Comparative diagnostic accuracy of magnetic resonance elastography vs. eight clinical prediction rules for non‐invasive diagnosis of advanced fibrosis in biopsy‐proven non‐alcoholic fatty liver disease: a prospective study

Summary Background Two‐dimensional magnetic resonance elastography (2D‐ MRE ) is an advanced magnetic resonance method with high diagnostic accuracy for predicting advanced fibrosis in non‐alcoholic fatty liver disease ( NAFLD ) patients. However, no prospective, head‐to‐head comparisons between 2D‐ MRE and clinical prediction rules ( CPR s) have been performed in patients with biopsy‐proven NAFLD . Aim To compare the diagnostic utility of 2D‐ MRE against that of eight CPR s ( AST : ALT ratio, APRI , BARD , FIB ‐4, NAFLD Fibrosis Score, Bonacini cirrhosis discriminant score, Lok Index and NASH CRN model) for predicting advanced fibrosis in a prospective cohort with paired liver biopsy as the gold standard. Methods This is a cross‐sectional analysis of a prospective study of 102 patients (58.8% women) with biopsy‐proven NAFLD , 2D‐ MRE and clinical research assessment within 90 days of biopsy. Receiver operating characteristic ( ROC ) analysis was performed to assess the performance of 2D‐ MRE and CPR s for predicting advanced fibrosis. Results The mean (± s.d. ) age and BMI were 51.3 (±14.0) years and 31.7 (±5.5) kg/m 2 respectively. 48, 26, 9, 13 and 6 patients had stage 0, 1, 2, 3 and 4 fibrosis respectively. The area under ROC curve ( AUROC ) was 0.957 for 2D‐ MRE and between 0.796 and 0.861 for the CPR s. FIB ‐4 was the best‐performing CPR at predicting advanced fibrosis with AUROC of 0.861. In head‐to‐head comparisons using the DeLong test, 2D‐ MRE had significantly better AUROC ( P < 0.05) than each CPR for predicting advanced fibrosis. Conclusion Compared to clinical prediction rules , 2D‐ MRE provides significantly higher accuracy for the diagnosis of advanced fibrosis in NAFLD patients.