The following list has been reviewed and approved by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR).
|
LIVER |
|
Imaging method |
Validated biomarkers |
Evidence for use (guidelines, PMID ref) |
Diagnostic accuracy |
Limitations |
Data acquisition requirements |
Image processing algorithm |
|
Metabolic |
Steatosis |
Ultrasonography |
Increased liver echogenicity |
Meta-analyses (Bohte AE et al. Eur Radiol 2011 ; Hernaez R et al. Hepatology 2011) and guidelines (EASL in J Hepatol 2016) |
AUROC > 0.8 |
Limited accuracy in patients with grade 1 steatosis or obesity (EASL in J Hepatol 2016) |
No |
No |
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CT |
Decreased density |
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Limited accuracy in patients with mild (grade 1) steatosis and in patients with concomitant steatosis and iron overload Radiation burden |
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MRS |
Fat peak |
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AUROC > 0.9 |
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spectroscopy |
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MRI |
Proton density fat fraction |
guidelines (EASL in J Hepatol 2016) |
AUROC > 0.9 |
|
Proton density weighted multiecho gradient echo imaging |
Corrections for T2* and multiple peaks of triglycerides |
|
|
Fibrosis |
Ultrasonography |
Stiffness at transient elastography (Fibroscan) |
|
AUROC > 0.8 for septal fibrosis and > 0.9 for cirrhosis |
Reliable results in 80% of patients Limited accuracy in obese patients and patients with ascites |
Mechanical transducer |
Mechanical wave speed |
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Stiffness at shear wave elastography (ARFI and SSI) |
Meta-analysis (Nierhoff J Eur Radiol 2013) |
AUROC ≥ 0.85 for septal fibrosis and cirrhosis |
|
Mechanical transducer |
Mechanical wave speed |
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MRI |
Visco-elasticity at MRE |
Meta-analysis (Su et al Clin radiol 2014) and systematic review (Van Beers, Semin Liv Dis 2017) |
AUROC about 0.9 for septal fibrosis and > 0.9 for cirrhosis (significantly higher than Fibroscan and ARFI in septal fibrosis (Imajo et al. Gastroenterology 2016; Nierhoff J Eur Radiol 2013) |
|
Mechanical transducer |
Inversion algorithm |
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Iron overload |
CT |
Increased density |
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Limited accuracy in patients with concomitant iron overload and steatosis
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MRI |
R2* and R2 |
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LIVER |
|
Imaging method |
Biomarkers in development/ not recommended |
Evidence for use (guidelines, PMID ref) |
|
Limitations |
Data acquisition requirements |
Image processing algorithm |
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Steatosis |
Ultrasonography |
Attenuation of longitudinal (CAP) or shear waves |
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Sound of speed |
Single center studies |
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CT |
Dual energy CT |
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Fibrosis |
MRI |
ADC |
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T1 |
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Hepatobiliary enhancement |
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Iron overload |
MRI |
Magnetic susceptibility |
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Inflammation |
MRI |
Visco -elasticity |
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USPIO enhancement |
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