1
|
Moura Cunha G, Fan B, Navin PJ, Olivié D, Venkatesh SK, Ehman RL, Sirlin CB, Tang A. Interpretation, Reporting, and Clinical Applications of Liver MR Elastography. Radiology 2024; 310:e231220. [PMID: 38470236 PMCID: PMC10982829 DOI: 10.1148/radiol.231220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 03/13/2024]
Abstract
Chronic liver disease is highly prevalent and often leads to fibrosis or cirrhosis and complications such as liver failure and hepatocellular carcinoma. The diagnosis and staging of liver fibrosis is crucial to determine management and mitigate complications. Liver biopsy for histologic assessment has limitations such as sampling bias and high interreader variability that reduce precision, which is particularly challenging in longitudinal monitoring. MR elastography (MRE) is considered the most accurate noninvasive technique for diagnosing and staging liver fibrosis. In MRE, low-frequency vibrations are applied to the abdomen, and the propagation of shear waves through the liver is analyzed to measure liver stiffness, a biomarker for the detection and staging of liver fibrosis. As MRE has become more widely used in clinical care and research, different contexts of use have emerged. This review focuses on the latest developments in the use of MRE for the assessment of liver fibrosis; provides guidance for image acquisition and interpretation; summarizes diagnostic performance, along with thresholds for diagnosis and staging of liver fibrosis; discusses current and emerging clinical applications; and describes the latest technical developments.
Collapse
Affiliation(s)
- Guilherme Moura Cunha
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - Boyan Fan
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - Patrick J. Navin
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - Damien Olivié
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - Sudhakar K. Venkatesh
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - Richard L. Ehman
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - Claude B. Sirlin
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| | - An Tang
- From the Department of Radiology, University of Washington, Seattle,
Wash (G.M.C.); Department of Radiology, Université Laval, Québec,
Québec, Canada (B.F.); Department of Radiology, Mayo Clinic, Rochester,
Minn (P.J.N., S.K.V., R.L.E.); Department of Radiology, Centre Hospitalier de
l'Université de Montréal, 1058 Rue Saint-Denis,
Montréal, QC, Canada H2X 3J4 (D.O., A.T.); and Department of Radiology,
University of California San Diego, San Diego, Calif (C.B.S.)
| |
Collapse
|
2
|
Almutawakel S, Halleck F, Dürr M, Grittner U, Schrezenmeier E, Budde K, Althoff CE, Hamm B, Sack I, Fischer T, Marticorena Garcia SR. Shear Wave Elastography for Assessing Liver Stiffness in HCV-Infected Kidney Transplant Recipients after Direct-Acting Antiviral Treatment: A Comparative Study with Magnetic Resonance Elastography. J Clin Med 2023; 12:7547. [PMID: 38137615 PMCID: PMC10743898 DOI: 10.3390/jcm12247547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/22/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Hepatitis C virus (HCV) infection can lead to hepatic fibrosis. The advent of direct-acting antivirals (DAAs) has substantially improved sustained virological response (SVR) rates. In this context, kidney transplant recipients (KTRs) are of particular interest due to their higher HCV infection rates and uncertain renal excretion and bioavailability of DAAs. We investigated liver stiffness after DAA treatment in 15 HCV-infected KTRs using ultrasound shear wave elastography (SWE) in comparison with magnetic resonance elastography (MRE). KTRs were treated with DAAs (daclatasvir and sofosbuvir) for three months and underwent SWE at baseline, end of therapy (EOT), and 3 (EOT+3) and 12 months (EOT+12) after EOT. Fourteen patients achieved SVR12. Shear wave speed (SWS)-as a surrogate parameter for tissue stiffness-was substantially lower at all three post-therapeutic timepoints compared with baseline (EOT: -0.42 m/s, p < 0.01; CI = -0.75--0.09, EOT+3: -0.43 m/s, p < 0.01; CI = -0.75--0.11, and EOT+12: -0.52 m/s, p < 0.001; CI = -0.84--0.19), suggesting liver regeneration after viral eradication and end of inflammation. Baseline SWS correlated positively with histopathological fibrosis scores (r = 0.48; CI = -0.11-0.85). Longitudinal results correlated moderately with APRI (r = 0.41; CI = 0.12-0.64) but not with FIB-4 scores (r = 0.12; CI = -0.19-0.41). Although higher on average, SWE-derived measurements correlated strongly with MRE (r = 0.64). In conclusion, SWE is suitable for non-invasive therapy monitoring in KTRs with HCV infection.
Collapse
Affiliation(s)
- Salma Almutawakel
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (S.A.)
| | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Michael Dürr
- Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Eva Schrezenmeier
- Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Christian E. Althoff
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (S.A.)
| | - Bernd Hamm
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (S.A.)
| | - Ingolf Sack
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (S.A.)
| | - Thomas Fischer
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (S.A.)
| | - Stephan R. Marticorena Garcia
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany; (S.A.)
| |
Collapse
|
3
|
Liu L, Nie Y, Liu Q, Zhu X. A Practical Model for Predicting Esophageal Variceal Rebleeding in Patients with Hepatitis B-Associated Cirrhosis. Int J Clin Pract 2023; 2023:9701841. [PMID: 37576938 PMCID: PMC10415078 DOI: 10.1155/2023/9701841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/13/2023] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Background Variceal rebleeding is a significant and potentially life-threatening complication of cirrhosis. Unfortunately, currently, there is no reliable method for stratifying high-risk patients. Liver stiffness measurements (LSM) have been shown to have a predictive value in identifying complications associated with portal hypertension, including first-time bleeding. However, there is a lack of evidence to confirm that LSM is reliable in predicting variceal rebleeding. The objective of our study was to evaluate the ability of generating a extreme gradient boosting (XGBoost) algorithm model to improve the prediction of variceal rebleeding. Methods This retrospective analysis examined a cohort of 284 patients with hepatitis B-related cirrhosis. XGBoost models were developed using laboratory data, LSM, and imaging data to predict the risk of rebleeding in the patients. In addition, we compared the XGBoost models with traditional logistic regression (LR) models. We evaluated and compared the two models using the area under the receiver operating characteristic curve (AUROC) and other model performance parameters. Lastly, we validated the models using nomograms and decision curve analysis (DCA). Results During a median follow-up of 66.6 weeks, 72 patients experienced rebleeding, including 21 (7.39%) and 61 (21.48%) patients who rebleed within 6 weeks and 1 year, respectively. In brief, the AUC of the LR models in predicting rebleeding at 6 weeks and 1 year was 0.828 (0.759-0.897) and 0.799 (0.738-0.860), respectively. In contrast, the accuracy of the XGBoost model in predicting rebleeding at 6 weeks and 1 year was 0.985 (0.907-0.731) and 0.931 (0.806-0.935), respectively. LSM and high-density lipoprotein (HDL) levels differed significantly between the rebleeding and nonrebleeding groups, with LSM being a reliable predictor in those models. The XGBoost models outperformed the LR models in predicting rebleeding within 6 weeks and 1 year, as demonstrated by the ROC and DCA curves. Conclusion The XGBoost algorithm model can achieve higher accuracy than the LR model in predicting rebleeding, making it a clinically beneficial tool. This implies that the XGBoost model is better suited for predicting the risk of esophageal variceal rebleeding in patients.
Collapse
Affiliation(s)
- Linxiang Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi, China
| | - Yuan Nie
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi, China
| | - Qi Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi, China
| | - Xuan Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi, China
| |
Collapse
|
4
|
Liang J, Ampuero J, Castell J, Zhang Q, Zhang S, Chen Y, Romero-Gómez M. Clinical application of Magnetic resonance elastography in hepatocellular carcinoma: from diagnosis to prognosis. Ann Hepatol 2023; 28:100889. [PMID: 36572210 DOI: 10.1016/j.aohep.2022.100889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/26/2022] [Accepted: 11/29/2022] [Indexed: 12/31/2022]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a major public health problem worldwide. Liver fibrosis is closely correlated with liver functional reserve and the risk of HCC development. Meanwhile, malignant tumors generally have high cellularity compared to benign tumors, which results in increased stiffness. Magnetic resonance elastography (MRE) has emerged as a new non-invasive technique for assessing tissue stiffness with excellent diagnostic accuracy, not only for assessing liver fibrosis but also for measuring tumor stiffness. Recent studies provide new evidence that MRE may play an important role in the management of patients with HCC and show several novel clinical applications, such as predicting the development of HCC, differentiating between benign/malignant liver lesions (FLL) and HCC pathological grades, assessing treatment response, and predicting recurrence after treatment, although some findings are controversial. Therefore, we conducted this review to summarize these novel applications of MRE in HCC patients and also discuss their limitations and future advancement.
Collapse
Affiliation(s)
- Jiaxu Liang
- Department of Diagnostic Radiology, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's hospital), Zhengzhou, China; Digestive Diseases Unit, CIBEREHD, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (HUVR/CSIC/US), Seville, Spain, University of Seville, Seville, Spain
| | - Javier Ampuero
- Digestive Diseases Unit, CIBEREHD, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (HUVR/CSIC/US), Seville, Spain, University of Seville, Seville, Spain
| | - Javier Castell
- Department of Radiology, Virgen del Rocío University Hospital, Seville, Spain
| | - Qiong Zhang
- Department of Diagnostic Radiology, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's hospital), Zhengzhou, China
| | - Sijia Zhang
- Department of Diagnostic Radiology, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's hospital), Zhengzhou, China
| | - Yong Chen
- Department of Diagnostic Radiology, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's hospital), Zhengzhou, China
| | - Manuel Romero-Gómez
- Digestive Diseases Unit, CIBEREHD, Virgen del Rocío University Hospital, Seville, Spain; Institute of Biomedicine of Seville (HUVR/CSIC/US), Seville, Spain, University of Seville, Seville, Spain.
| |
Collapse
|
5
|
Chuaypen N, Siripongsakun S, Hiranrat P, Tanpowpong N, Avihingsanon A, Tangkijvanich P. Improvement of liver fibrosis, but not steatosis, after HCV eradication as assessment by MR-based imaging: Role of metabolic derangement and host genetic variants. PLoS One 2022; 17:e0269641. [PMID: 35696400 PMCID: PMC9191717 DOI: 10.1371/journal.pone.0269641] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/22/2022] [Indexed: 12/05/2022] Open
Abstract
Significant liver fibrosis regression occurs after hepatitis C virus (HCV) therapy. However, the impact of direct-acting antivirals (DAAs) on steatosis is less clear. This study was aimed at evaluating serial fibrosis and steatosis alterations in patients with HCV genotype 1, who achieved sustained virological response (SVR). We enrolled 55 HCV mono-infected and 28 HCV/HIV co-infected patients receiving elbasvir/grazoprevir from a clinical trial. Fibrosis and steatosis were assessed at baseline, follow-up week-24 (FUw24) and week-72 (FUw72) by magnetic resonance elastography (MRE) and proton density fat fraction (PDFF), respectively. Patatin-like phospholipase domain-containing protein 3 (PNPLA3) rs738409, transmembrane six superfamily member 2 (TM6SF2) rs58542926 and membrane bound O-acyltransferase domain-containing 7 (MBOAT7) rs641738 polymorphisms were determined by allelic discrimination. Overall, mean MRE decreased significantly from baseline to FUw24 and FUw72. At FUw72, patients with baseline F2-F4 had higher rate of ≥30% MRE decline compared with individuals with baseline F0-F1 (30.2%vs.3.3%, P = 0.004). In multivariate analysis, significant fibrosis was associated with MRE reduction. The prevalence of steatosis (PDFF≥5.2%) at baseline was 21.7%. Compared to baseline, there were 17 (20.5%) patients with decreased PDFF values at FUw72 (<30%), while 23 (27.7%) patients had increased PDFF values (≥30%). Regarding the overall cohort, mean PDFF significantly increased from baseline to FUw72, and displayed positive correlation with body mass index (BMI) alteration. In multivariate analysis, the presence of diabetes, PNPLA3 CG+GG genotypes and increased BMI at FUw72 were significantly associated with progressive steatosis after SVR. Other genetic variants were not related to fibrosis and steatosis alteration. This study concluded that HCV eradication was associated with fibrosis improvement. However, progressive steatosis was observed in a proportion of patients, particularly among individuals with metabolic derangement and PNPLA3 variants. The combined clinical parameters and host genetic factors might allow a better individualized strategy in this sub-group of patients to alleviate progressive steatosis after HCV cure.
Collapse
Affiliation(s)
- Natthaya Chuaypen
- Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Surachate Siripongsakun
- Sonographer School, Faculty of Health Science Technology, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Pantajaree Hiranrat
- Sonographer School, Faculty of Health Science Technology, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Natthaporn Tanpowpong
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anchalee Avihingsanon
- The HIV Netherlands Australia Thailand Research Collaboration (HIV NAT), Bangkok, Thailand
| | - Pisit Tangkijvanich
- Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
| |
Collapse
|
6
|
Tamaki N, Kurosaki M, Yasui Y, Mori N, Tsuji K, Hasebe C, Joko K, Akahane T, Furuta K, Kobashi H, Kimura H, Yagisawa H, Marusawa H, Kondo M, Kojima Y, Yoshida H, Uchida Y, Tada T, Nakamura S, Yasuda S, Toyoda H, Loomba R, Izumi N. Hepatocellular Carcinoma Risk Assessment for Patients With Advanced Fibrosis After Eradication of Hepatitis C Virus. Hepatol Commun 2022; 6:461-472. [PMID: 34676692 PMCID: PMC8870028 DOI: 10.1002/hep4.1833] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The identification of patients with advanced fibrosis who do not need any further hepatocellular carcinoma (HCC) surveillance after the eradication of hepatitis C is pivotal. In this study, we developed a simple serum-based risk model that could identify patients with low-risk HCC. This was a nationwide multicenter study involving 16 Hospitals in Japan. Patients with advanced fibrosis (1,325 in a derivation cohort and 508 in a validation cohort) who achieved sustained virological responses at 24 weeks after treatment (SVR24) were enrolled. The HCC risk model at any point after SVR24 and its change were evaluated, and subsequent HCC development was analyzed. Based on the multivariable analysis, patients fulfilling all of the factors (GAF4 criteria: gamma-glutamyl transferase < 28 IU/L, alpha-fetoprotein < 4.0 ng/mL, and Fibrosis-4 Index < 4.28) were classified as low-risk and others were classified as high-risk. When patients were stratified at the SVR24, and 1 year, and 2 years after SVR24, subsequent HCC development was significantly lower in low-risk patients (0.5-1.1 per 100 person-years in the derivation cohort and 0.9-1.1 per 100 person-years in the validation cohort) than in high-risk patients at each point. HCC risk from 1 year after SVR24 decreased in patients whose risk improved from high-risk to low-risk (HCC incidence: 0.6 per 100 person-years [hazard ratio (HR) = 0.163 in the derivation cohort] and 1.3 per 100 person-years [HR = 0.239 in the validation cohort]) than in those with sustained high risk. Conclusion: The HCC risk model based on simple serum markers at any point after SVR and its change can identify patients with advanced fibrosis who are at low HCC risk, and these patients may be able to reduce HCC surveillance.
Collapse
Affiliation(s)
- Nobuharu Tamaki
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan.,NAFLD Research CenterDivision of Gastroenterology and HepatologyDepartment of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Masayuki Kurosaki
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Yutaka Yasui
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| | - Nami Mori
- Department of GastroenterologyHiroshima Red Cross Hospital and Atomic-bomb Survivors HospitalHiroshimaJapan
| | - Keiji Tsuji
- Department of GastroenterologyHiroshima Red Cross Hospital and Atomic-bomb Survivors HospitalHiroshimaJapan
| | - Chitomi Hasebe
- Department of GastroenterologyJapanese Red Cross Asahikawa HospitalAsahikawaHokkaidoJapan
| | - Kouji Joko
- Center for Liver-Biliary-Pancreatic DiseaseMatsuyama Red Cross HospitalMatsuyamaEhimeJapan
| | - Takehiro Akahane
- Department of GastroenterologyJapanese Red Cross Ishinomaki HospitalIshinomakiMiyagiJapan
| | - Koichiro Furuta
- Department of GastroenterologyMasuda Red Cross HospitalMasudaShimaneJapan
| | - Haruhiko Kobashi
- Department of GastroenterologyJapanese Red Cross Okayama HospitalOkayamaOkayamaJapan
| | - Hiroyuki Kimura
- Department of GastroenterologyJapanese Red Cross Kyoto Daiichi HospitalKyotoJapan
| | - Hitoshi Yagisawa
- Department of GastroenterologyJapanese Red Cross Akita HospitalAkitaJapan
| | - Hiroyuki Marusawa
- Department of Gastroenterology and HepatologyOsaka Red Cross HospitalOsakaJapan
| | - Masahiko Kondo
- Department of GastroenterologyJapanese Red Cross Otsu HospitalOtsuShigaJapan
| | - Yuji Kojima
- Department of HepatologyJapanese Red Cross Ise HospitalIseMieJapan
| | - Hideo Yoshida
- Department of GastroenterologyJapanese Red Cross Medical CenterTokyoJapan
| | - Yasushi Uchida
- Department of GastroenterologyMatsue Red Cross HospitalMatsueShimaneJapan
| | - Toshifumi Tada
- Department of Internal MedicineJapanese Red Cross Society Himeji HospitalHimejiJapan
| | - Shinichiro Nakamura
- Department of Internal MedicineJapanese Red Cross Society Himeji HospitalHimejiJapan
| | - Satoshi Yasuda
- Department of Gastroenterology and HepatologyOgaki Municipal HospitalOgakiJapan
| | - Hidenori Toyoda
- Department of Gastroenterology and HepatologyOgaki Municipal HospitalOgakiJapan
| | - Rohit Loomba
- NAFLD Research CenterDivision of Gastroenterology and HepatologyDepartment of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Namiki Izumi
- Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
| |
Collapse
|
7
|
Magnetic resonance elastography of the liver: everything you need to know to get started. Abdom Radiol (NY) 2022; 47:94-114. [PMID: 34725719 DOI: 10.1007/s00261-021-03324-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022]
Abstract
Magnetic resonance elastography (MRE) of the liver has emerged as the non-invasive standard for the evaluation of liver fibrosis in chronic liver diseases (CLDs). The utility of MRE in the evaluation of different CLD in both adults and children has been demonstrated in several studies, and MRE has been recommended by several clinical societies. Consequently, the clinical indications for evaluation of CLD with MRE have increased, and MRE is currently used as an add-on test during routine liver MRI studies or as a standalone test. To meet the increasing clinical demand, MRE is being installed in many academic and private practice imaging centers. There is a need for a comprehensive practical guide to help these practices to deliver high-quality liver MRE studies as well as troubleshoot the common issues with MRE to ensure smooth running of the service. This comprehensive clinical practice review summarizes the indications and provides an overview on why to use MRE, technical requirements, system set-up, patient preparation, acquiring the data, and interpretation.
Collapse
|