Monitoring of antiviral treatment with MR elastography in chronic hepatitis patient: Feasibility study
Yong Eun Chung1, Mi-Suk Park1, Seung Up Kim1, Beom Kyung Kim1, and Myeong-Jin Kim1

1Yonsei University College of Medicine, Seoul, Korea, Republic of


Multi-parametric MR including MR elastography (MRE), IDEAL IQ and diffusion weighted image were performed in patients with chronic liver disease. Among them, 15 patients were treated with antiviral agents which could improve liver fibrosis. In patients who underwent antiviral treatment, liver stiffness measured by MRE after treatment was significantly decreased. Liver stiffness in non-treated group and other MR parameters in both groups were not significantly changed. In conclusion, MRE could be used for the response evaluation of antiviral therapy in patients with chronic hepatitis


Along with the development of antiviral treatments, liver fibrosis has become a treatable disease if diagnosed early. Hence, it is necessary to diagnose liver fibrosis earlier and to evaluate the therapeutic effect. Liver biopsy is the golden standard methods for the diagnosis of liver fibrosis, but it is difficult to perform repeatedly, due to invasiveness. Recently, MR elastography (MRE) has been reported to be accurate for diagnosis liver fibrosis.1-3 The purpose of this study was to investigate the feasibility of MRE as a monitoring tool in patients who underwent antiviral therapy


This study enrolled 24 patients (mean age, 56.2±11.0 years; male, 33.3%) who had chronic liver disease confirmed by liver biopsy. Of those patients, 15 received antiviral treatment (group A) and the remaining 9 received no treatment (group B). Multi-parametric MR were obtained in all patients before and after antiviral treatment in 3T MR system (Discovery 750w 3.0T, GE healthchare) with a 32-channel torso coil. MRI protocol includes IDEAL IQ, diffusion weighted image (DWI), and MRE. Proton density fat fraction (PDFF), R2* value, ADC value, and liver stiffness were compared between the two groups. All MR parameters were also compared before and after antiviral treatment in two groups. A P value less than 0.05 were considered as statistically significant.


There were no significant difference in age (P=0.570) and sex (P>0.999) between group A (57.3±11.5 years old; 33.3%) and group B (54.6±10.5 years old; 33.3%). The interval between the pre-treatment MR and the post-treatment MR was 454.5 (standard deviation, ±102.1) days, and that between the pre-treatment MR and liver biopsy was 52.7 (±49.2) days. There was no difference in fibrosis stage between the two groups (P=0.782). In pretreatment MRI, all MR parameters were not significantly different between group A and group B (Figure 1). Compared to pretreatment, liver stiffness on MRE after antiviral treatment was significantly decreased in group A (4.2 kPa to 3.5 kPa, P=0.040), but there was no difference in group B (4.6 kPa to 3.9 kPa, P=0.076, Figure 2). PDFF, R2* and ADC were not significant different between before and after antiviral treatment in both groups (P>0.05)


Antiviral therapy has been reported to improve liver fibrosis.4 Previous studies used fibroscan, one of the noninvasive methods, to measure changes in liver fibrosis.4 However, MRE has better diagnostic accuracy than fibroscan in liver fibrosis assessment.5 According to our results, liver stiffness decreased only in the antiviral treatment group, which suggested that MRE can be used as a non-invasive diagnostic tool for evaluating treatment response of antiviral agents.


MRE might be used for the evaluation of treatment response of antiviral agents in patients with chronic hepatitis


No acknowledgement found.


1. Jayakumar S, Middleton MS, Lawitz EJ, et al. Longitudinal correlations between MRE, MRI-PDFF, and liver histology in patients with non-alcoholic steatohepatitis: Analysis of data from a phase II trial of selonsertib. J Hepatol 2018; doi:10.1016/j.jhep.2018.09.024. in press

2. Singh S, Venkatesh SK, Wang Z, et al. Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data. Clin Gastroenterol Hepatol 2015;13:440-451.e446.

3. Loomba R, Sirlin CB, Ang B, et al. Ezetimibe for the treatment of nonalcoholic steatohepatitis: assessment by novel magnetic resonance imaging and magnetic resonance elastography in a randomized trial (MOZART trial). Hepatology 2015;61:1239-1250.
4.Chon YE, Park JY, Myoung SM, et al. Improvement of Liver Fibrosis after Long-Term Antiviral Therapy Assessed by Fibroscan in Chronic Hepatitis B Patients With Advanced Fibrosis. Am J Gastroenterol 2017;112:882-891.

5.Xiao H, Shi M, Xie Y, Chi X. Comparison of diagnostic accuracy of magnetic resonance elastography and Fibroscan for detecting liver fibrosis in chronic hepatitis B patients: A systematic review and meta-analysis. PLoS One 2017;12:e0186660.


Figure 1. MR parameters were not significantly different between two groups in pretreatment MR

Figure 2. Liver stiffness measured by MR elastography was significantly decreased after antiviral treatment only in treatment group.

Proc. Intl. Soc. Mag. Reson. Med. 27 (2019)