Assessment of Liver Fibrosis and Steatosis in PBC With FibroScan, MRI, MR-spectroscopy, and Serum Markers

Background: In recent years noninvasive methods have been evaluated for the assessment of liver fibrosis predominantly in patients with viral hepatitis. In this study, transient elastography (FibroScan), magnetic resonance imaging (MRI), magnetic resonance (MR)-spectroscopy, and serum markers were compared in patients with primary biliary cirrhosis (PBC) for the assessment of liver fibrosis and steatosis. Methods: Forty-five patients with PBC and histologic assessment of liver fibrosis received transient elastography and examinations for serum markers of fibrosis and steatosis. In addition, 41 out of 45 patients received contrast-enhanced MRI and 38 Out of 45 patients received proton MR-spectroscopy. Results: The adjusted accuracy (area under the receiver operating characteristic) for the diagnosis of histologic-stage 11 for FibroScan, MRI-contrast enhancement and Forns index was 80%, 83%, and 69%, and for the diagnosis of liver cirrhosis 95%, 91%, and 94%, respectively. No correlation of histologic-stage was observed for FibroTest and AST to platelet ratio index. Histologic steatosis significantly correlated with body mass index (r = 0.46), the SteatoTest (r = 0.39), homeostasis model assessment of insulin resistance (r = 0.46), and MR-spectroscopy (r = -0.76). The accuracy for the diagnosis of histologic steatosis was best with MR-spectroscopy (88%). Conclusions: Contrast-enhanced MRI and FibroScan can be used with comparable results for the assessment of liver fibrosis in patients with PBC and seem to supplement each other. MR-spectroscopy represents the best method for highly accurate noninvasive measurement of liver steatosis.