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

Peter J Eddowes, Natasha McDonald, Nigel Davies, Scott IK Semple, T. J. Kendall, James Hodson, Phillip N Newsome, Robert Flintham, Roman Wesolowski, Laurence Blake, Rui V Duarte, Catherine J Kelly, Amy H Herlihy, Matthew D Kelly, Simon P Olliff, Stefan Hubscher, J. A. Fallowfield, Gideon M Hirschfield

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background: Validated diagnostic tools that are accurate, cost effective and acceptable to patients are required for disease stratification and monitoring in NAFLD. Aims: We investigated the performance and cost of multiparametric MRI alongside existing biomarkers in the assessment of NAFLD. Methods: 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. Results: Data were obtained in 50 patients and 6 healthy volunteers. Corrected T1 (cT1) correlated with NAFLD activity score (Rho=0.514, p<0.001). 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 £150,218.00 per 1000 patients compared to biopsy. Multiparametric MRI did not discriminate between individual histological fibrosis stages in this population (p=0.068). Conclusions: 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.
Original languageEnglish
JournalAlimentary Pharmacology and Therapeutics
Early online date22 Dec 2017
DOIs
Publication statusE-pub ahead of print - 22 Dec 2017

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