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. 2016 Jan;43(1):83-95.
doi: 10.1111/apt.13405. Epub 2015 Sep 15.

Non-invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE

I Doycheva  1 , J Cui  1 , P Nguyen  1   2 , E A Costa  3 , J Hooker  3 , H Hofflich  4 , R Bettencourt  5 , S Brouha  6 , C B Sirlin  3 , R Loomba  1   2   5
Affiliations

Non-invasive screening of diabetics in primary care for NAFLD and advanced fibrosis by MRI and MRE

I Doycheva et al. Aliment Pharmacol Ther. 2016 Jan.

Abstract

Background: Current guidelines do not recommend screening for non-alcoholic fatty liver disease (NAFLD) or advanced fibrosis. Patients with type 2 diabetes mellitus (T2DM) are known to be at increased risk for NAFLD and advanced fibrosis.

Aim: To assess the feasibility in diabetics in a primary care setting of screening for NAFLD and advanced fibrosis, by using non-invasive magnetic resonance imaging (MRI) to estimate the hepatic proton density fat fraction (MRI-PDFF) and magnetic resonance elastography (MRE) to estimate hepatic stiffness.

Methods: We performed a cross-sectional analysis of a prospective study that included 100 (53% men) consecutively enrolled diabetics who did not have any other aetiology of liver disease. All patients underwent a standardised research visit, laboratory tests, MRI-PDFF, and MRE.

Results: Mean (±s.d.) age and body mass index (BMI) was 59.7 (±11.2) years and 30.8 (±6.5) kg/m(2) , respectively. The prevalence of NAFLD (defined as MRI-PDFF ≥5%) and advanced fibrosis (defined as MRE ≥3.6 kPa) was 65% and 7.1%, respectively. One patient with advanced fibrosis had definite hepatocellular carcinoma. When compared to those without NAFLD, patients with NAFLD were younger (P = 0.028) and had higher mean BMI (P = 0.0008), waist circumference (P < 0.0001) and prevalence of metabolic syndrome (84.6% vs. 40.0%, P < 0.0001). Only 26% of those with NAFLD had elevated alanine aminotransferase.

Conclusions: This proof-of-concept study demonstrates that T2DM has significant rates of both NAFLD and advanced fibrosis. Concomitant screening for NAFLD and advanced fibrosis by using MRI-proton density fat fraction and magnetic resonance elastography in T2DM is feasible and may be considered after validation in a larger cohort.

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Conflict of interest statement

All authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Prevalence of NAFLD and advanced fibrosis among patients with type 2 diabetes in primary care
Patients with type 2 diabetes in the primary care setting were screened for NAFLD with magnetic resonance imaging-estimated proton density fat fraction (MRI-PDFF). NAFLD was defined by the presence of hepatic steatosis ≥ 5% on MRI-PDFF. Screening for advanced fibrosis was performed using magnetic resonance elastography (MRE) with a threshold of 3.6 kPa to identify those with advanced fibrosis.
Figure 2
Figure 2
Figure 2A. Hepatic steatosis by MRI-PDFF (upper row) and liver stiffness by MRE (lower row) in 4 different patients. (A) Example of a patient with no NAFLD and no advanced fibrosis, (B) patient with NAFLD, but no advanced fibrosis, (C) patient without NAFLD, but with advanced fibrosis, and (D) patient with both NAFLD and advanced fibrosis. Fat fraction on MRI-PDFF was expressed in percentages and liver stiffness in kPa, shown underneath each image. Figure 2B. MRI-PDFF, MRE, and Gadoxetic acid-enhanced 3T MRI of the patient with hepatocellular carcinoma. (A) MRI-PDFF shows 5.8 % hepatic steatosis, (B) MRE shows significant liver stiffness of 6.8 kPa, (C1) Pre-contrast 3D MRI image, (C2) Late arterial phase image shows 3-cm hyperenhancing lesion (arrow) in segment VI of the liver, (C3) Portal venous phase with definite “washout” (arrow) and “capsule” (arrowhead) of the lesion, typical features confirming the diagnosis of HCC; (C4) Hepatobiliary phase reveals markedly hypointense lesion (arrow)
Figure 2
Figure 2
Figure 2A. Hepatic steatosis by MRI-PDFF (upper row) and liver stiffness by MRE (lower row) in 4 different patients. (A) Example of a patient with no NAFLD and no advanced fibrosis, (B) patient with NAFLD, but no advanced fibrosis, (C) patient without NAFLD, but with advanced fibrosis, and (D) patient with both NAFLD and advanced fibrosis. Fat fraction on MRI-PDFF was expressed in percentages and liver stiffness in kPa, shown underneath each image. Figure 2B. MRI-PDFF, MRE, and Gadoxetic acid-enhanced 3T MRI of the patient with hepatocellular carcinoma. (A) MRI-PDFF shows 5.8 % hepatic steatosis, (B) MRE shows significant liver stiffness of 6.8 kPa, (C1) Pre-contrast 3D MRI image, (C2) Late arterial phase image shows 3-cm hyperenhancing lesion (arrow) in segment VI of the liver, (C3) Portal venous phase with definite “washout” (arrow) and “capsule” (arrowhead) of the lesion, typical features confirming the diagnosis of HCC; (C4) Hepatobiliary phase reveals markedly hypointense lesion (arrow)
Figure 3
Figure 3
Prevalence of NAFLD and advanced fibrosis in different age groups.
Figure 4
Figure 4
Estimated population with NAFLD and advanced fibrosis in type 2 diabetes based on diabetes prevalence in 2012 and results of our study
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Comment in

References

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