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S3-E16.5 – Ready for “Prime Time?” MRE and Hepatogram in NASH Clinical Practice

This episode is Sponsored by Resoundant.
What are the practical benefits and challenges for clinicians wishing to deploy MRE (through MAST and/or Hepatogram along with PDFF) as an outpatient test in NASH Clinical Practice?

The conversation was originally recorded on January 27, 2022. It focuses on use of MR Elastography to diagnose, treat and monitor NASH patients in an outpatient setting through two uses of MRE — the MAST test, which includes MRE, MRI-PDFF and AST and the basic Hepatogram test, which includes MRE and MRI-PDFF, or, as Mazen Noureddin describes it during the conversation, MREFF.

This conversation is too long and detailed for a typical section-by-section synopsis, so this write-up will summarize the major elements. After introductions and icebreakers, Mazen Noureddin starts the conversation by discussing MAST and how he came to develop the test. Fundamentally, Mazen saw this as a way to capitalize on and improve what researchers found while constructing and testing the FAST score. His basic logics was “if FAST can produce valuable results and MREFF produces more granular and consistent results than FibroScan, why don’t we evaluate the idea of a test that relies on MREFF?” The resulting study produced several promising outcomes: good NPV, “reasonable PPV,” higher Area Under Curve than with FAST and a multiple logistic regression analysis identifying MRE as the most powerful predictive factor, followed by PDFF and only then AST (AST was a powerful factor in similar FAST analysis).

The next stage of the conversation addresses practical short- and long-term issues around MRE use in the community. Scott Reeder discusses the practicality and economics of community MRE testing: a one breath-hold test can produce MRE, PDDD and liver iron concentration (LIC), which leads Mazen to describe the new test as “MREFFLIC.” Scott goes on discuss how he came to use MRE in Fatty Liver initially (pediatric NASH), to note that capital enhancements for MRE are low and that insurance reimbursement runs ~$300 test (later, Kay will estimate $170 – $200.) Kay continues to estimate that there are ~1,000 MRE machines in us in the US today.

Stephen Harrison follows Kay, discussing the likelihood that FDA will approve MRE in place of biopsy over time, and going on to discuss why MRE will probably turn out to be superior to biopsy. A major factor: MRE looks at the whole liver (which is a heterogenous organ), while biopsy looks at a slice that might be no greater than 1/700,000th of the liver. Scott notes that imaging studies with MRE are showing treatment effect and hypothesizes this might be the reason why. The conversation wraps up with 10 minutes looking at the practical benefits and challenges us using MRE today and how these might resolve over time.

This conversation is sponsored by Resoundant, a Mayo Clinic company and the developers of Magnetic Resonance Elastography. MRE is widely available with over 2000 locations worldwide, and can be done as a low-cost, rapid exam in just 5 minutes. Together with PDFF, this quantitative exam is called an Hepatogram – a powerful non-invasive alternative to liver biopsy in many cases. For more information, visit www.resoundant.com on the web.

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