MR elastography for the assessment of hepatic fibrosis in patients with chronic hepatitis B infection: Does histologic necroinflammation influence the measurement of hepatic stiffness?

Yu Shi, Qiyong Guo, Fei Xia, Bogdan Dzyubak, Kevin J. Glaser, Qiuju Li, Jiahui Li, Richard Lorne Ehman

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Abstract

Purpose: To determine the diagnostic performance of magnetic resonance (MR) elastography for the staging of hepatic fibrosis and to evaluate the influence of necroinflammation on hepatic stiffness in patients with chronic hepatitis B virus (HBV) infection by using histopathologic findings as the reference standard.

Materials and Methods: One hundred thirteen consecutive patients with chronic HBV infection were recruited prospectively in this institutional review board-approved study after providing written informed consent between March 2012 and October 2013. The stiffness measurements were obtained by using two-dimensional gradient-echo MR elastography with a 3.0-T MR system. The METAVIR scoring system was used for the assessment of fibrosis ("F" stage) and necroinflammation ("A" grade). The predictive ability of MR elastography was evaluated by using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC). Multiple linear regression analyses were conducted to determine the relationship between hepatic stiffness and the variables that showed a significant association in the univariate analysis or those that were of interest for comparison with earlier work (histologic scores, sex, age, aspartate aminotransferase level, and aspartate aminotransferase/alanine aminotransferase ratio).

Results: MR elastography showed excellent performance for characterization of ≥F1, ≥F2, ≥F3, and F4 findings, with AUC values of 0.961, 0.986, 1.000, and 0.998, respectively. It showed a moderate capability for evaluation of necroinflammatory activity of ≥A1, ≥A2, and A3 (AUC = 0.806, 0.834, and 0.906, respectively). Multiple linear regression analysis showed that fibrosis, necroinflammation, and sex were independently associated with hepatic stiffness (b = 0.799, 0.277, and 0.070, respectively; P < .05). For pairwise comparisons, log-transformed hepatic stiffness showed no difference between (a) groups F0/A2-3 and F1/A0-1 and (b) groups F1/ A2-3 and F2/A0-1 (P > .99 and P = .486, respectively).

Conclusion: MR elastography demonstrated excellent performance for distinguishing the stages of hepatic fibrosis in patients with chronic HBV infection. For hepatic tissue with ≥F2 fibrosis, necroinflammation can account for a substantial fraction of the increase in hepatic stiffness.

Original languageEnglish (US)
Pages (from-to)88-98
Number of pages11
JournalRadiology
Volume273
Issue number1
DOIs
StatePublished - Oct 1 2014

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Elasticity Imaging Techniques
Chronic Hepatitis B
Fibrosis
Liver
ROC Curve
Infection
Virus Diseases
Hepatitis B virus
Area Under Curve
Aspartate Aminotransferases
Linear Models
Regression Analysis
Research Ethics Committees
Informed Consent
Alanine Transaminase
varespladib methyl
Magnetic Resonance Spectroscopy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

MR elastography for the assessment of hepatic fibrosis in patients with chronic hepatitis B infection : Does histologic necroinflammation influence the measurement of hepatic stiffness? / Shi, Yu; Guo, Qiyong; Xia, Fei; Dzyubak, Bogdan; Glaser, Kevin J.; Li, Qiuju; Li, Jiahui; Ehman, Richard Lorne.

In: Radiology, Vol. 273, No. 1, 01.10.2014, p. 88-98.

Research output: Contribution to journalArticle

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title = "MR elastography for the assessment of hepatic fibrosis in patients with chronic hepatitis B infection: Does histologic necroinflammation influence the measurement of hepatic stiffness?",
abstract = "Purpose: To determine the diagnostic performance of magnetic resonance (MR) elastography for the staging of hepatic fibrosis and to evaluate the influence of necroinflammation on hepatic stiffness in patients with chronic hepatitis B virus (HBV) infection by using histopathologic findings as the reference standard.Materials and Methods: One hundred thirteen consecutive patients with chronic HBV infection were recruited prospectively in this institutional review board-approved study after providing written informed consent between March 2012 and October 2013. The stiffness measurements were obtained by using two-dimensional gradient-echo MR elastography with a 3.0-T MR system. The METAVIR scoring system was used for the assessment of fibrosis ({"}F{"} stage) and necroinflammation ({"}A{"} grade). The predictive ability of MR elastography was evaluated by using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC). Multiple linear regression analyses were conducted to determine the relationship between hepatic stiffness and the variables that showed a significant association in the univariate analysis or those that were of interest for comparison with earlier work (histologic scores, sex, age, aspartate aminotransferase level, and aspartate aminotransferase/alanine aminotransferase ratio).Results: MR elastography showed excellent performance for characterization of ≥F1, ≥F2, ≥F3, and F4 findings, with AUC values of 0.961, 0.986, 1.000, and 0.998, respectively. It showed a moderate capability for evaluation of necroinflammatory activity of ≥A1, ≥A2, and A3 (AUC = 0.806, 0.834, and 0.906, respectively). Multiple linear regression analysis showed that fibrosis, necroinflammation, and sex were independently associated with hepatic stiffness (b = 0.799, 0.277, and 0.070, respectively; P < .05). For pairwise comparisons, log-transformed hepatic stiffness showed no difference between (a) groups F0/A2-3 and F1/A0-1 and (b) groups F1/ A2-3 and F2/A0-1 (P > .99 and P = .486, respectively).Conclusion: MR elastography demonstrated excellent performance for distinguishing the stages of hepatic fibrosis in patients with chronic HBV infection. For hepatic tissue with ≥F2 fibrosis, necroinflammation can account for a substantial fraction of the increase in hepatic stiffness.",
author = "Yu Shi and Qiyong Guo and Fei Xia and Bogdan Dzyubak and Glaser, {Kevin J.} and Qiuju Li and Jiahui Li and Ehman, {Richard Lorne}",
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T1 - MR elastography for the assessment of hepatic fibrosis in patients with chronic hepatitis B infection

T2 - Does histologic necroinflammation influence the measurement of hepatic stiffness?

AU - Shi, Yu

AU - Guo, Qiyong

AU - Xia, Fei

AU - Dzyubak, Bogdan

AU - Glaser, Kevin J.

AU - Li, Qiuju

AU - Li, Jiahui

AU - Ehman, Richard Lorne

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Purpose: To determine the diagnostic performance of magnetic resonance (MR) elastography for the staging of hepatic fibrosis and to evaluate the influence of necroinflammation on hepatic stiffness in patients with chronic hepatitis B virus (HBV) infection by using histopathologic findings as the reference standard.Materials and Methods: One hundred thirteen consecutive patients with chronic HBV infection were recruited prospectively in this institutional review board-approved study after providing written informed consent between March 2012 and October 2013. The stiffness measurements were obtained by using two-dimensional gradient-echo MR elastography with a 3.0-T MR system. The METAVIR scoring system was used for the assessment of fibrosis ("F" stage) and necroinflammation ("A" grade). The predictive ability of MR elastography was evaluated by using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC). Multiple linear regression analyses were conducted to determine the relationship between hepatic stiffness and the variables that showed a significant association in the univariate analysis or those that were of interest for comparison with earlier work (histologic scores, sex, age, aspartate aminotransferase level, and aspartate aminotransferase/alanine aminotransferase ratio).Results: MR elastography showed excellent performance for characterization of ≥F1, ≥F2, ≥F3, and F4 findings, with AUC values of 0.961, 0.986, 1.000, and 0.998, respectively. It showed a moderate capability for evaluation of necroinflammatory activity of ≥A1, ≥A2, and A3 (AUC = 0.806, 0.834, and 0.906, respectively). Multiple linear regression analysis showed that fibrosis, necroinflammation, and sex were independently associated with hepatic stiffness (b = 0.799, 0.277, and 0.070, respectively; P < .05). For pairwise comparisons, log-transformed hepatic stiffness showed no difference between (a) groups F0/A2-3 and F1/A0-1 and (b) groups F1/ A2-3 and F2/A0-1 (P > .99 and P = .486, respectively).Conclusion: MR elastography demonstrated excellent performance for distinguishing the stages of hepatic fibrosis in patients with chronic HBV infection. For hepatic tissue with ≥F2 fibrosis, necroinflammation can account for a substantial fraction of the increase in hepatic stiffness.

AB - Purpose: To determine the diagnostic performance of magnetic resonance (MR) elastography for the staging of hepatic fibrosis and to evaluate the influence of necroinflammation on hepatic stiffness in patients with chronic hepatitis B virus (HBV) infection by using histopathologic findings as the reference standard.Materials and Methods: One hundred thirteen consecutive patients with chronic HBV infection were recruited prospectively in this institutional review board-approved study after providing written informed consent between March 2012 and October 2013. The stiffness measurements were obtained by using two-dimensional gradient-echo MR elastography with a 3.0-T MR system. The METAVIR scoring system was used for the assessment of fibrosis ("F" stage) and necroinflammation ("A" grade). The predictive ability of MR elastography was evaluated by using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC). Multiple linear regression analyses were conducted to determine the relationship between hepatic stiffness and the variables that showed a significant association in the univariate analysis or those that were of interest for comparison with earlier work (histologic scores, sex, age, aspartate aminotransferase level, and aspartate aminotransferase/alanine aminotransferase ratio).Results: MR elastography showed excellent performance for characterization of ≥F1, ≥F2, ≥F3, and F4 findings, with AUC values of 0.961, 0.986, 1.000, and 0.998, respectively. It showed a moderate capability for evaluation of necroinflammatory activity of ≥A1, ≥A2, and A3 (AUC = 0.806, 0.834, and 0.906, respectively). Multiple linear regression analysis showed that fibrosis, necroinflammation, and sex were independently associated with hepatic stiffness (b = 0.799, 0.277, and 0.070, respectively; P < .05). For pairwise comparisons, log-transformed hepatic stiffness showed no difference between (a) groups F0/A2-3 and F1/A0-1 and (b) groups F1/ A2-3 and F2/A0-1 (P > .99 and P = .486, respectively).Conclusion: MR elastography demonstrated excellent performance for distinguishing the stages of hepatic fibrosis in patients with chronic HBV infection. For hepatic tissue with ≥F2 fibrosis, necroinflammation can account for a substantial fraction of the increase in hepatic stiffness.

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