MRE-liver stiffness measure better for varices in NAFLD cirrhosis

For patients with obesity and nonalcoholic fatty liver disease (NAFLD) compensated cirrhosis (CC), liver stiffness measurement (LSM) by magnetic resonance elastography (MRE) is significantly higher than acoustic radiation force impulse (ARFI) for those with varices, according to a study published online April 23 in Abdominal Radiology.

Akash Roy, M.B.B.S., from Apollo Multispecialty Hospitals in Kolkata, India, and colleagues enrolled 108 patients with obesity and NAFLD-CC who underwent MRE and ARFI for LSM and endoscopy for varices screening. Area under the receiver operating characteristics (AUROC) curves were used for evaluating performance of MRE and ARFI for predicting esophageal varices (EVs) and high-risk varices (HRVs).

Overall, 52 patients had no varices, and 29 and 27 had low-risk varices (LRVs) and HRVs, respectively. The researchers found that in patients with LRVs or HRVs, MRE-LSM was higher compared with those without varices. No significant difference was seen in ARFI-LSM for those without and with LRVs or HRVs. In the overall cohort, there was a low correlation observed between ARFI-LSM and MRE-LSM.

The only predictors of HRVs were platelet count and MRE-LSM. MRE showed a sensitivity of 96.3 percent at a cutoff of 4.75. The diagnostic AUROC curves were 0.77 and 0.76 for EVs and HRVs, respectively, in a model combining MRE-LSM with platelet count.

“MRE combined with platelet count predicts EVs and HRVs with good accuracy,” the authors write. “MRE-LSM has low correlation with ARFI-LSM, with the latter underperforming in prediction of varices.”

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