A comparison of MR elastography and 31P MR spectroscopy with histological staging of liver fibrosis

AbstractObjectivesConventional imaging techniques are insensitive to liver fibrosis. This study assesses the diagnostic accuracy of MR elastography (MRE) stiffness values and the ratio of phosphomonoesters (PME)/phosphodiesters (PDE) measured using 31P spectroscopy against histological fibrosis staging.MethodsThe local research ethics committee approved this prospective, blinded study. A total of 77 consecutive patients (55 male, aged 49 ± 11.5 years) with a clinical suspicion of liver fibrosis underwent an MR examination with a liver biopsy later the same day. Patients underwent MRE and 31P spectroscopy on a 1.5 T whole body system. The liver biopsies were staged using an Ishak score for chronic hepatitis or a modified NAS fibrosis score for fatty liver disease.ResultsMRE increased with and was positively associated with fibrosis stage (Spearman’s rank = 0.622, P < 0.001). PME/PDE was not associated with fibrosis stage (Spearman’s rank = −0.041, p = 0.741). Area under receiver operating curves for MRE stiffness values were high (range 0.75–0.97). The diagnostic utility of PME/PDE was no better than chance (range 0.44–0.58).ConclusionsMRE-estimated liver stiffness increases with fibrosis stage and is able to dichotomise fibrosis stage groupings. We did not find a relationship between 31P MR spectroscopy and fibrosis stage.Key Points• Magnetic resonance elastography (MRE) and MR spectroscopy can both assess the liver. • MRE is superior to31P MR spectroscopy in staging hepatic fibrosis. • MRE is able to dichotomise liver fibrosis stage groupings. • Gradient-echo MRE may be problematic in genetic haemochromatosis.

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