Evaluation of MRI proton density fat fraction in hepatic steatosis: a systematic review and meta-analysis

IF 4.7 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING European Radiology Pub Date : 2024-09-10 DOI:10.1007/s00330-024-11001-1

Narges Azizi, Hamed Naghibi, Madjid Shakiba, Mina Morsali, Diana Zarei, Hedayat Abbastabar, Hossein Ghanaati

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Abstract

Background

Amidst the global rise of metabolic dysfunction-associated steatotic liver disease (MASLD), driven by increasing obesity rates, there is a pressing need for precise, non-invasive diagnostic tools. Our research aims to validate MRI Proton Density Fat Fraction (MRI-PDFF) utility, compared to liver biopsy, in grading hepatic steatosis in MASLD.

Methods

A systematic search was conducted across Embase, PubMed/Medline, Scopus, and Web of Science until January 13, 2024, selecting studies that compare MRI-PDFF with liver biopsy for hepatic steatosis grading, defined as grades 0 (< 5% steatosis), 1 (5–33% steatosis), 2 (34–66% steatosis), and 3 (> 66% steatosis).

Results

Twenty-two studies with 2844 patients were included. The analysis showed high accuracy of MRI-PDFF with AUCs of 0.97 (95% CI = 0.96–0.98) for grade 0 vs ≥ 1, 0.91 (95% CI = 0.88–0.93) for ≤ 1 vs ≥ 2, and 0.91 (95% CI = 0.88–0.93) for ≤ 2 vs 3, diagnostic odds ratio (DOR) from 98.74 (95% CI = 58.61–166.33) to 23.36 (95% CI = 13.76–39.68), sensitivity and specificity from 0.93 (95% CI = 0.88–0.96) to 0.76 (95% CI = 0.63–0.85) and 0.93 (95% CI = 0.88–0.96) to 0.89 (95% CI = 0.84–0.93), respectively. Likelihood ratio (LR) + ranged from 13.3 (95% CI = 7.4–24.0) to 7.2 (95% CI = 4.9–10.5), and LR − from 0.08 (95% CI = 0.05–0.13) to 0.27 (95% CI = 0.17–0.42). The proposed MRI-PDFF threshold of 5.7% for liver fat content emerges as a potential cut-off for the discrimination between grade 0 vs ≥ 1 (p = 0.075).

Conclusion

MRI-PDFF is a precise non-invasive technique for diagnosing and grading hepatic steatosis, warranting further studies to establish its diagnostic thresholds.

Clinical relevance statement

This study underscores the high diagnostic accuracy of MRI-PDFF for distinguishing between various grades of hepatic steatosis for early detection and management of MASLD, though further research is necessary for broader application.

Key Points

MRI-PDFF offers precision in diagnosing and monitoring hepatic steatosis.
The diagnostic accuracy of MRI-PDFF decreases as the grade of hepatic steatosis advances.
A 5.7% MRI-PDFF threshold differentiates steatotic from non-steatotic livers.

Graphical Abstract

Abstract Image

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评估肝脂肪变性的核磁共振质子密度脂肪分数：系统综述和荟萃分析

背景随着肥胖率的上升，代谢功能障碍相关性脂肪性肝病（MASLD）在全球范围内呈上升趋势，因此迫切需要精确、无创的诊断工具。我们的研究旨在验证核磁共振质子密度脂肪分数（MRI-PDFF）与肝活检相比在分级 MASLD 肝脂肪变性方面的效用。方法截至2024年1月13日，在Embase、PubMed/Medline、Scopus和Web of Science上进行了系统性检索，选择了将MRI-PDFF与肝活检进行肝脏脂肪变性分级比较的研究，定义为0级（5%脂肪变性）、1级（5-33%脂肪变性）、2级（34-66%脂肪变性）和3级（66%脂肪变性）。分析表明 MRI-PDFF 的准确性很高，0 级 vs ≥ 1 级的 AUC 为 0.97 (95% CI = 0.96-0.98)，≤ 1 vs ≥ 2 级的 AUC 为 0.91 (95% CI = 0.88-0.93)，≤ 2 vs 3 级的 AUC 为 0.91 (95% CI = 0.88-0.93)，诊断机率比 (DOR) 从 98.74（95% CI = 58.61-166.33）降至 23.36（95% CI = 13.76-39.68），敏感性和特异性分别从 0.93（95% CI = 0.88-0.96）降至 0.76（95% CI = 0.63-0.85）和 0.93（95% CI = 0.88-0.96）降至 0.89（95% CI = 0.84-0.93）。似然比 (LR) + 从 13.3（95% CI = 7.4-24.0）到 7.2（95% CI = 4.9-10.5）不等，LR - 从 0.08（95% CI = 0.05-0.13）到 0.27（95% CI = 0.17-0.42）不等。结论MRI-PDFF是一种诊断和分级肝脂肪变性的精确无创技术，值得进一步研究以确定其诊断阈值。本研究强调了 MRI-PDFF 在区分不同等级的肝脏脂肪变性以早期发现和治疗 MASLD 方面具有很高的诊断准确性，但要更广泛地应用还需要进一步的研究。

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来源期刊

European Radiology 医学-核医学

CiteScore

11.60

自引率

8.50%

发文量

874

审稿时长

2-4 weeks

期刊介绍： European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.