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

作者：Doycheva I; Cui J; Nguyen P; Costa E A; Hooker J; Hofflich H; Bettencourt R; Brouha S; Sirlin C B; Loomba R^*

来源：Alimentary Pharmacology and Therapeutics, 2016, 43(1): 83-95.

DOI：10.1111/apt.13405

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.

• 出版日期2016-1