Aims/Introduction: Several non-invasive tools are available for the assessment of steatosis and fibrosis in nonalcoholic fatty liver disease (NAFLD) including clinical scoring systems, serum markers, transient elastography (TE), and magnetic resonance imaging (MRI) techniques, such as MRI-proton density fat fraction (MRI-PDFF) and MR elastography (MRE). In the present study, we aimed to evaluate whether MRI-based examinations better reflected the pathophysiology and metabolic features of NAFLD and outperformed other non-invasive methods.

Materials and Methods: A total of 120 subjects (31 healthy volunteers and 89 NAFLD patients) were subjected to anthropometric and laboratory tests, TE, and MRI-based examinations in this cross-sectional study, including liver biopsy in some patients (n=39).

Results: MRI-PDFF correlated with hepatic fat measured by MR spectroscopy (r=0.978, p<0.001) and was superior to the TE controlled attenuation parameter (CAP) (r=0.741, p<0.001). In addition, MRI-PDFF showed stronger correlations with various pathophysiologic parameters for cellular injury, glucose and lipid metabolism, and inflammation, than the CAP. The MRI-PDFF and CAP cutoff levels associated with abnormal elevation of serum alanine aminotransferase were 9.8% and 269 dB/m, respectively. The MRE liver stiffness measurement (LSM) showed stronger correlations with liver enzymes, platelets, complement component 3, several clinical fibrosis scoring systems, the enhanced liver fibrosis (ELF) score than the TE LSM. In an analysis of only biopsied patients, MRE and TE performed better in discriminating significant fibrosis (≥F2) than the ELF test.

Conclusions: Our results suggest that MRI-based assessment of NAFLD is the best non-invasive tool that captures the histologic, pathophysiologic and metabolic features of the disease.


Y. Kim: None. D. Lee: None. K. Lee: None.

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