Magnetic resonance elastography biomarkers for detection of histologic alterations in nonalcoholic fatty liver disease in the absence of fibrosis

To investigate associations between histology and hepatic mechanical properties measured using multiparametric magnetic resonance elastography (MRE) in adults with known or suspected nonalcoholic fatty liver disease (NAFLD) without histologic fibrosis. This was a retrospective analysis of 88 adults who underwent 3T MR exams including hepatic MRE and MR imaging to estimate proton density fat fraction (MRI-PDFF) within 180 days of liver biopsy. Associations between MRE mechanical properties (mean shear stiffness (|G*|) by 2D and 3D MRE, and storage modulus (G'), loss modulus (G''), wave attenuation ($\alpha$), and damping ratio ($\zeta$) by 3D MRE) and histologic, demographic and anthropometric data were assessed. In univariate analyses, patients with lobular inflammation grade $\ge$2 had higher 2D |G*| and 3D G'' than those with grade $\le$1 (p = 0.04). |G*| (both 2D and 3D), G', and G'' increased with age (rho = 0.25 to 0.31; p $\le$0.03). In multivariable regression analyses, the association between inflammation grade $\ge$2 remained significant for 2D |G*| (p = 0.01) but not for 3D G'' (p = 0.06); age, sex, or BMI did not affect the MRE-inflammation relationship (p > 0.20). 2D |G*| and 3D G'' were weakly associated with moderate or severe lobular inflammation in patients with known or suspected NAFLD without fibrosis. With further validation and refinement, these properties might become useful biomarkers of inflammation. Age adjustment may help MRE interpretation, at least in patients with early-stage disease.