Chronic Liver Disease: Assessing Inflammation and Fibrosis Using Three‐Dimensional MR Elastography With Same‐Day Biopsy in a Prospective Cohort

BACKGROUND: Three-dimensional (3D) MR elastography (MRE) derives viscoelastic parameters that may reflect inflammation, but their frequency dependence and the influence of steatosis on inflammation grading and fibrosis staging remain unclear. PURPOSE: To investigate 3D multifrequency MRE for assessing hepatic inflammation, fibrosis stage across frequencies, and the influence of steatosis. STUDY TYPE: Prospective. POPULATION: Sixty-four (40 men, median age: 58 years) participants with chronic liver disease (CLD); 21 (8 men, median age: 28 years) healthy volunteers. FIELD STRENGTH/SEQUENCE: 3-T; gradient-echo sequence with mechanical vibrations at low (16.7 and 18 Hz), medium (33.4 and 36 Hz), and high (50.1 and 54 Hz) frequencies. ASSESSMENT: In CLD participants, MRE-derived viscoelastic parameters, shear stiffness, storage modulus, loss modulus, and damping ratio were compared with histologically assessed fibrosis, inflammation, and steatosis. MRE test-retest repeatability over 10 min was evaluated in healthy volunteers. STATISTICAL TESTS: Wilcoxon rank sum test, Spearman's correlation, multivariable regression analysis, and area under the receiver operating curve (AUROC). A p value of < 0.05 was considered statistically significant. RESULTS: Inflammation was significantly independently associated with damping ratio at medium frequency, which showed moderate performance for grading inflammation (AUROC = 0.76-0.83, sensitivity = 0.83-0.84, specificity = 0.70-0.79). Fibrosis staging using shear stiffness and moduli showed high diagnostic performance (AUROC = 0.82-0.95), with comparable accuracy between medium and high frequencies (p = 0.327-0.896). Steatosis was not significantly correlated with MRE overall (p = 0.212-0.459), but was significantly associated with 19% higher stiffness and 20% higher loss modulus at medium frequency in CLD participants without fibrosis or inflammation. DATA CONCLUSION: Medium frequency 3D MRE demonstrated an independent association with inflammation while preserving accurate fibrosis assessment. Steatosis seemed not to confound MRE-based evaluation. TECHNICAL EFFICACY: Stage 2.