Diagnostic Value of MR Elastography and MRI-Proton Density Fat Fraction in Cirrhosis Based on Explant Liver Histology

Abstract

Background and aims: Accurate assessment of advanced fibrosis and steatosis is essential for prognostication in chronic liver disease. This study aimed to evaluate the diagnostic performance of MRI in assessing liver fibrosis and steatosis in patients undergoing liver transplantation (LT). Methods: Patients who underwent LT between January 2019 and December 2023 with pretransplant MR elastography (MRE) and MRI-based proton density fat fraction (MRI-PDFF) examinations were included. Explanted livers were assessed for fibrosis and steatosis, with cirrhosis subclassified using the Laennec system. Diagnostic performance was evaluated using area under the receiver operating characteristic curve (AUC) analysis. Results: Among 187 patients (median age, 57 years), 72.2% were male. Hepatitis B virus (55%) and alcoholic liver disease (21.4%) were the most common etiologies. The median Model for End-Stage Liver Disease (MELD) score was 11. MRE detected cirrhosis (F4) with an AUC of 0.92 (95% confidence interval [CI], 0.87-0.97) and severe cirrhosis (F4c) with an AUC of 0.85 (95% CI, 0.79-0.91), at threshold values of 4.76 and 6.43 kPa, respectively. MRI-PDFF identified steatosis with an AUC of 0.83 (95% CI, 0.76-0.89) at a threshold of 2.80%. Comparisons of patients stratified by the threshold values for cirrhosis and severe cirrhosis revealed significant differences in MELD scores, history of portal hypertension-related complications, liver function parameters, and intraoperative transfusion requirements (all p < 0.05). Conclusions: MRI demonstrated high diagnostic accuracy for detecting cirrhosis and steatosis in patients with advanced fibrosis undergoing LT. MRE further stratified cirrhosis severity, suggesting clinical applicability in cirrhosis staging and risk assessment.