Lars Johannson’s 2021 Paris NASH presentation, “Innovations in Imaging Assessment of Fibrosis“,” introduced his audience to a dynamic, multidimensional view of tools that can show us how the liver works. His viewpoint combined with discussion on novel imaging tools and approaches creates an episode From the Vault that might leave you repeatedly thinking “Oh, Wow!”

This conversation excerpt begins with a comment from Louise Campbell that this entire approach might play a significant role in moving us beyond the biopsy. Lars agrees, noting that studying fibrosis and fat reduction places too much emphasis on “what shouldn’t be” in the liver instead of focusing on “what should be,” which are high functioning hepatocytes. To explore hepatocyte function, he discusses use of gadolinium contrast agents, more than 50% of which are taken up by hepatocytes. This provides a setting to combine dynamic functional inputs based on hepatocyte function with static measures based on stiffness and PDFF. This provides a truly dynamic look at liver disease, which is particularly important given the liver’s ability to regenerate. Stephen spends the last few minutes of the conversation discussing the results this approach can yield and contrasting it favorably to the techniques we use today, some of which are difficult to implement and none of which provide the richness of information achievable with the imaging techniques Lars describes.