Liver cT1 decreases following direct-acting antiviral therapy in patients with chronic hepatitis C virus

Arjun N A Jayaswal, Christina Levick, Jane Collier, Elizabeth M Tunnicliffe, Matthew D Kelly, Stefan Neubauer, Eleanor Barnes, Michael Pavlides, Arjun N A Jayaswal, Christina Levick, Jane Collier, Elizabeth M Tunnicliffe, Matthew D Kelly, Stefan Neubauer, Eleanor Barnes, Michael Pavlides

Abstract

Purpose: Direct-acting antiviral therapies (DAAs) for treatment of chronic hepatitis C virus (HCV) have excellent rates of viral eradication, but their effect on regression of liver fibrosis is unclear. The primary aim was to use magnetic resonance imaging (MRI) and spectroscopy (MRS) to evaluate changes in liver fibrosis, liver fat and liver iron content (LIC) in patients with chronic HCV following treatment with DAAs.

Methods: In this prospective study, 15 patients with chronic HCV due to start treatment with DAAs and with transient elastography (TE) > 8 kPa were recruited consecutively. Patients underwent MRI and MRS at baseline (before treatment), and at 24 weeks and 48 weeks after the end of treatment (EoT) for the measurement of liver cT1 (fibroinflammation), liver fat and T2* (LIC).

Results: All patients achieved a sustained virological response. Liver cT1 showed significant decreases from baseline to 24 weeks post EoT (876 vs 806 ms, p = 0.002, n = 15), baseline to 48 weeks post EoT (876 vs 788 ms, p = 0.0002, n = 13) and 24 weeks post EoT to 48 weeks post EoT (806 vs 788 ms, p = 0.016, n = 13). Between baseline and 48 weeks EoT significant reduction in liver fat (5.17% vs 2.65%, p = 0.027) and an increase in reported LIC (0.913 vs 0.950 mg/g, p = 0.021) was observed.

Conclusion: Liver cT1 decreases in patients with chronic HCV undergoing successful DAA treatment. The relatively fast reduction in cT1 suggests a reduction in inflammation rather than regression of fibrosis.

Keywords: Direct-acting antivirals; Hepatitis C virus; Iron corrected T1; T1 mapping.

Conflict of interest statement

ANAJ, MP, EMT, MK, EB and SN are shareholders in Perspectum Ltd. MK is an employee of Perspectum. EMT, EB, SN and MP have filed patent applications related to the use of MRI for the assessment of liver disease. CL has nothing to declare.

Figures

Fig. 1
Fig. 1
Study flow diagram. EoT end of treatment
Fig. 2
Fig. 2
Response in non-invasive markers of liver disease to DAA treatment from baseline to 24 weeks EoT, and 48 weeks EoT. Plots show response to treatment by a liver cT1, b transient elastography (TE), c liver fat, d liver iron content. Each line represents an individual patient. * denotes p < 0.05, ** denotes p < 0.01, ns denotes p > 0.05. EoT end of treatment, DAA direct-acting antiviral therapy
Fig. 3
Fig. 3
Abdominal cT1 images and segmentation masks pre and post treatment. Abdominal cT1 images are shown from a patient with chronic hepatitis C virus at baseline (a) and at 24 weeks after end of treatment (EoT) (b), together with the semi-automatically segmented liver cT1 masks from the same patient at baseline (c) and 24 weeks EoT (d). Mean liver cT1 at baseline was 874 ms and 24 weeks EoT was 735 ms
Fig. 4
Fig. 4
Comparison of liver cT1 between patients with and without cirrhosis at baseline, 24 weeks EoT and 48 weeks EoT. EoT end of treatment, * denotes p < 0.05. Dots represent outliers

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