Hepatitis activity should be considered a confounder of liver stiffness measured with MR elastography

J Magn Reson Imaging. 2015 May;41(5):1203-8. doi: 10.1002/jmri.24666. Epub 2014 Jun 3.


Purpose: To evaluate the effect of hepatitis activity on liver stiffness measurements and the role of serum alanine aminotransferase (ALT) in liver fibrosis staging by MR elastography (MRE).

Materials and methods: We measured liver stiffness (kPa) in 135 patients by MRE and histologically assessed fibrosis and hepatitis activity within 2 months. Stepwise multiple linear regression was performed to determine the maximum adjusted R(2) against liver stiffness, after adjusting for nothing (model 1), ALT/upper limit of normal categories (model 2), and hepatitis activity (A grade) by METAVIR (model 3). Logistic regression was used to identify independent factors associated with pathologically proven cirrhosis.

Results: Platelet count and METAVIR F score were strongly associated with liver stiffness. The adjusted R(2) value of model 3 (0.7026) was higher than those of models 1 (0.6472) and 2 (0.6564), showing that hepatitis activity affected liver stiffness measurement. High ALT levels (odds ratio, 0.0066; P = 0.0003) as well as MRE (odds ratio, 9.91; P < 0.0001) were independently associated with cirrhosis.

Conclusion: Hepatitis activity may be a confounder of liver stiffness measurement during liver fibrosis staging using MRE. MRE can potentially make an overdiagnosis of liver cirrhosis if the patient has high ALT levels.

Keywords: activity of hepatitis; hepatic fibrosis; liver stiffness; magnetic resonance elastography.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Confounding Factors, Epidemiologic
  • Elastic Modulus
  • Elasticity Imaging Techniques / methods
  • Elasticity Imaging Techniques / statistics & numerical data*
  • False Positive Reactions
  • Female
  • Hepatitis / diagnosis
  • Hepatitis / epidemiology*
  • Hepatitis / physiopathology*
  • Humans
  • Image Interpretation, Computer-Assisted / methods
  • Japan / epidemiology
  • Liver / physiopathology*
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / epidemiology*
  • Liver Cirrhosis / physiopathology*
  • Male
  • Middle Aged
  • Prevalence
  • Reproducibility of Results
  • Risk Factors
  • Sensitivity and Specificity
  • Young Adult