Long-term clinical outcomes and short-term treatment efficacy evaluation based on longitudinal MR elastography in patients with chronic hepatitis C virus infection.

Abstract

Magnetic resonance elastography (MRE) provides multiple quantitative biomarkers for assessing chronic liver disease. This study evaluated the prognostic value of MRE-based long-term liver stiffness (LS) changes in chronic hepatitis C virus (HCV) infection and explored short-term viscosity changes (loss modulus, LM) for monitoring responses to direct-acting antiviral treatment (DAA-Tx). One hundred fifty-nine adults were included. We retrospectively analyzed 138 HCV participants with at least two 2D MREs, defining progression as an LS increase ΔLS ≥ 19% above baseline (LS_B), predicting liver-related events (LREs) with Kaplan-Meier plots and Cox proportional hazards regression. We also prospectively analyzed 21 participants, 11 of whom underwent DAA-Tx and ten healthy controls. Dual-frequency 3D MRE-derived LS, LM, and damping ratio (DR) were compared at five time points during DAA-Tx. Among the 138 HCVs, 38 (27.5%) were progressors, with a ΔLS = 0.393 kPa/year; 11 developed LREs, showing a steeper rise of 0.614 kPa/year. LS_B and the combination of LS_B and ΔLS were significantly associated with LREs. Specifically, each 1 kPa increase in LS_B was associated with doubled risk of developing LREs [adjusted hazard ratio (aHR) = 2.05; C-statistic = 0.831, p < 0.001]. The combination of LS_B and ΔLS further improved predictive performance (aHR = 2.92; C-statistic = 0.883, p < 0.001). Progressors had a hazard ratio (HR) of 15.44 for developing cirrhosis (p < 0.001). LS decreased post-DAA-Tx, while LM initially increased (p < 0.05) and normalized by 12 months post-DAA-Tx. Two-dimensional MRE-assessed longitudinal change in LS can predict future clinical events in HCV patients, providing better risk stratification than LS alone. Multiparametric dual-frequency 3D MRE has promise for short-term changes in treatment effects. Question Accurately predicting clinical outcomes and monitoring direct-acting antiviral (DAA) treatment efficacy in HCV patients remains an unmet need. Findings Longitudinal LS changes predict future clinical events in HCV patients. Multiparametric dual-frequency 3D MRE detects short-term inflammatory and treatment-related changes, enhancing disease monitoring. Clinical relevance This study demonstrates longitudinal MRE as a reliable follow-up tool for chronic liver disease, enabling outcome prediction, risk stratification, and treatment monitoring, advancing personalized, non-invasive management for HCV patients.