Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Can gadoxetic acid–enhanced magnetic resonance imaging be used to avoid liver biopsy in patients with nonalcoholic fatty liver disease?
Viviane Brandão Amorim, Daniella Braz Parente, Fernando Fernandes Paiva, Jaime Araújo Oliveira Neto, Amanda Almeida Miranda, Cláudia Cravo Moreira, Flávia Ferreira Fernandes, Carlos Frederico Ferreira Campos, Nathalie Carvalho Leite, Renata de Mello Perez, Rosana Souza Rodrigues
Viviane Brandão Amorim, Daniella Braz Parente, Jaime Araújo Oliveira Neto, Renata de Mello Perez, Rosana Souza Rodrigues, Research Department, D’Or Institute for Research and Education, Rio de Janeiro 22281, Brazil
Viviane Brandão Amorim, Radiology Department, Brazilian National Cancer Institute, Rio de Janeiro 20230-130, Brazil
Viviane Brandão Amorim, Radiology Department, Fleury Group S.A., Rio de Janeiro 20765-000, Brazil
Daniella Braz Parente, Rosana Souza Rodrigues, Radiology Department, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
Fernando Fernandes Paiva, São Carlos Institute of Physics, University of São Paulo, São Carlos 13560-970, Brazil
Jaime Araújo Oliveira Neto, Radiology Department, Quinta D'Or Hospital, Rio de Janeiro 20941-150, Brazil
Amanda Almeida Miranda, Radiology Department, Centro de Diagnóstico Médico do Maranhão, Maranhão 65074-441, Brazil
Cláudia Cravo Moreira, Nathalie Carvalho Leite, Department of Clinical Medicine, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
Flávia Ferreira Fernandes, Gastroenterology and Hepatology Department, Hospital Federal de Bonsucesso, Rio de Janeiro 21041-030, Brazil
Carlos Frederico Ferreira Campos, Department of Pathology and Laboratories, University of the State of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil
Renata de Mello Perez, Internal Medicine Department, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-590, Brazil
Renata de Mello Perez, Gastroenterology Department, Hospital Universitário Pedro Ernesto, University of the State of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil
Author contributions: Amorim VB, Parente DB, Leite NC, Perez RM, and Rodrigues RS drafted the manuscript, was involved with data collection and analysis, and participated in design of the study; Parente DB participated in study design; Paiva FF contributed with imaging protocol, and data analysis; Oliveira Neto JA contributed with imaging protocol; Miranda AA, Moreira CC, and Fernades FF contributed equally to collecting the data; Campos CFF analyzed histopathological data; Perez RM performed statistical analysis; all authors read and approved the final manuscript.
Supported by D’Or Institute for Research and Education, No. CAAE-50521015.2.0000.5249.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Hospital Copa D'Or (Rio de Janeiro, RJ, Brazil), number 1.320.510.
Clinical trial registration statement: This study is registered at Hospital Copa D'Or, Rio de Janeiro/RJ. The registration identification number is CAAE-50521015.2.0000.5249.
Informed consent statement: All study participants provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Viviane Brandão Amorim, MD, PhD, Research Scientist, Staff Physician, Research Department, D’Or Institute for Research and Education, No. 30 Rua Diniz Cordeiro, Botafogo, Rio de Janeiro 22281-100, Brazil. viviane1brandao@gmail.com
Received: June 4, 2020
Peer-review started: June 4, 2020
First decision: June 20, 2020
Revised: June 29, 2020
Accepted: August 15, 2020
Article in press: August 15, 2020
Published online: September 27, 2020
ARTICLE HIGHLIGHTS
Research background
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, affecting up to 40% of the world population. It is characterized by fatty liver infiltration, and encompasses a wide clinical spectrum, ranging from a relatively benign isolated steatosis from potentially progressive nonalcoholic steatohepatitis (NASH), liver fibrosis and cirrhosis.
Research motivation
The diagnosis of NASH is crucial and has prognostic and therapeutic implications. Liver biopsy is currently the gold standard for diagnosing progressive NASH and has several limitations, such as sampling error, cost, and risk of complications.
Abundant research has been performed to develop noninvasive diagnostic methods for the early detection of NASH and its accurate differentiation from isolated steatosis, due to the utmost clinical importance of this diagnosis.
Research objectives
To evaluate the performance of gadoxetic acid–enhanced magnetic resonance imaging (GA-MRI) to differentiate NASH in patients with NAFLD using histopathology as the reference standard.
Research methods
In this prospective study, 56 patients with NAFLD (18 with isolated steatosis and 38 with NASH) underwent GA-MRI. Contrast enhancement index (CEI) was calculated as the rate of increase of the liver-to-muscle signal intensity ratio before and 20 min after intravenous GA administration. Between-group differences in mean CEI were tested with the Student's t-test. Area under the receiver operator characteristic curve, and the diagnostic performance of GA-MRI were evaluated.
Research results
The mean CEI for all subjects was 1.82 ± 0.19. The mean CEI was significantly lower in patients with NASH than in those with isolated steatosis (P = 0.008). Two CEI cut-off points were used: < 1.66 (94% specificity) to characterize NASH and > 2.00 (89% sensitivity) to characterize isolated steatosis. CEI values between 1.66 and 2.00 indicated liver biopsy, and the procedure could be avoided in 40% of patients with NAFLD.
Research conclusions
Patients with NASH have significantly lower CEIs in the hepatobiliary phase of GA-MRI than do patients with isolated steatosis. This study suggests that GA-MRI may be an effective noninvasive method for the identification of patients for whom early intervention and more aggressive therapy should be implemented, avoiding liver biopsy in up to 40% of the NAFLD population.
Research perspectives
The possibility of using GA-MRI as a noninvasive and comprehensive diagnostic modality holds great promise. As it is a preliminary study, further prospective studies with a larger sample size are warranted.
