Hepatitis Activity Should Be Considered a Confounder of Liver Stiffness Measured With MR Elastography

PurposeTo evaluate the effect of hepatitis activity on liver stiffness measurements and the role of serum alanine aminotransferase (ALT) in liver fibrosis staging by MR elastography (MRE). Materials and MethodsWe measured liver stiffness (kPa) in 135 patients by MRE and histologically assessed fibrosis and hepatitis activity within 2 months. Stepwise multiple linear regression was performed to determine the maximum adjusted R-2 against liver stiffness, after adjusting for nothing (model 1), ALT/upper limit of normal categories (model 2), and hepatitis activity (A grade) by METAVIR (model 3). Logistic regression was used to identify independent factors associated with pathologically proven cirrhosis. ResultsPlatelet count and METAVIR F score were strongly associated with liver stiffness. The adjusted R-2 value of model 3 (0.7026) was higher than those of models 1 (0.6472) and 2 (0.6564), showing that hepatitis activity affected liver stiffness measurement. High ALT levels (odds ratio, 0.0066; P=0.0003) as well as MRE (odds ratio, 9.91; P<0.0001) were independently associated with cirrhosis. ConclusionHepatitis activity may be a confounder of liver stiffness measurement during liver fibrosis staging using MRE. MRE can potentially make an overdiagnosis of liver cirrhosis if the patient has high ALT levels. J. Magn. Reson. Imaging 2015;41:1203-1208. (c) 2014 Wiley Periodicals, Inc.