{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T08:27:40Z","timestamp":1793089660540,"version":"4.5.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2022,2,22]],"date-time":"2022-02-22T00:00:00Z","timestamp":1645488000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>Despite that hepatic fibrosis often affects the liver globally, spatial distribution can be heterogeneous. This study aimed to investigate the effect of liver stiffness (LS) heterogeneity on concordance between MR elastography (MRE)\u2010based fibrosis staging and biopsy staging in patients with NAFLD.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results<\/jats:title>\n            <jats:p>We retrospectively evaluated data from 155 NAFLD patients who underwent liver biopsy and 3 Tesla MRE and undertook a retrospective validation study of 169 NAFLD patients at three hepatology centers. Heterogeneity of stiffness was assessed by measuring the range between minimum and maximum MRE\u2010based LS measurement (LSM). Variability of LSM was defined as the stiffness range divided by the maximum stiffness value. The cohort was divided into two groups (homogenous or heterogeneous), according to whether variability was below or above the average for the training cohort. Based on histopathology and receiver operating characteristic (ROC) analysis, optimum LSM thresholds were determined for MRE\u2010based fibrosis staging of stage 4 (4.43, kPa; AUROC, 0.89) and stage \u22653 (3.93, kPa; AUROC, 0.89). In total, 53 had LSM above the threshold for stage 4. Within this group, 30 had a biopsy stage of &lt;4. In 86.7% of these discordant cases, variability of LSM was classified as heterogeneous. In MRE\u2010based LSM stage \u22653, 88.9% of discordant cases were classified as heterogeneous. Results of the validation cohort were similar to those of the training cohort.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Discordance between biopsy\u2010 and MRE\u2010based fibrosis staging is associated with heterogeneity in LSM, as depicted with MRE.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.32302","type":"journal-article","created":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T10:18:45Z","timestamp":1640341125000},"page":"186-195","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":33,"title":["Influence of liver stiffness heterogeneity on staging fibrosis in patients with nonalcoholic fatty liver disease"],"prefix":"10.1097","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4201-3534","authenticated-orcid":false,"given":"Nobuyoshi","family":"Kawamura","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Yokohama City University Graduate School of Medicine,Yokohama,Japan"},{"name":"Department of Gastroenterology,Shin\u2010yurigaoka General Hospital,Kawasaki City,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kento","family":"Imajo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Yokohama City University Graduate School of Medicine,Yokohama,Japan"},{"name":"Department of Gastroenterology,Shin\u2010yurigaoka General Hospital,Kawasaki City,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle J.","family":"Kalutkiewicz","sequence":"additional","affiliation":[{"name":"Department of Radiology,Mayo Clinic,Rochester,Minnesota,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koki","family":"Nagai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Yokohama City University Graduate School of Medicine,Yokohama,Japan"},{"name":"Department of Gastroenterology,Shin\u2010yurigaoka General Hospital,Kawasaki City,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michihiro","family":"Iwaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Yokohama City University Graduate School of Medicine,Yokohama,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Yokohama City University Graduate School of Medicine,Yokohama,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6923-365X","authenticated-orcid":false,"given":"Asako","family":"Nogami","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Yokohama City University Graduate School of Medicine,Yokohama,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Honda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Yokohama City University Graduate School of Medicine,Yokohama,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaomi","family":"Kessoku","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Yokohama City University Graduate School of Medicine,Yokohama,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Yokohama City University Graduate School of Medicine,Yokohama,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuma","family":"Higurashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Yokohama City University Graduate School of Medicine,Yokohama,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunihiro","family":"Hosono","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Yokohama City University Graduate School of Medicine,Yokohama,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2374-2889","authenticated-orcid":false,"given":"Hirokazu","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Division of Metabolism and Endocrinology,Faculty of Medicine,Saga University,Saga,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Yoneda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Yokohama City University Graduate School of Medicine,Yokohama,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoru","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Yokohama City University Graduate School of Medicine,Yokohama,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Aishima","sequence":"additional","affiliation":[{"name":"Department of Pathology and Microbiology,Faculty of Medicine,Saga University,Saga,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidenori","family":"Toyoda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Ogaki Municipal Hospital,Ogaki City,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Gifu Municipal Hospital,Gifu 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