Magnetic resonance elastography can predict development of hepatocellular carcinoma with longitudinally acquired...

To evaluate the usefulness of longitudinal observation of liver stiffness measured using magnetic resonance elastography (MRE) to stratify the risk of hepatocellular carcinoma (HCC) in patients with chronic liver disease.

We retrospectively reviewed data for 161 patients with chronic liver disease using the following inclusion criteria: two MRE examinations separated by at least a 12-month interval, no history of HCC, no development of HCC between the two examinations and availability of laboratory results. Liver stiffness was classified as low (< 3 kPa), moderate (3-4.7 kPa) or high (> 4.7 kPa). The patients were divided into three groups according to sequential changes in liver stiffness as follows: high on the first MRE (group A, n = 60), low on both MRE examinations (group C, n = 36) and other combinations (group B, n = 65). Cox analyses and Kaplan-Meier methods were used to determine the risk of developing HCC.

Forty-seven patients (29.2%) developed HCC during follow-up (46.7% [28/60] in group A, 26.2% [17/65] in group B, and 5.6% [2/36] in group C). There was a significant difference in the rate of development of HCC between groups A (45.1%), B (26.1%) and C (12.4%) at 3 years (p = 0.0002). The independent risk factors for development of HCC were group A classification, age and a high alanine aminotransferase level (risk ratio 1.018-6.030; p = 0.0028-0.0268).

Longitudinal observation of liver stiffness using MRE can stratify the risk of HCC during follow-up of chronic liver disease.

• The results of MRE can stratify the risk for development of HCC during follow-up in patients with chronic liver disease. • Patients with chronic liver disease and high liver stiffness (> 4.7 kPa) on a previous MRE examination are at high risk for developing HCC, regardless of current liver stiffness. • Management of patients with chronic liver disease becomes more appropriate using longitudinally acquired two-point MRE data.