Magnetic resonance elastography plus Fibrosis‐4 versus FibroScan–aspartate aminotransferase in detection of candidates for pharmacological treatment of NASH‐related fibrosis
Background and Aims Patients with NAFLD with significant hepatic fibrosis (Stage ≥ 2) are at increased risk of liver‐related morbidity and are candidates for pharmacologic therapies. In this study, we compared the diagnostic accuracy of MEFIB (the combination of magnetic resonance elastography [MRE]...
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| Veröffentlicht in: | Hepatology (Baltimore, Md.) Md.), 2022-03, Vol.75 (3), p.661-672 |
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| creator | Tamaki, Nobuharu Imajo, Kento Sharpton, Suzanne Jung, Jinho Kawamura, Nobuyoshi Yoneda, Masato Valasek, Mark A. Behling, Cynthia Sirlin, Claude B. Nakajima, Atsushi Loomba, Rohit |
| description | Background and Aims
Patients with NAFLD with significant hepatic fibrosis (Stage ≥ 2) are at increased risk of liver‐related morbidity and are candidates for pharmacologic therapies. In this study, we compared the diagnostic accuracy of MEFIB (the combination of magnetic resonance elastography [MRE] and Fibrosis‐4 [FIB‐4]) and FAST (FibroScan–aspartate aminotransferase; combined liver stiffness measurement by vibration‐controlled transient elastography, controlled attenuation parameter, and aspartate aminotransferase) for detecting significant fibrosis.
Approach and Results
This prospective cohort study included 234 consecutive patients with NAFLD who underwent liver biopsy, MRE, and FibroScan at the University of California San Diego (UCSD cohort) and an independent cohort (N = 314) from Yokohama City University, Japan. The primary outcome was diagnostic accuracy for significant fibrosis (Stage ≥ 2). The proportions of significant fibrosis in the UCSD and Yokohama cohorts were 29.5% and 66.2%, respectively. Area under the receiver operating characteristic curve (95% CI) of MEFIB (0.860 [0.81–0.91]) was significantly higher than that of FAST (0.757 [0.69–0.82]) in the UCSD cohort (p = 0.005), with consistent results in the Yokohama cohort (AUROC, 0.899 [MEFIB] versus 0.724 [FAST]; p |
| doi_str_mv | 10.1002/hep.32145 |
| format | Article |
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Patients with NAFLD with significant hepatic fibrosis (Stage ≥ 2) are at increased risk of liver‐related morbidity and are candidates for pharmacologic therapies. In this study, we compared the diagnostic accuracy of MEFIB (the combination of magnetic resonance elastography [MRE] and Fibrosis‐4 [FIB‐4]) and FAST (FibroScan–aspartate aminotransferase; combined liver stiffness measurement by vibration‐controlled transient elastography, controlled attenuation parameter, and aspartate aminotransferase) for detecting significant fibrosis.
Approach and Results
This prospective cohort study included 234 consecutive patients with NAFLD who underwent liver biopsy, MRE, and FibroScan at the University of California San Diego (UCSD cohort) and an independent cohort (N = 314) from Yokohama City University, Japan. The primary outcome was diagnostic accuracy for significant fibrosis (Stage ≥ 2). The proportions of significant fibrosis in the UCSD and Yokohama cohorts were 29.5% and 66.2%, respectively. Area under the receiver operating characteristic curve (95% CI) of MEFIB (0.860 [0.81–0.91]) was significantly higher than that of FAST (0.757 [0.69–0.82]) in the UCSD cohort (p = 0.005), with consistent results in the Yokohama cohort (AUROC, 0.899 [MEFIB] versus 0.724 [FAST]; p < 0.001). When used as the rule‐in criteria (MEFIB, MRE ≥ 3.3 kPa and FIB‐4 ≥ 1.6; FAST ≥ 0.67), the positive predictive value for significant fibrosis was 91.2%–96.0% for MEFIB and 74.2%–89.2% for FAST. When used as the rule‐out criteria (MEFIB, MRE < 3.3 kPa and FIB‐4 < 1.6; FAST ≤ 0.35), the negative predictive value for significant fibrosis was 85.6%–92.8% for MEFIB and 57.8%–88.3% for FAST.
Conclusions
MEFIB has higher diagnostic accuracy than FAST for significant fibrosis in NAFLD, and our results support the utility of a two‐step strategy for detecting significant fibrosis in NAFLD.</description><identifier>ISSN: 0270-9139</identifier><identifier>EISSN: 1527-3350</identifier><identifier>DOI: 10.1002/hep.32145</identifier><identifier>PMID: 34496054</identifier><language>eng</language><publisher>United States: Wolters Kluwer Health, Inc</publisher><subject>Accuracy ; Aspartate aminotransferase ; Aspartate Aminotransferases - analysis ; Biopsy ; Biopsy - methods ; Cohort Studies ; Drug therapy ; Elasticity ; Elasticity Imaging Techniques - methods ; Female ; Fibrosis ; Hepatology ; Humans ; Japan - epidemiology ; Liver ; Liver - diagnostic imaging ; Liver - pathology ; Liver Cirrhosis - diagnosis ; Liver Cirrhosis - drug therapy ; Liver Cirrhosis - etiology ; Magnetic Resonance Imaging - methods ; Male ; Middle Aged ; Morbidity ; Multimodal Imaging - methods ; Non-alcoholic Fatty Liver Disease - complications ; Non-alcoholic Fatty Liver Disease - diagnosis ; Non-alcoholic Fatty Liver Disease - epidemiology ; Patient Selection ; Patients ; Predictive Value of Tests ; ROC Curve ; Severity of Illness Index</subject><ispartof>Hepatology (Baltimore, Md.), 2022-03, Vol.75 (3), p.661-672</ispartof><rights>2021 by the American Association for the Study of Liver Diseases.</rights><rights>2022 by the American Association for the Study of Liver Diseases.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5095-fe0919cb8203e99ef6a02abf3d85f3f686c29d3f6f7674cf698215012aaab5b53</citedby><cites>FETCH-LOGICAL-c5095-fe0919cb8203e99ef6a02abf3d85f3f686c29d3f6f7674cf698215012aaab5b53</cites><orcidid>0000-0002-4845-9991 ; 0000-0002-9786-5507 ; 0000-0002-4201-3534 ; 0000-0003-4634-6616</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fhep.32145$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fhep.32145$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34496054$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tamaki, Nobuharu</creatorcontrib><creatorcontrib>Imajo, Kento</creatorcontrib><creatorcontrib>Sharpton, Suzanne</creatorcontrib><creatorcontrib>Jung, Jinho</creatorcontrib><creatorcontrib>Kawamura, Nobuyoshi</creatorcontrib><creatorcontrib>Yoneda, Masato</creatorcontrib><creatorcontrib>Valasek, Mark A.</creatorcontrib><creatorcontrib>Behling, Cynthia</creatorcontrib><creatorcontrib>Sirlin, Claude B.</creatorcontrib><creatorcontrib>Nakajima, Atsushi</creatorcontrib><creatorcontrib>Loomba, Rohit</creatorcontrib><title>Magnetic resonance elastography plus Fibrosis‐4 versus FibroScan–aspartate aminotransferase in detection of candidates for pharmacological treatment of NASH‐related fibrosis</title><title>Hepatology (Baltimore, Md.)</title><addtitle>Hepatology</addtitle><description>Background and Aims
Patients with NAFLD with significant hepatic fibrosis (Stage ≥ 2) are at increased risk of liver‐related morbidity and are candidates for pharmacologic therapies. In this study, we compared the diagnostic accuracy of MEFIB (the combination of magnetic resonance elastography [MRE] and Fibrosis‐4 [FIB‐4]) and FAST (FibroScan–aspartate aminotransferase; combined liver stiffness measurement by vibration‐controlled transient elastography, controlled attenuation parameter, and aspartate aminotransferase) for detecting significant fibrosis.
Approach and Results
This prospective cohort study included 234 consecutive patients with NAFLD who underwent liver biopsy, MRE, and FibroScan at the University of California San Diego (UCSD cohort) and an independent cohort (N = 314) from Yokohama City University, Japan. The primary outcome was diagnostic accuracy for significant fibrosis (Stage ≥ 2). The proportions of significant fibrosis in the UCSD and Yokohama cohorts were 29.5% and 66.2%, respectively. Area under the receiver operating characteristic curve (95% CI) of MEFIB (0.860 [0.81–0.91]) was significantly higher than that of FAST (0.757 [0.69–0.82]) in the UCSD cohort (p = 0.005), with consistent results in the Yokohama cohort (AUROC, 0.899 [MEFIB] versus 0.724 [FAST]; p < 0.001). When used as the rule‐in criteria (MEFIB, MRE ≥ 3.3 kPa and FIB‐4 ≥ 1.6; FAST ≥ 0.67), the positive predictive value for significant fibrosis was 91.2%–96.0% for MEFIB and 74.2%–89.2% for FAST. When used as the rule‐out criteria (MEFIB, MRE < 3.3 kPa and FIB‐4 < 1.6; FAST ≤ 0.35), the negative predictive value for significant fibrosis was 85.6%–92.8% for MEFIB and 57.8%–88.3% for FAST.
Conclusions
MEFIB has higher diagnostic accuracy than FAST for significant fibrosis in NAFLD, and our results support the utility of a two‐step strategy for detecting significant fibrosis in NAFLD.</description><subject>Accuracy</subject><subject>Aspartate aminotransferase</subject><subject>Aspartate Aminotransferases - analysis</subject><subject>Biopsy</subject><subject>Biopsy - methods</subject><subject>Cohort Studies</subject><subject>Drug therapy</subject><subject>Elasticity</subject><subject>Elasticity Imaging Techniques - methods</subject><subject>Female</subject><subject>Fibrosis</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Japan - epidemiology</subject><subject>Liver</subject><subject>Liver - diagnostic imaging</subject><subject>Liver - pathology</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Liver Cirrhosis - drug therapy</subject><subject>Liver Cirrhosis - etiology</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Multimodal Imaging - methods</subject><subject>Non-alcoholic Fatty Liver Disease - complications</subject><subject>Non-alcoholic Fatty Liver Disease - diagnosis</subject><subject>Non-alcoholic Fatty Liver Disease - epidemiology</subject><subject>Patient Selection</subject><subject>Patients</subject><subject>Predictive Value of Tests</subject><subject>ROC Curve</subject><subject>Severity of Illness Index</subject><issn>0270-9139</issn><issn>1527-3350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kt9uFCEUhydGY9fqhS9gSLzRi20ZGGaGG5OmaV2T-iepXpMzzGGXZgZGYGv2ro9g4qP4Rn0SWXfbqIlXEPj4nQ84RfG8pEclpex4hdMRZ2UlHhSzUrBmzrmgD4sZZQ2dy5LLg-JJjFeUUlmx9nFxwKtK1lRUs-Lne1g6TFaTgNE7cBoJDhCTXwaYVhsyDetIzm0XfLTx9uZ7Ra4xxLu1Sw3u9uYHxAlCgoQERut8CuCiwQARiXWkx4Q6We-INyQf6G2f0UiMD2RaQRhB-8EvrYaBpICQRnRpy344uVzkkiELJeyJ2Vs8LR4ZGCI-24-HxZfzs8-ni_nFx7fvTk8u5lpQKeYGqSyl7lpGOUqJpgbKoDO8b4Xhpm5rzWSfJ6apm0qbWrasFLRkANCJTvDD4s0ud1p3I_Y6WwUY1BTsCGGjPFj1946zK7X010rWLRe8zQGv9gHBf11jTGq0UeMwgEO_joqJpqS5Im8y-vIf9Mqvg8vXU6xmLZOMy63R6x2l80PEgOZepqRq2woqt4L63QqZffGn_T159_cZON4B3-yAm_8nqcXZp13kL2lBxjU</recordid><startdate>202203</startdate><enddate>202203</enddate><creator>Tamaki, Nobuharu</creator><creator>Imajo, Kento</creator><creator>Sharpton, Suzanne</creator><creator>Jung, Jinho</creator><creator>Kawamura, Nobuyoshi</creator><creator>Yoneda, Masato</creator><creator>Valasek, Mark A.</creator><creator>Behling, Cynthia</creator><creator>Sirlin, Claude B.</creator><creator>Nakajima, Atsushi</creator><creator>Loomba, Rohit</creator><general>Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4845-9991</orcidid><orcidid>https://orcid.org/0000-0002-9786-5507</orcidid><orcidid>https://orcid.org/0000-0002-4201-3534</orcidid><orcidid>https://orcid.org/0000-0003-4634-6616</orcidid></search><sort><creationdate>202203</creationdate><title>Magnetic resonance elastography plus Fibrosis‐4 versus FibroScan–aspartate aminotransferase in detection of candidates for pharmacological treatment of NASH‐related fibrosis</title><author>Tamaki, Nobuharu ; Imajo, Kento ; Sharpton, Suzanne ; Jung, Jinho ; Kawamura, Nobuyoshi ; Yoneda, Masato ; Valasek, Mark A. ; Behling, Cynthia ; Sirlin, Claude B. ; Nakajima, Atsushi ; Loomba, Rohit</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5095-fe0919cb8203e99ef6a02abf3d85f3f686c29d3f6f7674cf698215012aaab5b53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Accuracy</topic><topic>Aspartate aminotransferase</topic><topic>Aspartate Aminotransferases - analysis</topic><topic>Biopsy</topic><topic>Biopsy - methods</topic><topic>Cohort Studies</topic><topic>Drug therapy</topic><topic>Elasticity</topic><topic>Elasticity Imaging Techniques - methods</topic><topic>Female</topic><topic>Fibrosis</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Japan - epidemiology</topic><topic>Liver</topic><topic>Liver - diagnostic imaging</topic><topic>Liver - pathology</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Liver Cirrhosis - drug therapy</topic><topic>Liver Cirrhosis - etiology</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Multimodal Imaging - methods</topic><topic>Non-alcoholic Fatty Liver Disease - complications</topic><topic>Non-alcoholic Fatty Liver Disease - diagnosis</topic><topic>Non-alcoholic Fatty Liver Disease - epidemiology</topic><topic>Patient Selection</topic><topic>Patients</topic><topic>Predictive Value of Tests</topic><topic>ROC Curve</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tamaki, Nobuharu</creatorcontrib><creatorcontrib>Imajo, Kento</creatorcontrib><creatorcontrib>Sharpton, Suzanne</creatorcontrib><creatorcontrib>Jung, Jinho</creatorcontrib><creatorcontrib>Kawamura, Nobuyoshi</creatorcontrib><creatorcontrib>Yoneda, Masato</creatorcontrib><creatorcontrib>Valasek, Mark A.</creatorcontrib><creatorcontrib>Behling, Cynthia</creatorcontrib><creatorcontrib>Sirlin, Claude B.</creatorcontrib><creatorcontrib>Nakajima, Atsushi</creatorcontrib><creatorcontrib>Loomba, Rohit</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Hepatology (Baltimore, Md.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tamaki, Nobuharu</au><au>Imajo, Kento</au><au>Sharpton, Suzanne</au><au>Jung, Jinho</au><au>Kawamura, Nobuyoshi</au><au>Yoneda, Masato</au><au>Valasek, Mark A.</au><au>Behling, Cynthia</au><au>Sirlin, Claude B.</au><au>Nakajima, Atsushi</au><au>Loomba, Rohit</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Magnetic resonance elastography plus Fibrosis‐4 versus FibroScan–aspartate aminotransferase in detection of candidates for pharmacological treatment of NASH‐related fibrosis</atitle><jtitle>Hepatology (Baltimore, Md.)</jtitle><addtitle>Hepatology</addtitle><date>2022-03</date><risdate>2022</risdate><volume>75</volume><issue>3</issue><spage>661</spage><epage>672</epage><pages>661-672</pages><issn>0270-9139</issn><eissn>1527-3350</eissn><abstract>Background and Aims
Patients with NAFLD with significant hepatic fibrosis (Stage ≥ 2) are at increased risk of liver‐related morbidity and are candidates for pharmacologic therapies. In this study, we compared the diagnostic accuracy of MEFIB (the combination of magnetic resonance elastography [MRE] and Fibrosis‐4 [FIB‐4]) and FAST (FibroScan–aspartate aminotransferase; combined liver stiffness measurement by vibration‐controlled transient elastography, controlled attenuation parameter, and aspartate aminotransferase) for detecting significant fibrosis.
Approach and Results
This prospective cohort study included 234 consecutive patients with NAFLD who underwent liver biopsy, MRE, and FibroScan at the University of California San Diego (UCSD cohort) and an independent cohort (N = 314) from Yokohama City University, Japan. The primary outcome was diagnostic accuracy for significant fibrosis (Stage ≥ 2). The proportions of significant fibrosis in the UCSD and Yokohama cohorts were 29.5% and 66.2%, respectively. Area under the receiver operating characteristic curve (95% CI) of MEFIB (0.860 [0.81–0.91]) was significantly higher than that of FAST (0.757 [0.69–0.82]) in the UCSD cohort (p = 0.005), with consistent results in the Yokohama cohort (AUROC, 0.899 [MEFIB] versus 0.724 [FAST]; p < 0.001). When used as the rule‐in criteria (MEFIB, MRE ≥ 3.3 kPa and FIB‐4 ≥ 1.6; FAST ≥ 0.67), the positive predictive value for significant fibrosis was 91.2%–96.0% for MEFIB and 74.2%–89.2% for FAST. When used as the rule‐out criteria (MEFIB, MRE < 3.3 kPa and FIB‐4 < 1.6; FAST ≤ 0.35), the negative predictive value for significant fibrosis was 85.6%–92.8% for MEFIB and 57.8%–88.3% for FAST.
Conclusions
MEFIB has higher diagnostic accuracy than FAST for significant fibrosis in NAFLD, and our results support the utility of a two‐step strategy for detecting significant fibrosis in NAFLD.</abstract><cop>United States</cop><pub>Wolters Kluwer Health, Inc</pub><pmid>34496054</pmid><doi>10.1002/hep.32145</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-4845-9991</orcidid><orcidid>https://orcid.org/0000-0002-9786-5507</orcidid><orcidid>https://orcid.org/0000-0002-4201-3534</orcidid><orcidid>https://orcid.org/0000-0003-4634-6616</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Hepatology (Baltimore, Md.), 2022-03, Vol.75 (3), p.661-672 |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; Wiley Online Library All Journals |
| subjects | Accuracy Aspartate aminotransferase Aspartate Aminotransferases - analysis Biopsy Biopsy - methods Cohort Studies Drug therapy Elasticity Elasticity Imaging Techniques - methods Female Fibrosis Hepatology Humans Japan - epidemiology Liver Liver - diagnostic imaging Liver - pathology Liver Cirrhosis - diagnosis Liver Cirrhosis - drug therapy Liver Cirrhosis - etiology Magnetic Resonance Imaging - methods Male Middle Aged Morbidity Multimodal Imaging - methods Non-alcoholic Fatty Liver Disease - complications Non-alcoholic Fatty Liver Disease - diagnosis Non-alcoholic Fatty Liver Disease - epidemiology Patient Selection Patients Predictive Value of Tests ROC Curve Severity of Illness Index |
| title | Magnetic resonance elastography plus Fibrosis‐4 versus FibroScan–aspartate aminotransferase in detection of candidates for pharmacological treatment of NASH‐related fibrosis |
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