Long-term clinical outcomes and short-term treatment efficacy evaluation based on longitudinal MR elastography in...

Magnetic resonance elastography (MRE) provides multiple quantitative biomarkers for assessing chronic liver disease. This study evaluated the prognostic value of MRE-based long-term liver stiffness (LS) changes in chronic hepatitis C virus (HCV) infection and explored short-term viscosity changes (loss modulus, LM) for monitoring responses to direct-acting antiviral treatment (DAA-Tx).

One hundred fifty-nine adults were included. We retrospectively analyzed 138 HCV participants with at least two 2D MREs, defining progression as an LS increase ΔLS ≥ 19% above baseline (LS_B), predicting liver-related events (LREs) with Kaplan-Meier plots and Cox proportional hazards regression. We also prospectively analyzed 21 participants, 11 of whom underwent DAA-Tx and ten healthy controls. Dual-frequency 3D MRE-derived LS, LM, and damping ratio (DR) were compared at five time points during DAA-Tx.

Among the 138 HCVs, 38 (27.5%) were progressors, with a ΔLS = 0.393 kPa/year; 11 developed LREs, showing a steeper rise of 0.614 kPa/year. LS_B and the combination of LS_B and ΔLS were significantly associated with LREs. Specifically, each 1 kPa increase in LS_B was associated with doubled risk of developing LREs [adjusted hazard ratio (aHR) = 2.05; C-statistic = 0.831, p < 0.001]. The combination of LS_B and ΔLS further improved predictive performance (aHR = 2.92; C-statistic = 0.883, p < 0.001). Progressors had a hazard ratio (HR) of 15.44 for developing cirrhosis (p < 0.001). LS decreased post-DAA-Tx, while LM initially increased (p < 0.05) and normalized by 12 months post-DAA-Tx.

Two-dimensional MRE-assessed longitudinal change in LS can predict future clinical events in HCV patients, providing better risk stratification than LS alone. Multiparametric dual-frequency 3D MRE has promise for short-term changes in treatment effects.

Question Accurately predicting clinical outcomes and monitoring direct-acting antiviral (DAA) treatment efficacy in HCV patients remains an unmet need. Findings Longitudinal LS changes predict future clinical events in HCV patients. Multiparametric dual-frequency 3D MRE detects short-term inflammatory and treatment-related changes, enhancing disease monitoring. Clinical relevance This study demonstrates longitudinal MRE as a reliable follow-up tool for chronic liver disease, enabling outcome prediction, risk stratification, and treatment monitoring, advancing personalized, non-invasive management for HCV patients.