The role of 3D‐MRE in the diagnosis of NASH in obese patients undergoing bariatric surgery

Abstract

The lack of reliable, noninvasive methods to diagnose early nonalcoholic steatohepatitis (NASH) is a major unmet need. We aimed to determine the diagnostic accuracy of 3D‐MRE, with shear stiffness measured at 60 Hz, damping ratio at 40 Hz, and MRI proton density fat fraction (MRI‐PDFF) in the detection of NASH in individuals undergoing bariatric surgery. Obese adults at risk for NASH were enrolled between 2015‐2017 (prospective cohort, n=88) and 2010‐2013 (retrospective cohort, n=87). The imaging protocol consisted of multifrequency 3D‐MRE (mf3D‐MRE) with shear waves delivered at different frequencies to explore parameters that best correlated with histologic NASH; and MRI‐PDFF to estimate steatosis. The prospective cohort was used to establish the optimal mf3D‐MRE technical parameters for NASH detection. The 2 cohorts were then combined to derive predictive models of NASH and disease activity by NAFLD activity score (NAS) using the 3 imaging parameters that correlated with NASH. A total of 175 patients, median age 45, 81% women, and 81 (46%) with histologic NASH were used for model derivation. From the complex shear modulus output generated by mf3D‐MRE, the damping ratio at 40Hz and shear stiffness at 60Hz best correlated with NASH. The fat fraction obtained from MRI‐PDFF correlated with steatosis (p<0.05 for all). These 3 parameters were fit into a logistic regression model which predicted NASH with cross‐validated AUROC=0.73, sensitivity=0.67, specificity= 0.80, PPV= 0.73 and NPV=0.74 and disease activity by NAS with cross‐validated AUROC=0.82.

Conclusion

Multifrequency 3D‐MRE allows identification of novel imaging parameters that predict early NASH and disease activity. This imaging biomarker represents a promising alternative to liver biopsy for NASH diagnosis and monitoring. The results provide motivation for further studies in non‐bariatric cohorts.

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