis C patients by transient elastography. J Clin Gastroenterol 42:839–843
Park MS, Han KH, Kim SU (2014) Non-invasive prediction of development of hepatocellular carcinoma using transient elastography in patients with chronic liver disease. Expert Rev Gastroenterol Hepatol 8:501–511
Ichikawa S, Motosugi U, Enomoto N, Matsuda M, Onishi H (2017) Noninvasive hepatic fibrosis staging using MR elastography: the usefulness of the bayesian prediction method. J Magn Reson Imaging 46:375–382
Yin M, Glaser KJ, Talwalkar JA, Chen J, Manduca A, Ehman RL (2016) Hepatic MR elastography: clinical performance in a series of 1377 consecutive examinations. Radiology 278:114–124
Kim SU, Kim BK, Park JY et al (2016) Transient elastography is superior to FIB-4 in assessing the risk of hepatocellular carcinoma in patients with chronic hepatitis B. Medicine (Baltimore) 95:e3434
Motosugi U, Ichikawa T, Koshiishi T et al (2013) Liver stiffness measured by magnetic resonance elastography as a risk factor for hepatocellular carcinoma: a preliminary case-control study. Eur Radiol 23:156–162
Heimbach JK, Kulik LM, Finn RS et al (2018) AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 67:358–380
European Association for the Study of the Liver (2018) EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. https://doi.org/10.1016/j.jhep.2018.03.019
Rouviere O, Yin M, Dresner MA et al (2006) MR elastography of the liver: preliminary results. Radiology 240:440–448
Yin M, Talwalkar JA, Glaser KJ et al (2007) Assessment of hepatic fibrosis with magnetic resonance elastography. Clin Gastroenterol Hepatol 5:1207–1213.e2
Manduca A, Oliphant TE, Dresner MA et al (2001) Magnetic resonance elastography: non-invasive mapping of tissue elasticity. Med Image Anal 5:237–254
Talwalkar JA, Yin M, Venkatesh S et al (2009) Feasibility of in vivo MR elastographic splenic stiffness measurements in the assessment of portal hypertension. AJR Am J Roentgenol 193:122–127
Wang JH, Chuah SK, Lu SN et al (2014) Baseline and serial liver stiffness measurement in prediction of portal hypertension progression for patients with compensated cirrhosis. Liver Int 34:1340–1348
Coulon S, Heindryckx F, Geerts A, Van Steenkiste C, Colle I, Van Vlierberghe H (2011) Angiogenesis in chronic liver disease and its complications. Liver Int 31:146–162
Machado MV, Cortez-Pinto H (2015) Proangiogenic factors in the development of HCC in alcoholic cirrhosis. Clin Res Gastroenterol Hepatol 39(Suppl 1):S104–S108
Bartolomeo N, Trerotoli P, Serio G (2011) Progression of liver cirrhosis to HCC: an application of hidden Markov model. BMC Med Res Methodol 11:38
Guo J, Büning C, Schott E et al (2015) In vivo abdominal magnetic resonance elastography for the assessment of portal hypertension before and after transjugular intrahepatic portosystemic shunt implantation. Invest Radiol 50:347–351
Morisaka H, Motosugi U, Ichikawa S et al (2015) Association of splenic MR elastographic findings with gastroesophageal varices in patients with chronic liver disease. J Magn Reson Imaging 41:117–124
Asrani SK, Talwalkar JA, Kamath PS et al (2014) Role of magnetic resonance elastography in compensated and decompensated liver disease. J Hepatol 60:934–939
Takamura T, Motosugi U, Ichikawa S et al (2016) Usefulness of MR elastography for detecting clinical progression of cirrhosis from child-pugh class A to B in patients with type C viral hepatitis. J Magn Reson Imaging 44:715–722
Thompson SM, Wang J, Chandan VS et al (2017) MR elastography of hepatocellular carcinoma: correlation of tumor stiffness with histopathology features—preliminary findings. Magn Reson Imaging 37:41–45
Hennedige TP, Hallinan JT, Leung FP et al (2016) Comparison of magnetic resonance elastography and diffusion-weighted imaging for differentiating benign and malignant liver lesions. Eur Radiol 26:398–406
Gordic S, Ayache JB, Kennedy P et al (2017) Value of tumor stiffness measured with MR elastography for assessment of response of hepatocellular carcinoma to locoregional therapy. Abdom Radiol (NY) 42:1685–1694
Lee DH, Lee JM, Yi NJ et al (2017) Hepatic stiffness measurement by using MR elastography: prognostic values after hepatic resection for hepatocellular carcinoma. Eur Radiol 27:1713–1721
Crespo G, Castro-Narro G, García-Juárez I et al (2016) Usefulness of liver stiffness measurement during acute cellular rejection in liver transplantation. Liver Transpl 22:298–304
Anthony PP, Ishak KG, Nayak NC et al (1978) The morphology of cirrhosis. Recommendations on definition, nomenclature, and classification by a working group sponsored by the World Health Organization. J Clin Pathol 31:395–414
D'Amico G, Garcia-Tsao G, Pagliaro L (2006) Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 44:217–231
Shiratori Y, Imazeki F, Moriyama M et al (2000) Histologic improvement of fibrosis in patients with hepatitis C who have sustained response to interferon therapy. Ann Intern Med 132:517–524
Kim SU, Oh HJ, Wanless IR et al (2012) The Laennec staging system for histological sub-classification of cirrhosis is useful for stratification of prognosis in patients with liver cirrhosis. J Hepatol 57:556–563
Wang W, Li J, Pan R et al (2015) Association of the Laennec staging system with degree of cirrhosis, clinical stage and liver function. Hepatol Int 9:621–626
Kim SU, Kim JK, Park YN et al (2012) Discordance between liver biopsy and Fibroscan® in assessing liver fibrosis in chronic hepatitis b: risk factors and influence of necroinflammation. PLoS One 7:e32233
Krawczyk M, Ligocka J, Ligocki M et al (2017) Does transient elastography correlate with liver fibrosis in patients with PSC? Laennec score-based analysis of explanted livers. Scand J Gastroenterol 52:1407–1412
Yoshida H, Shiratori Y, Moriyama M et al (1999) Interferon therapy reduces the risk for hepatocellular carcinoma: national surveillance program of cirrhotic and noncirrhotic patients with chronic hepatitis C in Japan. IHIT Study Group. Inhibition of Hepatocarcinogenesis by Interferon Therapy. Ann Intern Med 131:174–181
Tran SA, Le A, Zhao C et al (2008) Rate of hepatocellular carcinoma surveillance remains low for a large, real-life cohort of patients with hepatitis C cirrhosis. BMJ Open Gastroenterol 5:e000192
Ichikawa S, Motosugi U, Nakazawa T et al (2015) Hepatitis activity should be considered a confounder of liver stiffness measured with MR elastography. J Magn Reson Imaging 41:1203–1208
Yoshimitsu K, Mitsufuji T, Shinagawa Y et al (2016) MR elastography of the liver at 3.0 T in diagnosing liver fibrosis grades; preliminary clinical experience. Eur Radiol 26:656–663
Shi Y, Guo Q, Xia F et al (2014) MR elastography for the assessment of hepatic fibrosis in patients with chronic hepatitis B infection: does histologic necroinflammation influence the measurement of hepatic stiffness? Radiology 273:88–98
Chhatwal J, Wang X, Ayer T et al (2016) Hepatitis C disease burden in the United States in the era of oral direct-acting antivirals. Hepatology 64:1442–1450
Alexopoulou A, Karayiannis P (2015) Interferon-based combination treatment for chronic hepatitis C in the era of direct acting antivirals. Ann Gastroenterol 28:55–65
Kanwal F, Kramer J, Asch SM, Chayanupatkul M, Cao Y, El-Serag HB (2017) Risk of hepatocellular cancer in HCV patients treated with direct acting antiviral agents. Gastroenterology 153:996–1005.e1
Ogata F, Kobayashi M, Akuta N et al (2017) Outcome of all-oral direct-acting antiviral regimens on the rate of development of hepatocellular carcinoma in patients with hepatitis C virus genotype 1-related chronic liver disease. Oncology 93:92–98
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The scientific guarantor of this publication is Hiroshi Onishi.
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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
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No complex statistical methods were necessary for this paper.
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Written informed consent was waived by the Institutional Review Board.
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Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in an earlier report (Ichikawa S, et al. J Magn Reson Imaging 2017;46(2):375-382.). Data of magnetic resonance elastography (MRE) for 42 patients in this study were included in the paper; however, the results for two MRE examinations for these patients have not been reported previously.
Methodology
• Retrospective
• Observational
• Performed at one institution
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Ichikawa, S., Motosugi, U., Enomoto, N. et al. Magnetic resonance elastography can predict development of hepatocellular carcinoma with longitudinally acquired two-point data. Eur Radiol 29, 1013–1021 (2019). https://doi.org/10.1007/s00330-018-5640-7
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DOI: https://doi.org/10.1007/s00330-018-5640-7