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Purpose <p>Visceral adiposity is a key factor in the development of nonalcoholic steatohepatitis (NASH), yet its quantitative relationship with fibrotic progression remains inadequately characterized. This study aimed to assess the diagnostic performance of MRI-derived visceral fat content (VFC) for stratifying NASH severity and fibrosis in obese individuals.</p> Methods <p>In this retrospective, single-center study, 138 obese patients (body mass index ≥ 30&#xa0;kg/m²) who underwent liver biopsy and chemical shift–encoded MRI (iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation (IDEAL-IQ)) between April 2020 and September 2022 were included. Fibrotic NASH (Fibro-NASH) was defined histologically as a NAFLD activity score (NAS) ≥ 4 and fibrosis stage ≥ 2. MRI-derived metrics, including VFC and visceral fat area (VFA), were compared between groups. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed.</p> Results <p>Patients with Fibro-NASH had significantly lower median VFC compared to those without Fibro-NASH (<i>P</i> &lt; 0.001). VFC was identified as an independent predictor of Fibro-NASH (odds ratio (OR) = 0.51, 95% CI: 0.26–0.97). A model combining VFC, muscle fat content, and aspartate aminotransferase exhibited the highest predictive accuracy for Fibro-NASH (AUC = 0.89; 95% CI, 0.80–0.97), outperforming models using VFA and VFC alone (both <i>P</i> &lt; 0.05).</p> Conclusion <p>MRI-derived VFC represents a promising, noninvasive biomarker for assessing NASH severity and its progression to Fibro-NASH in obesity. Integrating VFC into clinical practice may enhance risk stratification and facilitate timely interventions for advanced liver disease.</p>

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MRI-derived visceral adipose tissue quantification enhances stratification of nonalcoholic steatohepatitis severity and fibrosis in obesity

  • 期刊论文

  • 发表日期：

    2026年3月9日

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  • Xin Yu,
  • Ying-Long Li,
  • You-Zhen Feng,
  • Zhong-Yuan Cheng,
  • Bin Sun,
  • Xiang-Ran Cai

摘要

Purpose

Visceral adiposity is a key factor in the development of nonalcoholic steatohepatitis (NASH), yet its quantitative relationship with fibrotic progression remains inadequately characterized. This study aimed to assess the diagnostic performance of MRI-derived visceral fat content (VFC) for stratifying NASH severity and fibrosis in obese individuals.

Methods

In this retrospective, single-center study, 138 obese patients (body mass index ≥ 30 kg/m²) who underwent liver biopsy and chemical shift–encoded MRI (iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation (IDEAL-IQ)) between April 2020 and September 2022 were included. Fibrotic NASH (Fibro-NASH) was defined histologically as a NAFLD activity score (NAS) ≥ 4 and fibrosis stage ≥ 2. MRI-derived metrics, including VFC and visceral fat area (VFA), were compared between groups. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed.

Results

Patients with Fibro-NASH had significantly lower median VFC compared to those without Fibro-NASH (P < 0.001). VFC was identified as an independent predictor of Fibro-NASH (odds ratio (OR) = 0.51, 95% CI: 0.26–0.97). A model combining VFC, muscle fat content, and aspartate aminotransferase exhibited the highest predictive accuracy for Fibro-NASH (AUC = 0.89; 95% CI, 0.80–0.97), outperforming models using VFA and VFC alone (both P < 0.05).

Conclusion

MRI-derived VFC represents a promising, noninvasive biomarker for assessing NASH severity and its progression to Fibro-NASH in obesity. Integrating VFC into clinical practice may enhance risk stratification and facilitate timely interventions for advanced liver disease.