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Prediction of nonalcoholic fatty liver disease (NAFLD) activity score (NAS) with multiparametric hepatic magnetic resonance imaging and elastography

  • Magnetic Resonance
  • Published:
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Abstract

Objectives

To investigate the use of MR elastography (MRE)–derived mechanical properties (shear stiffness (|G*|) and loss modulus (G″)) and MRI-derived fat fraction (FF) to predict the nonalcoholic fatty liver disease (NAFLD) activity score (NAS) in a NAFLD mouse model.

Methods

Eighty-nine male mice were studied, including 64 training and 25 independent testing animals. An MRI/MRE exam and histologic evaluation were performed. Pairwise, nonparametric comparisons and multivariate analyses were used to evaluate the relationships between the three imaging parameters (FF, |G*|, and G″) and histologic features. A virtual NAS score (vNAS) was generated by combining three imaging parameters with an ordinal logistic model (OLM) and a generalized linear model (GLM). The prediction accuracy was evaluated by ROC analyses.

Results

The combination of FF, |G*|, and G″ predicted NAS > 1 with excellent accuracy in both training and testing sets (AUROC > 0.84). OLM and GLM predictive models misclassified 3/54 and 6/54 mice in the training, and 1/25 and 1/25 in the testing cohort respectively, in distinguishing between “not-NASH” and “definite-NASH.” “Borderline-NASH” prediction was poorer in the training set, and no borderline-NASH mice were available in the testing set.

Conclusion

This preliminary study shows that multiparametric MRI/MRE can be used to accurately predict the NAS score in a NAFLD animal model, representing a promising alternative to liver biopsy for assessing NASH severity and treatment response.

Key Points

• MRE-derived liver stiffness and loss modulus and MRI-assessed fat fraction can be used to predict NAFLD activity score (NAS) in our preclinical mouse model (AUROC > 0.84 for all NAS levels greater than 1).

• The overall agreement between the histological-determined NASH diagnosis and the imaging-predicted NASH diagnosis is 80–92%.

• The multiparametric hepatic MRI/MRE has great potential for noninvasively assessing liver disease severity and treatment efficacy.

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Abbreviations

AUROC:

Area under receiver operating characteristic curve

FF:

Fat fraction

FOV:

Field of view

GLM:

Generalized linear model

H&E:

Hematoxylin-eosin

IQR:

Interquartile range

MRE:

Magnetic resonance elastography

NAFLD:

Nonalcoholic fatty liver disease

NAS:

NAFLD activity score

NASH:

Nonalcoholic steatohepatitis

OLM:

Ordinal logistic model

ROC:

Receiver operating characteristic

ROI:

Region of interest

TE:

Echo time

TR:

Repetition time

vNAS:

Virtual NAS

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Funding

This work has been supported by National Institutes of Health (NIH) grants EB017197, EB001981, and DK111378.

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Correspondence to Meng Yin.

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Guarantor

The scientific guarantor of this publication is Richard L. Ehman, M.D., Department of Radiology, Mayo Clinic.

Conflict of interest

The Mayo Clinic and the authors of this manuscript have intellectual property and a financial interest related to this research.

This research has been reviewed by the Mayo Clinic Conflict of Interest Review Board and is being conducted in compliance with the Mayo Clinic Conflict of Interest policies.

Statistics and biometry

Two of the authors (Terry M. Therneau and Heshan Liu) are senior statisticians.

Informed consent

Written informed consent was not required for this study because this is an animal study.

Ethical approval

Institutional Review Board approval was obtained.

Approval from the institutional animal care committee was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have not been previously reported.

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• prospective

• experimental

• performed at one institution

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Yin, Z., Murphy, M.C., Li, J. et al. Prediction of nonalcoholic fatty liver disease (NAFLD) activity score (NAS) with multiparametric hepatic magnetic resonance imaging and elastography. Eur Radiol 29, 5823–5831 (2019). https://doi.org/10.1007/s00330-019-06076-0

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  • DOI: https://doi.org/10.1007/s00330-019-06076-0

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