Utility and cost evaluation of multiparametric magnetic resonance imaging for the assessment of non-alcoholic fatty liver disease



Eddowes, PJ, McDonald, N, Davies, N, Semple, SIK, Kendall, TJ, Hodson, J, Newsome, PN, Flintham, RB, Wesolowski, R, Blake, L
et al (show 8 more authors) (2018) Utility and cost evaluation of multiparametric magnetic resonance imaging for the assessment of non-alcoholic fatty liver disease. ALIMENTARY PHARMACOLOGY & THERAPEUTICS, 47 (5). pp. 631-644.

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Abstract

<h4>Background</h4>Validated diagnostic tools that are accurate, cost effective and acceptable to patients are required for disease stratification and monitoring in NAFLD.<h4>Aims</h4>To investigate the performance and cost of multiparametric MRI alongside existing biomarkers in the assessment of NAFLD.<h4>Methods</h4>Adult patients undergoing standard of care liver biopsy for NAFLD were prospectively recruited at two UK liver centres and underwent multiparametric MRI, blood sampling and transient elastography withing 2 weeks of liver biopsy. Non-invasive markers were compared to histology as the gold standard.<h4>Results</h4>Data were obtained in 50 patients and 6 healthy volunteers. Corrected T1 (cT1) correlated with NAFLD activity score (ρ = 0.514, P < .001). cT1, enhanced liver fibrosis (ELF) test and liver stiffness differentiated patients with simple steatosis and NASH with AUROC (95% CI) of 0.69 (0.50-0.88), 0.87 (0.77-0.79) and 0.82 (0.70-0.94) respectively and healthy volunteers from patients with AUROC (95% CI) of 0.93 (0.86-1.00), 0.81 (0.69-0.92) and 0.89 (0.77-1.00) respectively. For the risk stratification of NAFLD, multiparametric MRI could save £150,218 per 1000 patients compared to biopsy. Multiparametric MRI did not discriminate between individual histological fibrosis stages in this population (P = .068).<h4>Conclusions</h4>Multiparametric MRI accurately identified patients with steatosis, stratifies those with NASH or simple steatosis and reliably excludes clinically significant liver disease with superior negative predictive value (83.3%) to liver stiffness (42.9%) and ELF (57.1%). For the risk stratification of NAFLD, multiparametric MRI was cost effective and, combined with transient elastography, had the lowest cost per correct diagnosis.

Item Type: Article
Uncontrolled Keywords: Liver, Humans, Liver Cirrhosis, Magnetic Resonance Imaging, Biopsy, Predictive Value of Tests, Adolescent, Adult, Aged, Middle Aged, Cost-Benefit Analysis, Female, Male, Elasticity Imaging Techniques, Young Adult, Healthy Volunteers, Non-alcoholic Fatty Liver Disease
Depositing User: Symplectic Admin
Date Deposited: 31 Jan 2019 11:58
Last Modified: 19 Jan 2023 06:46
DOI: 10.1111/apt.14469
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3015719