Liver stiffness measurement in patients with nodular regenerative hyperplasia undergoing magnetic resonance elastography

Application of the three-phase T1-derived model in staging liver fibrosis in chronic hepatitis: a comparative study with magnetic resonance elastography

OBJECTIVE

This study aims to evaluate the accuracy of a three-phase T1-derived model in staging liver fibrosis in patients with chronic hepatitis, in comparison with magnetic resonance elastography (MRE).

METHODS

A total of 174 patients with chronic hepatitis were enrolled. The acquisition of three-phase longitudinal relaxation times (T1-Unenh = A, T1-DLP = B, T1HBP = C) from magnetic resonance enhancement examinations, as well as magnetic resonance elastography (MRE) and liver biopsy information for patients.Binary logistic regression was employed to construct models ABC. The diagnostic performance of these models was evaluated using the receiver operating characteristic (ROC) curve and DeLong's test. Furthermore, the MRE and ABC models were subjected to a comprehensive analysis through 10-fold cross-validation.

RESULTS

In all liver fibrosis stages (≥ F1-≥F4), both MRE and the ABC model showed moderate correlation with METAVIR fibrosis staging, with significant differences between groups (all P < 0.05). The area under the curve (AUC) for each group of the ABC model was above 0.84. DeLong's test indicated that in the ≥ F2, ≥F3, and ≥ F4 groups, the ABC model was comparable to MRE (all P > 0.05). Ten-fold cross-validation further confirmed that only in the ≥ F3 group did the ABC model outperform MRE in terms of comprehensive performance.

CONCLUSION

This study successfully validated the effectiveness of the three-phase T1-derived model in staging liver fibrosis in patients with chronic hepatitis. In stages ≥ F2, ≥F3, and ≥ F4, it is comparable to MRE, especially showing superior application value in the ≥ F3 stage.

Diagnostic performance of transient elastography in differentiation between porto-sinusoidal vascular liver disease and compensated cirrhosis

BACKGROUND AND AIMS

The efficacy of transient elastography (TE) in the differential diagnosis between porto-sinusoidal vascular disease (PSVD) and compensated cirrhosis has not been sufficiently studied. We aimed to investigate the diagnostic performance of TE and identify histological lesions associated with liver stiffness.

METHODS

We conducted a retrospective cohort study including patients with PSVD and cirrhosis (Child-Turcotte-Pugh class A) and healthy subjects. Both the PSVD and cirrhotic patients had at least one sign of PH. The area under the receiver operating characteristic curve (AUROC) was used for differentiation.

RESULTS

Ninety-two patients with PSVD (median age: 53 years, 33% male), 100 patients with compensated cirrhosis and 101 healthy subjects were included. The median TE-LSM in the PSVD patients (10.0 [7.0-13.0] kPa) was significantly lower than that in the cirrhotic patients (21.0 [15.0-28.0] kPa, p < .001) but was significantly higher than that in the healthy subjects (5.1 [4.6-6.0] kPa, p < .001). The AUROCs of TE-LSM for the discrimination of PSVD from the cirrhosis and healthy subjects were 0.886 (95% CI: 0.833-0.928) and 0.913 (95% CI: 0.864-0.949), respectively. The sensitivity and specificity to discriminate PSVD from compensated cirrhosis were 78.3% and 82.0%, respectively, at a cut-off of 13.6 kPa. Furthermore, portal fibrosis and aberrant cytokeratin 7 expression of centrilobular hepatocytes were significantly associated with higher TE-LSM (≥10.0 kPa).

CONCLUSION

TE-LSM can be used to differentiate PSVD from compensated cirrhosis. Pathological features in association with increased liver stiffness are identified.

MR elastography of liver: current status and future perspectives

Non-invasive evaluation of liver fibrosis has evolved over the last couple of decades. Currently, elastography techniques are the most widely used non-invasive methods for clinical evaluation of chronic liver disease (CLD). MR elastography (MRE) of the liver has been used in the clinical practice for nearly a decade and continues to be widely accepted for detection and staging of liver fibrosis. With MRE, one can directly visualize propagating shear waves through the liver and an inversion algorithm in the scanner automatically converts the shear wave properties into an elastogram (stiffness map) on which liver stiffness can be calculated. The commonly used MRE method, two-dimensional gradient recalled echo (2D-GRE) sequence has produced excellent results in the evaluation of liver fibrosis in CLD from various etiologies and newer clinical indications continue to emerge. Advances in MRE technique, including 3D MRE, automated liver elasticity calculation, improvements in shear wave delivery and patient experience, are promising to provide a faster and more reliable MRE of liver. Innovations, including evaluation of mechanical parameters, such as loss modulus, displacement, and volumetric strain, are promising for comprehensive evaluation of CLD as well as understanding pathophysiology, and in differentiating various etiologies of CLD. In this review, the current status of the MRE of liver in CLD are outlined and followed by a brief description of advanced techniques and innovations in MRE of liver.