TY - JOUR
T1 - Diagnostic accuracy of magnetic resonance imaging hepatic proton density fat fraction in pediatric nonalcoholic fatty liver disease
AU - for the NASH Clinical Research Network
AU - Middleton, Michael S.
AU - Van Natta, Mark L.
AU - Heba, Elhamy R.
AU - Alazraki, Adina
AU - Trout, Andrew T.
AU - Masand, Prakash
AU - Brunt, Elizabeth M.
AU - Kleiner, David E.
AU - Doo, Edward
AU - Tonascia, James
AU - Lavine, Joel E.
AU - Shen, Wei
AU - Hamilton, Gavin
AU - Schwimmer, Jeffrey B.
AU - Sirlin, Claude B.
N1 - Funding Information:
We would like to express our appreciation to all of the patients who participated in this study, as well as to the staff of the NASH CRN Data Coordinating Center, the UCSD Radiology Coordinating Center, and all of the participating clinical centers for their support and assistance in conducting this study.
Funding Information:
Received March 17, 2017; accepted October 12, 2017. Supported by NIDDK U01 DK061713, NIDDK U01 DK061718, NIDDK U01 DK061728, NIDDK U01 DK061730, NIDDK U01 DK061731, NIDDK U01 DK061732, NIDDK U01 DK061734, NIDDK U01 DK061737, NIDDK U01 DK061738, NCATS UL1 TR000004, NCATS UL1 TR000006, NCATS UL1 TR000040 NCATS UL1 TR000077 NCATS UL1 TR000100, NCATS UL1 TR000150, NCATS UL1 TR000423, NCATS UL1 TR000424, NCATS UL1 TR000448, and NCATS UL1 TR000454. Supported, in part, by the Intramural Research Program of the NIH, National Cancer Institute. This work was presented in abstract form at the annual meeting of the Radiological Society of North America on November 28, 2017 in Chicago, IL.
Publisher Copyright:
© 2017 by the American Association for the Study of Liver Diseases. This article has been contributed to by US Government employees and their work is in the public domain in the USA.
PY - 2018/3
Y1 - 2018/3
N2 - We assessed the performance of magnetic resonance imaging (MRI) proton density fat fraction (PDFF) in children to stratify hepatic steatosis grade before and after treatment in the Cysteamine Bitartrate Delayed-Release for the Treatment of Nonalcoholic Fatty Liver Disease in Children (CyNCh) trial, using centrally scored histology as reference. Participants had multiecho 1.5 Tesla (T) or 3T MRI on scanners from three manufacturers. Of 169 enrolled children, 110 (65%) and 83 (49%) had MRI and liver biopsy at baseline and at end of treatment (EOT; 52 weeks), respectively. At baseline, 17% (19 of 110), 28% (31 of 110), and 55% (60 of 110) of liver biopsies showed grades 1, 2, and 3 histological steatosis; corresponding PDFF (mean ± SD) values were 10.9 ± 4.1%, 18.4 ± 6.2%, and 25.7 ± 9.7%, respectively. PDFF classified grade 1 versus 2-3 and 1-2 versus 3 steatosis with areas under receiving operator characteristic curves (AUROCs) of 0.87 (95% confidence interval [CI], 0.80, 0.94) and 0.79 (0.70, 0.87), respectively. PDFF cutoffs at 90% specificity were 17.5% for grades 2-3 steatosis and 23.3% for grade 3 steatosis. At EOT, 47% (39 of 83), 41% (34 of 83), and 12% (10 of 83) of biopsies showed improved, unchanged, and worsened steatosis grade, respectively, with corresponding PDFF (mean ± SD) changes of –7.8 ± 6.3%, –1.2 ± 7.8%, and 4.9 ± 5.0%, respectively. PDFF change classified steatosis grade improvement and worsening with AUROCs (95% CIs) of 0.76 (0.66, 0.87) and 0.83 (0.73, 0.92), respectively. PDFF change cut-off values at 90% specificity were –11.0% and +5.5% for improvement and worsening. Conclusion: MRI-estimated PDFF has high diagnostic accuracy to both classify and predict histological steatosis grade and change in histological steatosis grade in children with NAFLD. (Hepatology 2018;67:858–872).
AB - We assessed the performance of magnetic resonance imaging (MRI) proton density fat fraction (PDFF) in children to stratify hepatic steatosis grade before and after treatment in the Cysteamine Bitartrate Delayed-Release for the Treatment of Nonalcoholic Fatty Liver Disease in Children (CyNCh) trial, using centrally scored histology as reference. Participants had multiecho 1.5 Tesla (T) or 3T MRI on scanners from three manufacturers. Of 169 enrolled children, 110 (65%) and 83 (49%) had MRI and liver biopsy at baseline and at end of treatment (EOT; 52 weeks), respectively. At baseline, 17% (19 of 110), 28% (31 of 110), and 55% (60 of 110) of liver biopsies showed grades 1, 2, and 3 histological steatosis; corresponding PDFF (mean ± SD) values were 10.9 ± 4.1%, 18.4 ± 6.2%, and 25.7 ± 9.7%, respectively. PDFF classified grade 1 versus 2-3 and 1-2 versus 3 steatosis with areas under receiving operator characteristic curves (AUROCs) of 0.87 (95% confidence interval [CI], 0.80, 0.94) and 0.79 (0.70, 0.87), respectively. PDFF cutoffs at 90% specificity were 17.5% for grades 2-3 steatosis and 23.3% for grade 3 steatosis. At EOT, 47% (39 of 83), 41% (34 of 83), and 12% (10 of 83) of biopsies showed improved, unchanged, and worsened steatosis grade, respectively, with corresponding PDFF (mean ± SD) changes of –7.8 ± 6.3%, –1.2 ± 7.8%, and 4.9 ± 5.0%, respectively. PDFF change classified steatosis grade improvement and worsening with AUROCs (95% CIs) of 0.76 (0.66, 0.87) and 0.83 (0.73, 0.92), respectively. PDFF change cut-off values at 90% specificity were –11.0% and +5.5% for improvement and worsening. Conclusion: MRI-estimated PDFF has high diagnostic accuracy to both classify and predict histological steatosis grade and change in histological steatosis grade in children with NAFLD. (Hepatology 2018;67:858–872).
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U2 - 10.1002/hep.29596
DO - 10.1002/hep.29596
M3 - Article
C2 - 29028128
AN - SCOPUS:85042471785
VL - 67
SP - 858
EP - 872
JO - Hepatology
JF - Hepatology
SN - 0270-9139
IS - 3
ER -