Automated, quantitative liver assessment to help address a silent epidemic

A silent epidemic is occurring worldwide and it doesn’t show signs of slowing down. It’s not COVID, rather, it’s nonalcoholic fatty liver disease (NAFLD) and it affects an estimated 25% of the world’s population – and possibly up to 40% of Americans.^1,2 NAFLD is the direct result of increasing rates of obesity and NAFLD is one of the leading causes of chronic liver disease and liver transplantation.² For most suspected NAFLD patients, the progression of liver fibrosis is the most critical component of the diagnosis.

While biopsy has traditionally been used for diagnosing NAFLD, it is painful, expensive and can lead to complications. MR elastography (MRE), invented at Mayo Clinic (Rochester, MN USA), is an accurate noninvasive technique for detecting and staging liver disease with the potential to replace biopsy.³ MRE is currently recognized by the American Gastroenterological Association, the American Association for the Study of Liver Diseases, and the American College of Radiologists as the recommended exam for assessing and staging of liver fibrosis. Because ultrasound techniques may suffer from technical failure in larger-sized patients, these guidelines note that MRE is particularly preferred in patients with elevated BMI who are more likely to be at-risk for nonalcoholic steatohepatitis (NASH).

“MRE is becoming the gold standard for answering the very difficult question of how much fibrosis or cirrhosis has developed in a patient’s liver,” says Randall Stenoien, CEO, MD, Houston Medical Imaging.

Houston Medical Imaging has implemented GE Healthcare’s MRE solution, MR Touch, and IDEAL IQ for quantitative liver fat fraction/ iron assessment, to help physicians manage patients with NAFLD or hepatic dysfunction. At Mayo clinic, this rapid, comprehensive MRI protocol has become known as a Hepatogram.

Dr. Stenoien expects continued growth in the demand for MRE and proton density fat fraction (PDFF) imaging as new therapeutics are anticipated in 2023. However, as MRE orders grow, ensuring consistent and reproducible results is an important consideration.

“We would typically schedule these exams only on certain days when our lead technologist was available,” Dr. Stenoien explains. “As with any newer imaging technology, it can be difficult to achieve consistent results when volumes are still ramping up.”

That has all changed with the introduction of Hepatogram plus+, a comprehensive reporting solution (Resoundant, Rochester, MN). Hepatogram plus+ automates the MRE and PDFF analyses by creating ROIs with the highest data reliability for each acquisition. It is designed to be a rapid, comprehensive snapshot of the most clinically actionable parameters and the essential workflow complement to MR Touch and IDEAL IQ, enabling fast and consistent analysis. This improved and quantitative workflow can greatly reduce inter-reader variability and exam time/costs.

Figure 1. Example of a Hepatogram plus+ report.

With Hepatogram plus+, Dr. Stenoien gets good results regardless of the technologist who performs the exam, removing prior scheduling considerations. The solution is automated, so any radiologist can review the study and deliver consistent, actionable results.

“With Hepatogram plus+, it is much easier to review and confirm a high quality liver study. Additionally, we can add the rich content to our reports,” Dr. Stenoien says. “Now, hepatologists and gastroenterologists can see the MRE and PDFF images along with corresponding quantitative data to develop the best care plan. Further, they can share the report with their patients to educate them on lifestyle and behavior modifications.”

He adds, “Whether you’re just getting started and are looking for higher repeatability, or if you’re a high-volume MRE/PDFF practice looking for richer reporting, Hepatogram plus+ is an essential component to a high-quality NAFLD/NASH diagnosis.”