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Cited by 212Liver Disease Diagnosis and TreatmentAdvanced MRI Techniques and ApplicationsLiver Disease and Transplantation

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Multiparametric magnetic resonance imaging predicts clinical outcomes in patients with chronic liver disease

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Pavlides, Michael, Banerjee, Rajarshi, Sellwood, Joanne, Kelly, Catherine J., Robson, Matthew D., Booth, Jonathan C., Collier, Jane, Neubauer, Stefan, Barnes, Eleanor·2016·Journal of Hepatology
DOI 10.1016/j.jhep.2015.10.009PMC PMC4751288
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Abstract

BACKGROUND & AIMS: Multiparametric magnetic resonance (MR) imaging has been demonstrated to quantify hepatic fibrosis, iron, and steatosis. The aim of this study was to determine if MR can be used to predict negative clinical outcomes in liver disease patients. METHODS: Patients with chronic liver disease (n=112) were recruited for MR imaging and data on the development of liver related clinical events were collected by medical records review. The median follow-up was 27months. MR data were analysed blinded for the Liver Inflammation and Fibrosis score (LIF; <1, 1-1.99, 2-2.99, and ⩾3 representing normal, mild, moderate, and severe liver disease, respectively), T2∗ for liver iron content and proportion of liver fat. Baseline liver biopsy was performed in 102 patients. RESULTS: Liver disease aetiologies included non-alcoholic fatty liver disease (35%) and chronic viral hepatitis (30%). Histologically, fibrosis was mild in 54 (48%), moderate in 17 (15%), and severe in 31 (28%) patients. Overall mortality was 5%. Ten patients (11%) developed at least one liver related clinical event. The negative predictive value of LIF<2 was 100%. Two patients with LIF 2-2.99 and eight with LIF⩾3 had a clinical event. Patients with LIF⩾3 had a higher cumulative risk for developing clinical events, compared to those with LIF<1 (p=0.02) and LIF 1-1.99 (p=0.03). Cox regression analysis including all 3 variables (fat, iron, LIF) resulted in an enhanced LIF predictive value. CONCLUSIONS: Non-invasive standardised multiparametric MR technology may be used to predict clinical outcomes in patients with chronic liver disease.

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Crossref · 10.1016/j.jhep.2015.10.009

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Graphical abstract CC BY · PubMed Central
Fig. 1 Study flow chart. The Liver Inflammation and Fibrosis (LIF) score is a standardised continuous score (0–4) derived from liver T1 and T2∗ values. T1 primarily reflects the amount of extracellular fluid and can change with inflammation and fibrosis and T2∗ primarily reflects the amount of iron deposition. Liver iron has a confounding effect on T1, and this is accounted for in the LIF score calculation. ∗Liver iron concentration from T2∗ maps and hence LIF calculation was not possible in 4 cases. MR, magnetic resonance; 1H-MRS: proton (1H) magnetic resonance spectroscopy; LIF, Liver Inflammation and Fibrosis score.
Fig. 1 Study flow chart. The Liver Inflammation and Fibrosis (LIF) score is a standardised continuous score (0–4) derived from liver T1 and T2∗ values. T1 primarily reflects the amount of extracellular fluid and can change with inflammation and fibrosis and T2∗ primarily reflects the amount of iron deposition. Liver iron has a confounding effect on T1, and this is accounted for in the LIF score calculation. ∗Liver iron concentration from T2∗ maps and hence LIF calculation was not possible in 4 cases. MR, magnetic resonance; 1H-MRS: proton (1H) magnetic resonance spectroscopy; LIF, Liver Inflammation and Fibrosis score.CC BY · PubMed Central
Fig. 2 Examples of LiverMultiScan MR data. Representative images from patients in each Liver Inflammation and Fibrosis (LIF) severity category, produced by analysis of the raw data using LiverMultiScan. LIF was measured in operator chosen regions of interest in the right liver lobe, in the liver parenchyma, away from vascular and biliary structures. The LIF scores measured for each image in this figure are indicated under each image. The predefined colour scale used to generate these maps is also included. LIF, Liver Inflammation and Fibrosis score. (This figure appears in colour on the web.)
Fig. 2 Examples of LiverMultiScan MR data. Representative images from patients in each Liver Inflammation and Fibrosis (LIF) severity category, produced by analysis of the raw data using LiverMultiScan. LIF was measured in operator chosen regions of interest in the right liver lobe, in the liver parenchyma, away from vascular and biliary structures. The LIF scores measured for each image in this figure are indicated under each image. The predefined colour scale used to generate these maps is also included. LIF, Liver Inflammation and Fibrosis score. (This figure appears in colour on the web.)CC BY · PubMed Central
Fig. 3 Kaplan–Meier curves for liver related event free survival with patients stratified according to Liver Inflammation and Fibrosis scores. In the entire cohort, (A) there were significant differences between those with Liver Inflammation and Fibrosis (LIF) ⩾3 vs. LIF <1 (p = 0.02) and vs. LIF 1–1.99 (p = 0.003). There was a strong trend towards significance between LIF 2–2.99 vs. LIF 1–1.99 (p = 0.054). Including only compensated patients at baseline, (B) there was a significant difference between LIF ⩾ 3 vs. LIF 1–1.99 (p = 0.023) and a strong trend towards significance between LIF 2–2.99 vs. LIF 1–1.99 (p = 0.058). (This figure appears in colour on the web.)
Fig. 3 Kaplan–Meier curves for liver related event free survival with patients stratified according to Liver Inflammation and Fibrosis scores. In the entire cohort, (A) there were significant differences between those with Liver Inflammation and Fibrosis (LIF) ⩾3 vs. LIF <1 (p = 0.02) and vs. LIF 1–1.99 (p = 0.003). There was a strong trend towards significance between LIF 2–2.99 vs. LIF 1–1.99 (p = 0.054). Including only compensated patients at baseline, (B) there was a significant difference between LIF ⩾ 3 vs. LIF 1–1.99 (p = 0.023) and a strong trend towards significance between LIF 2–2.99 vs. LIF 1–1.99 (p = 0.058). (This figure appears in colour on the web.)CC BY · PubMed Central
Fig. 4 Kaplan–Meier curves for liver related event free survival with patients stratified according to severity of liver iron and fat. There were no significant differences between the curves for (A) iron or (B) fat. Liver fat was categorised according to the liver fat content measured by proton magnetic resonance spectroscopy as 0: <1.5%, 1: 1.5% <fat <7.5% and 2: ⩾7.5%. Liver iron was categorised according to T2∗ as low iron: T2∗ >12.5 ms or high iron: T2∗ ⩽12.5 ms. (This figure appears in colour on the web.)
Fig. 4 Kaplan–Meier curves for liver related event free survival with patients stratified according to severity of liver iron and fat. There were no significant differences between the curves for (A) iron or (B) fat. Liver fat was categorised according to the liver fat content measured by proton magnetic resonance spectroscopy as 0: <1.5%, 1: 1.5% <fat <7.5% and 2: ⩾7.5%. Liver iron was categorised according to T2∗ as low iron: T2∗ >12.5 ms or high iron: T2∗ ⩽12.5 ms. (This figure appears in colour on the web.)CC BY · PubMed Central

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Metadata

Authors
Pavlides, M., Banerjee, R., Sellwood, J., Kelly, C. J., Robson, M. D., Booth, J. C., Collier, J., Neubauer, S., & Barnes, E.
Affiliations
  • University of Oxford (GB)
  • Perspectum Ltd. (United Kingdom) (GB)
  • Royal Berkshire Hospital (GB)
Corresponding author
Barnes, Eleanor
ORCID
Venue
Journal of Hepatology
Publisher
Elsevier BV
Published
2016-02
Volume
64
Issue
2
Pages
308-315
ISSN
0168-8278 (ISSN-L)
DOI
10.1016/j.jhep.2015.10.009
PMC
PMC4751288
OpenAlex
W2201457922
Cited by
212
References
37
Citations by year
2026: 10 · 2025: 17 · 2024: 18 · 2023: 9 · 2022: 24 · 2021: 29 · 2020: 38 · 2019: 14 · 2018: 24 · 2017: 14 · 2016: 15
FWCI
13.85
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Hepatology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Oxford NIHR Biomedical Research Centre
Topics
  • Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Keywords
chronic liver disease, multiparametric MRI, liver fibrosis, liver iron concentration, hepatic steatosis, non-alcoholic fatty liver disease, chronic viral hepatitis, T2-weighted imaging
MeSH terms
Adult, Biopsy, Female, Fibrosis, United Kingdom, Hepatitis, Chronic, Humans, Inflammation, Liver, Magnetic Resonance Imaging, Male, Middle Aged, Predictive Value of Tests, Prognosis, Severity of Illness Index, Risk Assessment, Kaplan-Meier Estimate, Non-alcoholic Fatty Liver Disease

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