A new study shows that an imaging technology developed by Mayo Clinic researchers can identify liver fibrosis with high accuracy and help eliminate the need for liver biopsies. Liver fibrosis is a common condition that can lead to incurable cirrhosis if not treated in time.

The technology, called magnetic resonance elastography (MRE), produces color-coded images known as elastograms that indicate how internal organs, muscles and tissues would feel to the touch. Red is the stiffest; purple, the softest. Other imaging techniques do not provide this information.

“Knowing the liver’s elasticity or stiffness is invaluable in diagnosing liver disease,” says Jayant Talwalkar, M.D., M.P.H., a Mayo Clinic hepatologist and co-investigator on the study. “A healthy liver is very soft, while a liver with early disease begins to stiffen. A liver with cirrhosis, advanced liver disease, can be rock hard.”

The study, which included 113 patients, will be presented Nov. 3 at The Liver Meeting, an annual gathering of the American Association for the Study of Liver Disease, in San Francisco. Study participants had undergone liver biopsy in the year preceding the study and had a wide variety of liver diseases, including nonalcoholic and alcoholic fatty liver disease, hepatitis C, hepatitis B, autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis. Patients ranged in age from 19 to 78, and their body weight ranged from normal to severely obese.

“Results showed that elastography was highly accurate in detecting moderate-to-severe hepatic fibrosis even with the variety in age, types of liver disease and body size,” says Dr. Talwalkar. Among the study’s findings:

* The detection of cirrhosis by MRE when compared to liver biopsy results was 88 percent accurate.

* Patients with nonalcoholic fatty liver disease and no significant inflammation or fibrosis were identified with 97 percent accuracy.

“Using MRE, we can confidently avoid liver biopsies for patients with no evidence of advanced fibrosis, as well as for patients with cirrhosis,” says Dr. Talwalkar.

Liver biopsies, conducted by extracting tissue samples with a needle, can underestimate the degree of hepatic fibrosis about 20 to 30 percent of the time because of the patchy distribution of fibrosis that occurs in the liver. Another drawback is that since liver biopsy is invasive, patients may be reluctant to have a biopsy performed and sometimes delay the procedure when liver disease is first suspected, says Dr. Talwalkar.

“Our goal in hepatology is to be able to diagnose liver disease early so that novel as well as established therapies can be provided to our patients,” says Dr. Talwalkar. Treatment and lifestyle changes can help stop the progression of hepatic fibrosis to liver cirrhosis and liver failure, which would eventually require a liver transplant.

The incidence and prevalence of chronic liver disease is increasing in the United States. Nonalcoholic fatty liver disease has become the most common liver disease and is linked to the growing numbers of patients with obesity and diabetes. The number of patients seeking medical care for hepatitis C is also increasing. This disease, spread by coming into contact with blood contaminated by the virus, slowly damages the liver over decades.

MRE research began at Mayo Clinic about 10 years ago. The technology measures low-frequency acoustic waves transmitted into the abdomen. The wave motions measured are miniscule, 0.01 of the width of a human hair.

The noninvasive procedure takes seconds to conduct. Mayo Clinic is already using MRE to diagnose patients with liver conditions. Research is under way to study how MRE might aid in the diagnosis of Alzheimer’s disease and some cancers.

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No simple blood test exists to determine which of the millions of people infected with hepatitis C virus will develop cirrhosis of the liver or cancer. Now, researchers are developing new technology to find blood proteins that herald the earliest signs of chronic liver disease. If successful, they hope to extend the use of the technology, and to do the same for many other diseases and to make it commercially available for broad clinical use.

Washington State’s Life Sciences Discovery Fund Board of Trustees has announced that the collaboration between scientists at the Department of Energy’s Pacific Northwest National Laboratory and the University of Washington Liver Transplantation Program in Seattle will receive $4.8 million over the next three years to develop a new proteomics technology and apply it in search of biomarkers for liver disease.

“This is really fantastic,” says grant recipient and lead investigator Dick Smith of PNNL. “This funding will support work that is almost impossible to get funded by conventional sources. The grant brings together a larger program that could have significant positive impacts on the health of people, certainly in Washington, but in the whole country as well.”

The announcement caps a lengthy selection process by LSDF. “This has been a highly-competitive process. The proposals were weighed on their scientific merits and their abilities to utilize this funding to provide statewide economic returns, to build a competitive life sciences industry and to advance the health of, and health care for, our citizens. These newly-awarded grants will leverage substantial additional investment in Washington State by a variety of other funders such as federal agencies and philanthropic organizations,” says LSDF Executive Director Lee Huntsman.

About 1.6 percent of the U.S. population has signs indicating they have been or are infected with hepatitis C virus, and up to 12,000 people each year die from HCV-induced liver damage and cancer. A percentage of infected people develop various levels of liver disease — the worst requiring liver transplants — but doctors have no way of telling who’s most at risk.

PNNL’s Smith is leading development of the new technology at DOE’s Environmental Molecular Sciences Laboratory on the PNNL campus. In collaboration with UW’s Michael Katze, Smith’s group with use proteomics to compare blood and tissue samples from individuals who have advanced liver disease or are healthy to find proteins that indicate the potential for advanced illness.

The researchers’ long term goal is to make such technology efficient and inexpensive enough for use in clinical settings. In addition, Smith’s development plans include making the technology widely applicable to biomarker searches for other diseases.

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