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BACKGROUND & AIMS: With the increasing prevalence of liver disease worldwide, there is an urgent clinical need for reliable methods to diagnose and stage liver pathology. Liver biopsy, the current gold standard, is invasive and limited by sampling and observer dependent variability. In this study, we aimed to assess the diagnostic accuracy of a novel magnetic resonance protocol for liver tissue characterisation. METHODS: We conducted a prospective study comparing our magnetic resonance technique against liver biopsy. The individual components of the scanning protocol were T1 mapping, proton spectroscopy and T2* mapping, which quantified liver fibrosis, steatosis and haemosiderosis, respectively. Unselected adult patients referred for liver biopsy as part of their routine care were recruited. Scans performed prior to liver biopsy were analysed by physicians blinded to the histology results. The associations between magnetic resonance and histology variables were assessed. Receiver-operating characteristic analyses were also carried out. RESULTS: Paired magnetic resonance and biopsy data were obtained in 79 patients. Magnetic resonance measures correlated strongly with histology (r(s)=0.68 p<0.0001 for fibrosis; r(s)=0.89 p<0.001 for steatosis; r(s)=-0.69 p<0.0001 for haemosiderosis). The area under the receiver operating characteristic curve was 0.94, 0.93, and 0.94 for the diagnosis of any degree of fibrosis, steatosis and haemosiderosis respectively. CONCLUSION: The novel scanning method described here provides high diagnostic accuracy for the assessment of liver fibrosis, steatosis and haemosiderosis and could potentially replace liver biopsy for many indications. This is the first demonstration of a non-invasive test to differentiate early stages of fibrosis from normal liver.

Original publication




Journal article


J Hepatol

Publication Date





69 - 77


(1)H MRS, ANOVA, AUROC, Analysis of Variance, Area Under the Receiver Operating Characteristic Curve, BMI, Body Mass Index, CPA, CoV, Coefficient of Variance, Collagen Proportionate Area, HLC, Hepatic Lipid Content, Iron corrected T1, Liver fibrosis, Liver haemosiderosis, Liver steatosis, MR, Magnetic Resonance, Magnetic resonance T1 mapping, Magnetic resonance T2(⁎) mapping, NAFLD, Non-Alcoholic Fatty Liver Disease, Proton Magnetic Resonance Spectroscopy, Proton magnetic resonance spectroscopy, ROI, Region of interest, shMOLLI, shortened Modified Look Locker Inversion, Adolescent, Adult, Aged, Biopsy, Fatty Liver, Female, Humans, Iron, Liver, Liver Cirrhosis, Liver Diseases, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, Male, Middle Aged, Prospective Studies