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European Radiology
Published in: European Radiology 1/2014

01-01-2014 | Magnetic Resonance

Magnetic resonance elastography for the detection and staging of liver fibrosis in chronic hepatitis B

Authors: Sudhakar Kundapur Venkatesh, Gang Wang, Seng Gee Lim, Aileen Wee

Published in: European Radiology | Issue 1/2014

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Abstract

Objectives

We measured the accuracy of magnetic resonance elastography (MRE) for the detection and staging of liver fibrosis in chronic hepatitis B (CHB) and compared it with serum fibrosis markers.

Methods

Prospective comparison of MRE and routine serum fibrosis markers, namely serum alanine aminotransferase (ALT), serum aspartate aminotransferase (AST), ALT/AST ratio (AAR), AST to platelet ratio index (APRI) and prothrombin index (PI), was performed in 63 consecutive CHB patients who underwent MRE and histological confirmation of liver fibrosis within a 6-month interval. Diagnostic performance of MRE and serum markers for staging fibrosis (≥F1), significant fibrosis (≥F2), advanced fibrosis (≥F3) and cirrhosis (F4) was compared.

Results

The study group comprised 63 patients (19 female; mean age ± SD, 50 ± 11.9 years). MRE (ρ = 0.94, P < 0.0001), APRI (ρ = 0.42, P = 0.0006), PI (ρ = 0.42, P = 0.0006) and AST (ρ = 0.28, P = 0.028) results correlated significantly with fibrosis stage. MRE was significantly more accurate than serum fibrosis markers for the detection of significant fibrosis (0.99 vs. 0.55–0.73) and cirrhosis (0.98 vs. 0.53–0.77). Sensitivity, specificity, positive predictive and negative predictive values for MRE for significant fibrosis and cirrhosis were 97.4 %, 100 %, 100 % and 96 %, and 100 %, 95.2 %, 91.3 % and 100 %, respectively.

Conclusion

MRE is an accurate non-invasive technique for the detection and staging of liver fibrosis in CHB.

Key Points

• Magnetic resonance elastography is accurate for liver fibrosis detection and staging.
• MR elastography is more accurate than serum tests for staging liver fibrosis.
• MR elastography can potentially replace liver biopsy in chronic hepatitis B.
Literature
1.
Liver EAFTSOT (2012) EASL clinical practice guidelines: management of chronic hepatitis B virus infection. J Hepatol 57:167–185
2.
3.
McMahon BJ (2004) The natural history of chronic hepatitis B virus infection. Semin Liver Dis 24:17–21PubMedCrossRef
4.
Hadziyannis SJ, Papatheodoridis GV (2006) Hepatitis B e antigen-negative chronic hepatitis B: natural history and treatment. Semin Liver Dis 26:130–141PubMedCrossRef
5.
Fattovich G, Olivari N, Pasino M, D'Onofrio M, Martone E, Donato F (2008) Long-term outcome of chronic hepatitis B in Caucasian patients: mortality after 25 years. Gut 57:84–90PubMedCrossRef
6.
Fattovich G, Stroffolini T, Zagni I, Donato F (2004) Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology 127:S35–S50PubMedCrossRef
7.
Bosch FX, Ribes J, Cléries R, Díaz M (2005) Epidemiology of hepatocellular carcinoma. Clin Liver Dis 9:191–211PubMedCrossRef
8.
9.
Dienstag JL, Goldin RD, Heathcote EJ et al (2003) Histological outcome during long-term lamivudine therapy. Gastroenterology 124:105–117PubMedCrossRef
10.
Marcellin P, Chang TT, Lim SG et al (2008) Long-term efficacy and safety of adefovir dipivoxil for the treatment of hepatitis B e antigen-positive chronic hepatitis B. Hepatology 48:750–758PubMedCrossRef
11.
Chang TT, Liaw YF, Wu SS et al (2010) Long-term entecavir therapy results in the reversal of fibrosis/cirrhosis and continued histological improvement in patients with chronic hepatitis B. Hepatology 52:886–893PubMedCrossRef
12.
Liver EAFTSOT (2009) EASL clinical practice guidelines: management of chronic hepatitis B. J Hepatol 50:227–242CrossRef
13.
Castéra L, Nègre I, Samii K, Buffet C (1999) Pain experienced during percutaneous liver biopsy. Hepatology 30:1529–1530PubMedCrossRef
14.
Castera L (2011) Invasive and non-invasive methods for the assessment of fibrosis and disease progression in chronic liver disease. Best Pract Res Clin Gastroenterol 25:291–303PubMedCrossRef
15.
Piccinino F, Sagnelli E, Pasquale G, Giusti G (1986) Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol 2:165–173PubMedCrossRef
16.
17.
Cadranel JF, Rufat P, Degos F (2000) Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). Hepatology 32:477–481PubMedCrossRef
18.
Regev A, Berho M, Jeffers L et al (2002) Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 97:2614–2618PubMedCrossRef
19.
Maharaj B, Maharaj R, Leary W et al (1986) Sampling variability and its influence on the diagnostic yield of percutaneous needle biopsy of the liver. Lancet 1:523–525PubMedCrossRef
20.
Wai CT, Greenson JK, Fontana RJ et al (2003) A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 38:518–526PubMedCrossRef
21.
Castera L (2012) Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology 142:1293–1302, e1294PubMedCrossRef
22.
23.
Halfon P, Bacq Y, De Muret A et al (2007) Comparison of test performance profile for blood tests of liver fibrosis in chronic hepatitis C. J Hepatol 46:395–402PubMedCrossRef
24.
Chan HL, Wong GL, Choi PC et al (2009) Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B. J Viral Hepat 16:36–44PubMedCrossRef
25.
Wong GL, Wong VW, Choi PC et al (2008) Assessment of fibrosis by transient elastography compared with liver biopsy and morphometry in chronic liver diseases. Clin Gastroenterol Hepatol 6:1027–1035PubMedCrossRef
26.
Castéra L, Foucher J, Bernard PH et al (2010) Pitfalls of liver stiffness measurement: a 5-year prospective study of 13,369 examinations. Hepatology 51:828–835PubMed
27.
Friedrich-Rust M, Nierhoff J, Lupsor M et al (2012) Performance of acoustic radiation force impulse imaging for the staging of liver fibrosis: a pooled meta-analysis. J Viral Hepat 19:e212–e219PubMedCrossRef
28.
Sporea I, Sirli R, Popescu A, Danilă M (2010) Acoustic radiation force impulse (ARFI)–a new modality for the evaluation of liver fibrosis. Med Ultrason 12:26–31PubMed
29.
Yin M, Talwalkar JA, Glaser KJ et al (2007) Assessment of hepatic fibrosis with magnetic resonance elastography. Clin Gastroenterol Hepatol 5:1207–1213, e1202PubMedCentralPubMedCrossRef
30.
Huwart L, Sempoux C, Salameh N et al (2007) Liver fibrosis: noninvasive assessment with MR elastography versus aspartate aminotransferase-to-platelet ratio index. Radiology 245:458–466PubMedCrossRef
31.
Huwart L, Sempoux C, Vicaut E et al (2008) Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterology 135:32–40PubMedCrossRef
32.
Rustogi R, Horowitz J, Harmath C et al (2012) Accuracy of MR elastography and anatomic MR imaging features in the diagnosis of severe hepatic fibrosis and cirrhosis. J Magn Reson Imaging 35:1356–1364PubMedCentralPubMedCrossRef
33.
Wang Y, Ganger DR, Levitsky J et al (2011) Assessment of chronic hepatitis and fibrosis: comparison of MR elastography and diffusion-weighted imaging. AJR Am J Roentgenol 196:553–561PubMedCentralPubMedCrossRef
34.
Godfrey EM, Patterson AJ, Priest AN et al (2012) A comparison of MR elastography and 31P MR spectroscopy with histological staging of liver fibrosis. Eur Radiol 22:2790–2797PubMedCrossRef
35.
Wang QB, Zhu H, Liu HL, Zhang B (2012) Performance of magnetic resonance elastography and diffusion-weighted imaging for the staging of hepatic fibrosis: a meta-analysis. Hepatology 56:239–247PubMedCrossRef
36.
Kim BH, Lee JM, Lee YJ et al (2011) MR elastography for noninvasive assessment of hepatic fibrosis: experience from a tertiary center in Asia. J Magn Reson Imaging 34:1110–1116PubMedCrossRef
37.
Ichikawa S, Motosugi U, Ichikawa T et al (2012) Magnetic resonance elastography for staging liver fibrosis in chronic hepatitis C. Magn Reson Med Sci 11:291–297PubMedCrossRef
38.
Chen J, Talwalkar JA, Yin M, Glaser KJ, Sanderson SO, Ehman RL (2011) Early detection of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease by using MR elastography. Radiology 259:749–756PubMedCentralPubMedCrossRef
39.
Vizzotto L, Vertemati M, Gambacorta M, Sabatella G, Goffredi M, Minola E (2005) Computerized morphometry in liver cirrhosis: histological and immunohistochemical properties. In: Liver cirrhosis: new research. Nova Science, New York, p 97–112
40.
Yano M, Kumada H, Kage M et al (1996) The long-term pathological evolution of chronic hepatitis C. Hepatology 23:1334–1340PubMedCrossRef
41.
Kage M, Shimamatu K, Nakashima E, Kojiro M, Inoue O, Yano M (1997) Long-term evolution of fibrosis from chronic hepatitis to cirrhosis in patients with hepatitis C: morphometric analysis of repeated biopsies. Hepatology 25:1028–1031PubMedCrossRef
42.
Marcellin P, Ziol M, Bedossa P et al (2009) Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B. Liver Int 29:242–247PubMedCrossRef
43.
Vizzotto L, Vertemati M, Gambacorta M, Sabatella G, Spina V, Minola E (2002) Analysis of histological and immunohistochemical patterns of the liver in posthepatitic and alcoholic cirrhosis by computerized morphometry. Mod Pathol 15:798–806PubMedCrossRef
44.
Bensamoun SF, Leclerc GE, Debernard L et al (2013) Cutoff values for alcoholic liver fibrosis using magnetic resonance elastography technique. Alcohol Clin Exp Res 37:811–817PubMedCrossRef
45.
Kim D, Kim WR, Talwalkar JA, Kim HJ, Ehman RL (2013) Advanced fibrosis in nonalcoholic fatty liver disease: noninvasive assessment with MR elastography. Radiology. doi:10.​1148/​radiol.​13121193
46.
Bohte AE, van Dussen L, Akkerman EM et al (2013) Liver fibrosis in type I Gaucher disease: magnetic resonance imaging, transient elastography and parameters of iron storage. PLoS One 8:e57507PubMedCentralPubMedCrossRef
47.
Venkatesh SK, Yin M, Ehman RL (2013) Magnetic resonance elastography of liver: technique, analysis, and clinical applications. J Magn Res Imaging 37:544–555CrossRef
48.
Bedossa P, Poynard T (1996) An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 24:289–293PubMedCrossRef
49.
Motosugi U, Ichikawa T, Sano K et al (2010) Magnetic resonance elastography of the liver: preliminary results and estimation of inter-rater reliability. Jpn J Radiol 28:623–627PubMedCrossRef
50.
Hines CDG, Bley TA, Lindstrom MJ, Reeder SB (2010) Repeatability of magnetic resonance elastography for quantification of hepatic stiffness. J Magn Res Imaging 31:725–731CrossRef
51.
Shire NJ, Yin M, Chen J et al (2011) Test-retest repeatability of MR elastography for noninvasive liver fibrosis assessment in hepatitis C. J Magn Reson Imaging 34:947–955PubMedCentralPubMedCrossRef
52.
Fraquelli M, Rigamonti C, Casazza G et al (2011) Etiology-related determinants of liver stiffness values in chronic viral hepatitis B or C. J Hepatol 54:621–628PubMedCrossRef
53.
Myers RP, Crotty P, Pomier-Layrargues G, Ma M, Urbanski SJ, Elkashab M (2010) Prevalence, risk factors and causes of discordance in fibrosis staging by transient elastography and liver biopsy. Liver Int 30:1471–1480PubMedCrossRef
54.
Poynard T, Halfon P, Castera L et al (2007) Standardization of ROC curve areas for diagnostic evaluation of liver fibrosis markers based on prevalences of fibrosis stages. Clin Chem 53:1615–1622PubMedCrossRef
55.
Asbach P, Klatt D, Hamhaber U et al (2008) Assessment of liver viscoelasticity using multifrequency MR elastography. Magn Reson Med 60:373–379PubMedCrossRef
56.
Mariappan YK, Venkatesh SK, Glaser KJ, McGee KP, Ehman RL (2013) MR elastography of liver with iron overload: development, evaluation and preliminary clinical experience with improved spin echo and spin echo EPI sequences. Proceedings of the 21st annual meeting of ISMRM, Salt Lake City, 2012 (abstract 985)
Metadata
Title
Magnetic resonance elastography for the detection and staging of liver fibrosis in chronic hepatitis B
Authors
Sudhakar Kundapur Venkatesh
Gang Wang
Seng Gee Lim
Aileen Wee
Publication date
01-01-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 1/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-013-2978-8

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