Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2017; 23(5): 859-868
Published online Feb 7, 2017. doi: 10.3748/wjg.v23.i5.859
Magnetic resonance elastography is accurate in detecting advanced fibrosis in autoimmune hepatitis
Jin Wang, Neera Malik, Meng Yin, Thomas C Smyrk, Albert J Czaja, Richard L Ehman, Sudhakar K Venkatesh
Jin Wang, Neera Malik, Meng Yin, Richard L Ehman, Sudhakar K Venkatesh, Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, United States
Jin Wang, Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
Thomas C Smyrk, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, United States
Albert J Czaja, Department of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Wang J, Malik N, and Venkatesh SK contributed equally to this work; Ehman RL and Venkatesh SK designed the research; Wang J, Malik N, Yin M, and Venkatesh SK performed the research; Smyrk TC analyzed the pathology samples; Venkatesh SK analyzed the data; Malik N, Venkatesh SK and Czaja AJ wrote the paper.
Supported by National Institutes of Health, No. EB001981 to Ehman RL and No. EB017197 to Yin M; and the National Natural Science Foundation of China, No. 81271562 to Wang J.
Institutional review board statement: This retrospective study was approved by the Institution Review Board.
Informed consent statement: Informed consent was waived by the institution review board for this retrospective review study.
Conflict-of-interest statement: Mayo Clinic, RLE and MY have intellectual property rights and a financial interest in MRE technology. Mayo clinic and RLE hold equity and RLE serve as CEO of Resoundant, Inc. None of the other authors have conflicts of interest of any specific financial interests relevant to the subject of this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sudhakar K Venkatesh, MD, FRCR, Professor, Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. venkatesh.sudhakar@mayo.edu
Telephone: +1-507-2841728 Fax: +1-507-2842405
Received: August 28, 2016
Peer-review started: September 1, 2016
First decision: October 20, 2016
Revised: November 20, 2016
Accepted: January 11, 2017
Article in press: January 11, 2017
Published online: February 7, 2017
Processing time: 146 Days and 22.9 Hours
Abstract
AIM

To assess the value of magnetic resonance elastography (MRE) in detecting advanced fibrosis/cirrhosis in autoimmune hepatitis (AIH).

METHODS

In this retrospective study, 36 patients (19 treated and 17 untreated) with histologically confirmed AIH and liver biopsy performed within 3 mo of MRE were identified at a tertiary care referral center. Liver stiffness (LS) with MRE was calculated by a radiologist, and inflammation grade and fibrosis stage in liver biopsy was assessed by a pathologist in a blinded fashion. Two radiologists evaluated morphological features of cirrhosis on conventional magnetic resonance imaging (MRI). Accuracy of MRE was compared to laboratory markers and MRI for detection of advanced fibrosis/cirrhosis.

RESULTS

Liver fibrosis stages of 0, 1, 2, 3 and 4 were present in 4, 6, 7, 6 and 13 patients respectively. There were no significant differences in distribution of fibrosis stage and inflammation grade between treated and untreated patient groups. LS with MRE demonstrated stronger correlation with liver fibrosis stage in comparison to laboratory markers for chronic liver disease (r = 0.88 vs -0.48-0.70). A trend of decreased mean LS in treated patients compared to untreated patients was observed (3.7 kPa vs 3.84 kPa) but was not statistically significant. MRE had an accuracy/sensitivity/specificity/positive predictive value/negative predictive value of 0.97/90%/100%/100%/90% and 0.98/92.3%/96%/92.3%/96% for detection of advanced fibrosis and cirrhosis, respectively. The performance of MRE was significantly better than laboratory tests for detection of advanced fibrosis (0.97 vs 0.53-0.80, P < 0.01), and cirrhosis (0.98 vs 0.58-0.80, P < 0.01) and better than conventional MRI for diagnosis of cirrhosis (0.98 vs 0.78, P = 0.002).

CONCLUSION

MRE is a promising modality for detection of advanced fibrosis and cirrhosis in patients with AIH with superior diagnostic accuracy compared to laboratory assessment and MRI.

Keywords: Autoimmune hepatitis; Advanced fibrosis; Magnetic resonance elastography; Liver stiffness; Cirrhosis

Core tip: Magnetic resonance elastography (MRE) provides a non-invasive imaging-based biomarker with excellent diagnostic accuracy for detecting advanced fibrosis and cirrhosis in patients with autoimmune hepatitis (AIH). The diagnostic performance of MRE is superior compared to conventional laboratory tests and morphology assessment with conventional magnetic resonance imaging. MRE may have utility in assessing disease progression during therapy, anticipating complications of cirrhosis, and evaluation of the risk of hepatocellular carcinoma in patients with AIH.