Clinical utility of 30% relative decline in MRI-PDFF in predicting fibrosis regression in non-alcoholic fatty liver disease
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Objective Emerging data suggest that a 30% relative decline in liver fat, as assessed by MRI-proton density fat fraction (MRI-PDFF), may be associated with Non-Alcoholic Fatty Liver Disease Activity Score improvement, but the association between decline in MRI-PDFF and fibrosis regression is not known. Therefore, we aimed to examine the association between ≥30% relative decline in MRI-PDFF and fibrosis regression in non-alcoholic fatty liver disease (NAFLD). Design This prospective study included 100 well-characterised patients with biopsy-proven NAFLD with paired contemporaneous MRI-PDFF assessment at two time points. MRI-PDFF response was defined as ≥30% relative decline in MRI-PDFF. The primary outcome was ≥1 stage histological fibrosis regression. Results The median (IQR) age was 54 (43–62) years and body mass index was 31.9 (29–36) kg/m 2 . In multivariable-adjusted logistic regression analysis (adjusted for age, gender, diabetes status, race/ethnicity, interval between biopsies, gamma-glutamyl transferase, liver stiffness by magnetic resonance elastography and change in platelet counts), MRI-PDFF response was an independent predictor of fibrosis regression with an adjusted OR of 6.46 (95% CI 1.1 to 37.0, p=0.04). The proportion of patients with MRI-PDFF response with fibrosis regression, no change in fibrosis and fibrosis progression was 40.0%, 24.6% and 13.0%, respectively, and the proportion of patients with MRI-PDFF response increased with fibrosis regression (p=0.03). Conclusion ≥30% reduction in MRI-PDFF in early phase trials can provide a useful estimate of odds of ≥1 stage improvement in fibrosis. These data may be helpful in sample size estimation in non-alcoholic steatohepatitis trials.
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A recent study of 100 paired biopsies suggests that a relative reduction in MRI-PDFF of > -30% correlates with fibrosis regression (adjusted OR of 6.46), but further validation is needed.
“A recent study of 100 paired biopsies also suggests that this endpoint correlates with fi brosis regression (adjusted OR of 6.46), but further validation is needed. 263”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [263]
A relative reduction in MRI-PDFF-measured liver lipid content of > -30% predicted fibrosis regression in one study.
“it also predicted fi brosis regression in one study 263”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [263]
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- Authors
- Tamaki, N., Munaganuru, N., Jung, J., Yonan, A. Q., Loomba, R. R., Bettencourt, R., Ajmera, V., Valasek, M. A., Behling, C., Sirlin, C. B., & Loomba, R.
- Affiliations
- University of California San Diego (US)
- Corresponding author
- Loomba, Rohit
- ORCID
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2021-04-21
- Volume
- 71
- Issue
- 5
- Pages
- 983-990
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC8594562
- OpenAlex
- W3154470597
- Cited by
- 130
- References
- 46
- Citations by year
- 2026: 34 · 2025: 17 · 2024: 36 · 2023: 23 · 2022: 13 · 2021: 7
- FWCI
- 14.23
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Gut (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Environmental Health Sciences (5P42ES010337)
- National Center for Advancing Translational Sciences (5UL1TR001442)
- U.S. Department of Defense, the Peer Reviewed Cancer Research Program (W81XWH-18-2-0026)
- Uehara Memorial Foundation (201940021)
- National Institute on Alcohol Abuse and Alcoholism (K23DK119460, U01AA029019)
- National Heart, Lung, and Blood Institute (P01HL147835, U01AA029019)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK119460, P30DK120515, R01DK106419, R01DK121378, R01DK124318, U01DK061734)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- non-alcoholic fatty liver disease, fibrosis regression, proton density fat fraction, liver fat reduction, NAFLD activity score, nonalcoholic steatohepatitis, sample size determination, liver fibrosis progression
- MeSH terms
- Fibrosis, Humans, Liver, Magnetic Resonance Imaging, Middle Aged, Prospective Studies, Protons, Non-alcoholic Fatty Liver Disease
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