COMMENTARY

Ongoing Trials Put Focus Back on Fatty Liver Disease

The Liver Meeting 2017: American Association for the Study of Liver Diseases (AASLD)

William F. Balistreri, MD

Disclosures

December 11, 2017

In This Article

With the ongoing success in the efforts to cure patients with hepatitis C, this year's Liver Meeting saw a shift in focus to new science in fatty liver disease, including important clinical drug trials.

Predicting Nonalcoholic Steatohepatitis (NASH)

One area of interest came from investigators lamenting the lack of a reliable, accurate, noninvasive method to diagnose and stage the degree of liver injury in patients with NASH.

Allen and colleagues[1] examined the role of a multiparametric magnetic resonance elastography (MRE) protocol for the detection of NASH before the onset of fibrosis in obese subjects. Multifrequency three-dimensional (3D) MRE (at 30, 40, and 60 Hz) was used to determine which viscoelastic imaging parameters correlated with early histologic changes in patients with NASH scheduled to undergo bariatric surgery.

There were 83 subjects included, of whom 37 had biopsy-proven NASH and three had advanced fibrosis (F3-4). MRE analysis showed that the damping ratio at 30 Hz and the shear stiffness at 60 Hz correlated with lobular inflammation and hepatocellular ballooning, respectively. The fat fraction determined by MRI-proton density fat fraction (PDFF) correlated with the degree of steatosis. These three parameters were used to construct a generalized linear model that was highly predictive of biopsy-proven NASH.

The investigators concluded that multifrequency 3D MRE allows identification of novel, accurate imaging parameters that predict early NASH and disease activity.

This imaging biomarker represents a promising alternative to liver biopsy for diagnosing and monitoring patients with NASH.

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