Clinical

New diagnostic technique accurately detects liver fibrosis

Last Updated: 2008-11-03 15:45:16 -0400 (Reuters Health)

By Martha Kerr

SAN FRANCISCO (Reuters Health) - Magnetic resonance elastography (MRE) can accurately measure the extent and severity of hepatic fibrosis, Mayo clinic investigators announced here at Liver Week 2008, the annual meeting of the American Association for the Study of Liver Disease.

Results of a study designed to assess the performance of MRE from the Mayo Clinic and Foundation in Rochester, Minnesota, presented by principal investigator Dr. Jayant A. Talwalker, show that MRE is accurate in detecting fibrosis caused by a broad spectrum of liver diseases, he told Reuters Health.

The study involved 113 patients who had had liver biopsies within the previous year. MRE was performed and liver stiffness measured in all subjects. Excluded from the study were patients with hepatocellular carcinoma, decompensated liver disease or anyone treated previously for liver disease. Mean age was 56 years and 57% were women.

Etiology of disease was non-alcoholic fatty liver disease (NAFLD) in 42%, hepatitis C virus infection in 24%, primary biliary cirrhosis (PBC) in 7%, primary sclerosing cholangitis (PSC) in 6% and alcoholic liver disease in 3%.

There was no fibrosis visible in 20% of patients, stage I fibrosis was found in 22%, stage II fibrosis in 13%, stage III in fibrosis in 13% and stage IV fibrosis was found in 28% of patients.

"Hepatic stiffness increased systematically with fibrosis stage," Dr. Talwalker noted. "Diagnostic threshold levels for detecting cirrhosis and moderate to severe fibrosis were similar for patients with HCV or NAFLD," the Mayo Clinic team found.

Shear stiffness values in patients with simple hepatic steatosis on liver histology were similar to healthy individuals without liver disease.

"MRE shows a bigger picture [of the liver] than biopsy," he said. "Early fibrosis, especially, is a patchy disease. The biopsy can greatly underestimate or overestimate disease," depending on whether or not the biopsy takes tissue from a fibrotic area. "Biopsy is restricted to the right lobe," he added. "MRE visualizes the whole liver."

"MRE can guide treatment decisions," the Mayo Clinic investigator pointed out. "Patients with HCV who were reluctant to take antiviral therapy because of side effects can be educated about the need for therapy based on MRE findings of fibrosis."