Multiparametric Liver Biomarker Analysis Using MR Elastography and MRI for Non-Invasive Assessment of Fibrosis, Steatosis, and Iron Overload in Patients with Non-Alcoholic Fatty Liver Disease

Abstract

Traditionally, liver disease diagnosis relied heavily on invasive liver biopsies, considered the gold standard for direct liver assessment. However, the emergence of less invasive alternatives, such as magnetic resonance elastography (MRE) and magnetic resonance imaging (MRI), has transformed the field. In this study, a wide array of novel biomarkers, including stiffness, corrected longitudinal relaxation time (cT1), longitudinal relaxation time (T1), and apparent diffusion coefficient (ADC), were employed to assess liver fibrosis. Proton density fat fraction (PDFF) was determined using the Dixon technique for steatosis evaluation, and transversal relaxation time (T2*) was utilized to gauge iron overload. A comprehensive imaging protocol, including calibration with an albumin phantom, encompassed five sequences performed on 27 patients suspected of non-alcoholic steatohepatitis (NASH). The MRI data were acquired using a 3 Tesla GE Medical Systems SIGNA Architect MRI scanner. This study calibrated T1 maps with an albumin phantom and assessed the reliability of elastography by magnetic resonance (MRE) for fibrosis analysis. Significant correlations were observed between biomarkers and liver health indicators: cT1 correlated with stiffness (r=0.4272, p=0.0331) and PDFF (r=0.6699, p=0.0002), ADC correlated with stiffness (r=0.6278, p=0.0008), and PDFF demonstrated a strong association with the IDEAL technique (r=0.9792, p=0.0001), confirming its reliability for steatosis assessment.Clinical Relevance- The current study presents a novel and innovative approach to the non-invasive diagnosis of liver diseases, including conditions like iron overload, steatosis, and fibrosis. This groundbreaking approach involves a multiparametric and multimodal analysis of biomarkers, enabling a higher degree of non-invasive diagnostic accuracy.