Multiparametric MRI: bridging the diagnostic gap for liver disease

Date
August 7, 2020
Topics

Oxford, August 7th, 2020. A review of techniques for clinical decision making in diffuse liver disease, published this week in Abdominal Radiology, highlights the potential for multiparametric MRI (mpMRI) to transform clinical practice.

Chronic liver disease leads to progressive injury from aetiologies such as iron overload, steatosis, steatohepatitis, viral hepatitis, autoimmune, metabolic disease and some drug toxicities; of 112 million cases of compensated cirrhosis in 2017, 36·7 million were due to hepatitis B, 23·6 million from alcoholic liver disease and 4.06 million from non-alcoholic steatohepatitis.

The needs of payers, clinicians and healthcare systems that support patients go beyond the existing guidelines and highlight diagnostic gaps. These needs are largely dictated by costs and availability of treatment options. The burden is increasing, largely driven by the global rise in obesity and autoimmune diseases, placing additional pressure on already overloaded healthcare systems. Accurate, sensitive and non-invasive tools are required for disease stratification, early diagnosis and monitoring. This is especially important now as new pharmacotherapies in steatohepatitis and diabetes could lead to new treatment and diagnostic opportunities. 

The evaluation of liver biopsy, the current diagnostic gold standard for liver disease, is known to have poor reliability across readers. This is a limitation that is gaining increasing awareness among clinicians and thought leaders (read the latest publication by Davison et al., 2020). New developments in mpMRI, using MRI measures, such as T2*, PDFF, cT1, MRE, DWI, could bridge the diagnostic gap between non-specific blood-based biomarkers and invasive and variable histological diagnosis. mpMRI could obviate the need for histological confirmation via biopsy in many disease states. These developments could improve the clinical care and treatment pathways across the spectrum of chronic liver disease, including haemochromatosis, steatohepatitis, autoimmune and viral hepatitis.

As recent applications in patients with chronic liver disease described in this review suggest, mpMRI techniques have the potential to influence clinical guidelines and, by enabling clinicians to diagnose and stratify liver disease earlier and with greater confidence, improve patient experience and outcomes. 

Read the full paper here.

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