NAFLD is a common cause of liver disease. To determine the optimal testing strategy for NAFLD patients with advanced fibrosis, several factors such as diagnostic accuracy, failure rates, costs of ...examinations, and potential treatment options need to be considered. The purpose of this study was to determine the cost-effectiveness of combination testing involving vibration-controlled transient elastography (VCTE) versus magnetic resonance elastography (MRE) as a frontline imaging strategy for NAFLD patients with advanced fibrosis.
A Markov model was developed from the US perspective. The base-case scenario in this model included patients aged 50 years with a Fibrosis-4 score of ≥2.67 and suspected advanced fibrosis. The model included a decision tree and a Markov state-transition model including 5 health states: fibrosis stage 1-2, advanced fibrosis, compensated cirrhosis, decompensated cirrhosis, and death. Both deterministic and probabilistic sensitivity analyses were performed.
Staging fibrosis with MRE cost $8388 more than VCTE but led to an additional 1.19 Quality-adjusted life years (QALYs) with the incremental cost-effectiveness ratio of $7048/QALY. The cost-effectiveness analysis of the 5 strategies revealed that MRE+biopsy and VCTE+MRE+biopsy were the most cost-effective with the incremental cost-effectiveness ratios of $8054/QALY and $8241/QALY, respectively. Furthermore, sensitivity analyses indicated that MRE remained cost-effective with a sensitivity of ≥0.77, whereas VCTE became cost-effective with a sensitivity of ≥0.82.
MRE was not only cost-effective than VCTE as the frontline modality for staging NAFLD patients with Fibrosis-4 ≥2.67 with incremental cost-effectiveness ratio of $7048/QALY but also remained cost-effective when used as a follow-up in instances of VCTE failure to diagnose.
Longer examination time, need for anesthesia in smaller children and the inability of most children to hold their breath are major limitations of MRI in pediatric body imaging. Fortunately, with ...technical advances, many new and upcoming MRI sequences are overcoming these limitations. Advances in data acquisition and k-space sampling methods have enabled sequences with improved temporal and spatial resolution, and minimal artifacts. Sequences to minimize movement artifacts mainly utilize radial k-space filling, and examples include the stack-of-stars method for T1-weighted imaging and the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER)/BLADE method for T2-weighted imaging. Similarly, the sequences with improved temporal resolution and the ability to obtain multiple phases in a single breath-hold in dynamic imaging mainly use some form of partial k-space filling method. New sequences use a variable combination of data sampling methods like compressed sensing, golden-angle radial k-space filling, parallel imaging and partial k-space filling to achieve free-breathing, faster sequences that could be useful for pediatric abdominal and thoracic imaging. Simultaneous multi-slice method has improved diffusion-weighted imaging (DWI) with reduction in scan time and artifacts. In this review, we provide an overview of data sampling methods like parallel imaging, compressed sensing, radial k-space sampling, partial k-space sampling and simultaneous multi-slice. This is followed by newer available and upcoming sequences for T1-, T2- and DWI based on these other advances. We also discuss the Dixon method and newer approaches to reducing metal artifacts.
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