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

  • Magnetic Resonance
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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.


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.


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.


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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Area under receiver operating characteristic curve


Fat fraction


Field of view


Generalized linear model




Interquartile range


Magnetic resonance elastography


Nonalcoholic fatty liver disease


NAFLD activity score


Nonalcoholic steatohepatitis


Ordinal logistic model


Receiver operating characteristic


Region of interest


Echo time


Repetition time


Virtual NAS


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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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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.

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

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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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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).

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