From the October 2017 issue of HealthCare Business News magazine

With MRE, however, clinicians would be able to consider treatment at an earlier stage of disease progression. MRE is capable of distinguishing among earlier stages of fibrosis with a very high level of sensitivity, bringing the “treat earlier” model closer to a reality. This type of model would result in systemic savings that outweigh the marginal increase of an MRE scan by a factor of 100. That would net billions of dollars in savings over a population model – all while meeting the calls of patients to avoid an acute stage of disease in order to qualify for treatment.

For health systems and practices looking for strategies that can help control overall costs, MRE is a "poster child" for improved outcomes at lower resource utilization. As a radiologist, it is one of my favorite examples of the value of advanced imaging.


The future of MRE
The future of MR elastography is extremely bright for liver disease patients. Looking beyond fibrosis staging alone, multiparametric MRE may soon add additional capabilities, including assessment of inflammation, in the same exam. If a traditional workup for hepatocellular carcinoma (HCC) is also included, referring clinicians now have everything they need to diagnose and manage a patient with suspected liver disease. This “hepatogram”, as some have dubbed it, represents the emergence of one of the most clinically efficient patient management strategies in recent years. Not far from now, the standard of care for suspected liver disease patients may begin with a patient’s hepatologist saying, “let’s get you a hepatogram and then go from there.”

From a population perspective, the emergence and proliferation of MRE couldn’t have arrived at a better time. The clinical and economic burden of chronic liver diseases is enormous. As around 3.5 million HCV patients begin to navigate toward a cure, clinicians, pharmaceutical companies and epidemiologists are turning their attention to an emerging disease threat, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). NAFLD affects an estimated 25 percent to 30 percent of the population, with about 10 percent to 15 percent of those patients going on to develop NASH. Due to the comorbidity with obesity (which is a source of high technical failure for other noninvasive diagnostics), and the need for an assessment of steatosis and inflammation, multiparametric MRE is poised to become the optimal diagnostic pathway for patients and providers. As such, it will be great to see radiology offering clinicians and patients an innovative and comprehensive solution to a complex set of diseases.

About the author: Dr. Amy Salinas is a private practice radiologist at Austin Radiological Associates, which was among the earliest adopters of MR elastography for liver fibrosis assessment. She received her medical doctorate at Georgetown University School of Medicine, and completed her radiology residency and abdominal imaging fellowship at the University of California San Francisco.

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