BACKGROUND & AIMS:Liver biopsy remains the reference standard for diagnosing steatohepatitis in metabolic dysfunction-associated steatotic liver disease (MASLD), but its use is limited by interobserver variability. Morphometric analysis offers continuous and objective quantification of steatosis and fibrosis, potentially overcoming these limitations. METHODS:We compared morphometric quantification of steatosis and fibrosis to noninvasive imaging in 233 patients with type 2 diabetes mellitus (T2DM) enrolled in the QUID-NASH project. Steatosis was assessed by magnetic resonance imaging-proton density fat fraction (MRI-PDFF), and liver stiffness by magnetic resonance elastography (MRE) and vibration-controlled transient elastography (VCTE). Morphometry was performed on biopsy slides measuring steatosis proportionate area (SPA) and collagen proportionate area (CPA). RESULTS:Steatosis grade was related to SPA (P < .0001), which was significantly correlated with %PDFF (rho: 0.88; 95% confidence interval [CI], 0.82-0.91). Median SPA increased from 0.85% in Grade 0 to 19.85% in Grade 3; MRI-PDFF values ranged from 4.25% to 33.67%. Fibrosis stage was related to CPA and weakly correlated with liver stiffness measurement (LSM) by MRE (rho: 0.26; 95% CI, 0.12-0.39), and moderately with LSM by VCTE (rho: 0.52; 95% CI, 0.42-0.61). Fibrosis stage was significantly associated with CPA (P < .0001), which increased from 3.17% in stage 0 to 18.05% in stage 4. CONCLUSIONS:Our study demonstrates the relevance of quantitative morphometric assessment of steatosis and fibrosis in patients with T2DM and MASLD. Such an easily applicable approach could be used in routine practice to better characterize 2 cardinal features of the disease and to improve monitoring.

Comprendre les raisons de la grande variabilité des dépenses de santé chez les patients atteints de Stéatose hépatique non alcoolique (NAFLD) peut être bénéfique pour le développement d'interventions thérapeutiques visant à améliorer les outcomes des patients et l'allocation des dépenses de santé. L'objectif de notre étude était d'estimer les dépenses de santé remboursées par l'Assurance maladie des patients NAFLD prévalents en 2019 et de déterminer les facteurs associés aux patients NAFLD à coût élevé (HC). La population étudiée était composée de participants de la cohorte Constances de 2015 à 2019 présentant une NAFLD. Le diagnostic non invasif de la NAFLD a été réalisé à l'aide de l'index du foie gras ou « Fatty Liver Index » (FLI). Les comorbidités ont été sélectionnées via les algorithmes validés de la cartographie de la Cnam. Les personnes atteintes de NAFLD ont été classées selon la distribution des coûts totaux comme HC "high cost" (au-dessus du 90e percentile) ou NHC "non-high cost" (en dessous du 90e percentile). Un modèle de régression logistique a été créé pour identifier les facteurs significativement associés aux coûts élevés. La dépense moyenne parmi les 14 437 patients NAFLD inclus était de 1860 € par patient. L'hospitalisation, les honoraires médicaux et la pharmacie représentaient respectivement 36 %, 25 % et 21 % des dépenses de santé. Le coût total annuel moyen par patient était de 859 € dans le groupe NHC et de 10 863 € dans le groupe HC. Les coûts hospitaliers représentaient 51 % du coût total dans le groupe HC contre 16 % dans le groupe NHC. Les prédicteurs les plus fortement liés au fait d'être un patient NAFLD HC étaient l'hypertension, le diabète et les maladies respiratoires chroniques. Les patients HC ont encouru plus de 58 % du coût total chez les patients NAFLD. Une prise en charge adaptée aux patients pourrait permettre des soins plus efficaces pour la NAFLD. Coûts des soins de santé, Segmentation, NAFLD, CONSTANCES, SNDS Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.

Purpose: To construct an appropriate phantom for quality control use in diffusion‐weighted imaging (DWI), to establish ground truth for measurement of apparent diffusion coefficient (ADC) and to characterize measurement linearity across a relevant physiological range of ADC. Methods: Aqueous solutions containing the polymer polyvinylpyrrolidone (PVP) were mixed at concentrations of 0, 10, 20, 30, 40 and 50% by mass PVP. These solutions were placed in 20 mL vials, arranged in concentric inner and outer circles, with a central water vial, and were fixed in a spherical phantom with a diameter of 194 mm, designed to fit into commercially‐available MRI head coils. Two prototype phantoms were constructed, and underwent inter‐site comparison in the US and EU. The phantoms were filled with an ice‐water bath to ensure stable temperature; 0 °C temperature was verified by use of a thermocouple before and after scans. The phantoms were scanned using b‐values of 0, 500 and 900 s/mm 2 at several sites, using coronal and/or axial orientations and scan planes. Results: ADC values ranged from 0.12 to 1.12 × 10 ‐3 mm 2 /s, and exhibited a high degree of reproducibility across different scanners and imaging sites (coefficient of variations (CoV) ranged from 1.1 to 2.2% for 0 to 40% PVP, with 50% PVP at 11.3%). Little difference in ADCs was seen between inner and outer ring vials of the same PVP concentration (average CoV< 5% across vials, 10.3% for 50% PVP). Conclusion: The range of ADCs covers a relevant physiological range, most notably in brain white matter. The ADCs of water vials were in excellent agreement with literature values of the diffusion coefficient of water at 0 °C (1.1 × 10 ‐3 mm 2 /s). The phantom provides a much needed quality control tool for DWI, and provides ground truth with the diffusion coefficient of water at 0 °C.

Lauriane Jugé, Simon Auguste Lambert, Simon Chatelin, Leon ter BEEK, Valérie Vilgrain, Bernard E Van BEERS, Lynne E Bilston, Bojan Guzina, Sverre Holm, and Ralph Sinkus U773-CRB3, INSERM, Paris, France, Philips Medical Systems, Best, Netherlands, University of New South Wales, Neuroscience Research Australia, New South Wales, Australia, Dept. of Civil Engineering, University of Minnesota, Minneapolis, MN, United States, Informatics, University of Oslo, Oslo, Norway