MRI-PDFF as a New Paradigm in the Longitudinal Follow-up of Patients with Liver Steatosis
Background: Hepatic steatosis linked to metabolic syndrome (MS) can lead to liver fibrosis, decompensation of liver cirrhosis and hepatocarcinoma (HCC).However, the focus of attention is usually on accessing hepatic fibrosis rather than accessing inflammation, when it would be more possible to intervene and minimize consequences.Objective: Put into perspectives the current new concepts in liver steatosis and diagnose image methods for steatosis with liver Ultrasound (US), computerized tomography (CT), Magnetic Resonance Imaging (MRI), Magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) and other noninvasive marks of liver fibrosis and steatosis and the relationship of improvement in liver steatosis inflammation.Design: Review of recent medical literature about the new concepts in Metabolic Association Fatty Liver Disease (MAFLD), new noninvasive diagnostic features for Non-Alcoholic Fatty Liver Disease (NAFLD) and the impact of nonalcoholic steatohepatitis (NASH) trials in access the improvement in liver steatosis and the correlation with improvement in histologic liver inflammation.Salient Features: There is a correlation between improvement in liver steatosis accessed by MRI-PDFF and improvement in liver histologic NASH.Conclusions: MRI-PDFF has established itself as a reliable standard for longitudinally assessing hepatic steatosis, as it is accurate, non-invasive and because variation in fat percentage correlates with NASH resolution and hepatocyte ballooning, being a new paradigm to predict response in NASH trials.Furthermore, a focus on resolving inflammation is likely to be associated with better outcomes in NAFLD and MAFLD.