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, 11 (5), 674-683

Noninvasive Assessment of Advanced Fibrosis Based on Hepatic Volume in Patients With Nonalcoholic Fatty Liver Disease

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Noninvasive Assessment of Advanced Fibrosis Based on Hepatic Volume in Patients With Nonalcoholic Fatty Liver Disease

Tatsuya Hayashi et al. Gut Liver.

Abstract

Background/aims: Noninvasive liver fibrosis evaluation was performed in patients with nonalcoholic fatty liver disease (NAFLD). We used a quantitative method based on the hepatic volume acquired from gadoxetate disodium-enhanced (Gd-EOB-DTPA-enhanced) magnetic resonance imaging (MRI) for diagnosing advanced fibrosis in patients with NAFLD.

Methods: A total of 130 patients who were diagnosed with NAFLD and underwent Gd-EOB-DTPA-enhanced MRI were retrospectively included. Histological data were available for 118 patients. Hepatic volumetric parameters, including the left hepatic lobe to right hepatic lobe volume ratio (L/R ratio), were measured. The usefulness of the L/R ratio for diagnosing fibrosis ≥F3-4 and F4 was assessed using the area under the receiver operating characteristic (AUROC) curve. Multiple regression analysis was performed to identify variables (age, body mass index, serum fibrosis markers, and histological features) that were associated with the L/R ratio.

Results: The L/R ratio demonstrated good performance in differentiating advanced fibrosis (AUROC, 0.80; 95% confidence interval, 0.72 to 0.88) from cirrhosis (AUROC, 0.87; 95% confidence interval, 0.75 to 0.99). Multiple regression analysis showed that only fibrosis was significantly associated with the L/R ratio (coefficient, 0.121; p<0.0001).

Conclusions: The L/R ratio, which is not influenced by pathological parameters other than fibrosis, is useful for diagnosing cirrhosis in patients with NAFLD.

Keywords: Fibrosis; Gadoxetate disodium; Liver cirrhosis; Magnetic resonance imaging; Non-alcoholic fatty liver disease.

Conflict of interest statement

CONFLICTS OF INTEREST

H.K. has received honoraria and expenses for speaking at events organized by MSD K.K., Bristol-Myers Squibb, GlaxoSmithKline K.K., and Janssen Pharmaceutical K.K. K.I. has received honoraria and expenses for speaking at events organized by Sumitomo Dainippon Pharma Co., Ltd., Eisai Co., Ltd., and Olympus Corp. All other authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Three-dimensional magnetic resonance images of a patient with fibrosis stage 4. (A) The entire liver and (B) the right and left lobes in a 67-year-old woman with fibrosis stage 4 are shown. Cantlie’s line is used to divide the two lobes. The ratio of the left to right hepatic lobe volumes is 1.37 in this patient.
Fig. 2
Fig. 2
Relationship of liver volumetric parameters with the fibrosis stage. The parameters measured are (A) MR-LV, (B) MR-LV/estimated LV, (C) MR-RLV/estimated LV, (D) MR-LLV/estimated LV, and (E) L/R ratios. Boxes represent interquartile ranges, which are demarcated by median values. Error bars represent minimum and maximum values. The MR-RLV/estimated LV, MR-LLV/estimated LV, and L/R ratios demonstrated a significant correlation with the fibrosis stage (ρ=−0.376, p<0.0001; ρ=0.272, p=0.002; and ρ=0.693, p<0.0001, respectively). MR-LV/estimated LV, ratio of entire liver volume (LV) measured by magnetic resonance imaging (MRI) to estimated LV; MR-RLV/estimated LV, ratio of right hepatic lobe volume measure by MRI to estimated liver volume; MR-LLV/estimated LV, ratio of left hepatic lobe volume measure by MRI to estimated liver volume; L/R, ratio of left to right hepatic lobe volumes.
Fig. 3
Fig. 3
Receiver operating characteristic curves for hepatic volumetric parameters and serum fibrosis markers for the diagnosis of fibrosis stage (A) F ≥3 and (B) F4. MR-RLV/estimated LV, ratio of right hepatic lobe volume measured by magnetic resonance imaging (MRI) to estimated liver volume (LV); MR-LLV/estimated LV, ratio of left hepatic lobe volume measured by MRI to estimated liver volume; L/R, ratio of left to right hepatic lobe volumes; APRI, aspartate aminotransferase to platelet ratio index.

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