Fibrosis Staging
MR Elastography (MRE) measures stiffness by assessing four images across the entire liver, resulting in a comprehensive and incredibly accurate diagnosis not available with other non-invasive technologies. In addition to a stiffness score measured in kPa, clinicians and patients often receive color-coded maps of their liver fibrosis, called Elastograms. In these intuitive maps, red corresponds to highly advanced fibrosis, while purple represents healthy liver tissue.
When to use MRE
MR Elastography is able to overcome many confounding factors that can impact the performance in other non-invasive technologies. Notably for fatty liver disease, this most often includes BMI and increased waist circumference, as ultrasound-based elastography (e.g., Fibroscan®) methods often perform poorly in these patient groups.
Because MRE is not affected by waist circumference or obesity, clinical guidelines recommend that MRE be incorporated into the clinical workflow to reliably estimate the degree of fibrosis present. Clinicians may also request fat fraction measurements (for steatosis), inflammation, and/or malignancy via traditional MR workup, resulting in a powerful and comprehensive liver assessment.
BMI ≤ 20
BMI ≥ 25
BMI ≥ 30
Clinical guidance suggests that the utilization of MR Elastography increases as BMI increases
MR Elastography for Liver Fibrosis Assessment
Recommended in
Clinical Guidelines
“In adults with NAFLD and a higher risk of cirrhosis, MRE is suggested, rather than VCTE, for detection of cirrhosis”
American Gastroenterological Association Institute Guideline on the Role of Elastography in the Evaluation of Liver Fibrosis (2017)
"MRE is excellent for identifying varying degrees of fibrosis in patients with NAFLD."
The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance From the American Association for the Study of Liver Diseases (2017)
"MR elastography is the most accurate method for diagnosing liver fibrosis non-invasively because it assesses the whole liver and can stage liver fibrosis."
American College of Radiology Appropriateness Criteria®: Chronic Liver Disease (2017)
≥F2
Magnetic Resonance Elastography
.94
≥F4
.84
≥F3
≥F1
.70
.80
.90
1.00
AUROC
Transient Elastography
.84
Performance
In a pooled analysis of data from individual participants with NAFLD in 3 independent studies, MRE demonstrated a significantly higher diagnostic accuracy than TE for the detection of individual stages of fibrosis using liver biopsy as a reference.
Hsu, C., et al. Magnetic Resonance Elastography versus Transient Elastography in detection of fibrosis in nonalcoholic fatty liver disease: A systematic review and meta-analysis of individual participant data. Poster presented at ILC 2018, April 13, 2018, Paris, France.
Are Your Patients Responding to Therapy?
MRE provides highly sensitive and comprehensive assessment to treatment response, something previously not possible with traditional T2w MR imaging.
A 57-YEAR-OLD MALE PATIENT WITH CHRONIC HEPATITIS C
Baseline liver stiffness = 4.2 kPa ± 0.88
3-year follow-up liver stiffness = 2.80 kPa ± 0.69
Decreasing liver stiffness indicating response to treatment
Can You Monitor Fibrosis in All of Your Patients?
MRE was developed specifically to provide the most accurate and
complete diagnosis for all patient populations.
30-year-old male with severe ascites
BMI = 17 kg/m2
Chronic cholecystitis due to biliary stone
Liver stiffness = 11.5 ± 0.88 kPa
Liver biopsy 13 months ago: inflammation
grade = 2; fibrosis stage = 0-1
55-year-old male with NAFLD
BMI = 48 kg/m2
Liver biopsy: inflammation grade = 1 fibrosis stage = 1
Liver stiffness: 3.95 ± 0.59 kPa
The MRE Report
Your patient is more than just a score. Show them their liver and find a new level of patient engagement.
"Seeing my liver and the state of disease for the first time was a very powerful, emotional moment - it left me speechless," recalls Deb.
"MRE painted a true picture of the PBC progression.
I used to be mad at my liver, but then I felt bad for it and decided to protect and take care of it as much as possible."
Accessibility
Beginning January 1, 2019, MR Elastography exams are reimbursed under Medicare Category I Current Procedural Terminology® (CPT) code:
76391 - magnetic resonance (eg, vibration)
Professional (-26) - $56.94
Technical (-TC) - $183.08
Global - $240.02
Moreover, the standalone MRE exam only takes 10 minutes on average, compared to 30-45 minutes for a full abdominal MR examination. Resoundant is proud to have worked with the American College of Radiology in support of this new code and level of accessibility for MRE.
While referring physicians now have the option of a rapid, standalone MRE exam for fibrosis assessment, MRE also remains available to clinicians as an add-on to a traditional abdominal MR exam.
Note: MRE may be a covered benefit if such usage meets all requirements established by the particular payer. However, it is advisable that you verify coverage policies with your local Medicare Administrative Contractor.
Value
As part of a comprehensive MRI-based liver assessment for fibrosis, steatosis, inflammation, iron and malignancy, an MR diagnostic pathway is often less expensive than a multi-modality approach, which can increases cost, inconvenience, and entries into the patient record.
This makes an MR-based liver assessment, powered by MR Elastography, a cost-effective solution.
€161
Liver Ultrasound
FibroTest
Transient Elastography
€69
MRI/MRE/PDFF
France
$744
€387
€278
€299
€186
€228
€167
€230
€129
$569
Switzerland
UK
Spain
Germany
US
While the costs for each exam
can differ significantly,
an MR diagnostic pathway
is 52% less expensive on average
than a multi-modality pathway
in OECD countries
All figures in Euros except for the U.S. All MRI scans were abdominal MRI protocols with contrast. Ultrasound exams were also priced with contrast. Coverage varied greatly based on country for each procedure. Figures are mainly sourced from publicly available reimbursement data in each country. When no public coverage was offered, we sourced retail rates for exams via online practice search, emails and phone calls.
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