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    MRI-based technologies for assessing non-alcoholic fatty liver disease

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    1 Recommendations

    1.1 There is not enough evidence to recommend LiverMultiScan or magnetic resonance elastography (MRE) to assess non-alcoholic fatty liver disease (NAFLD) in people:

    • with indeterminate or discordant results from previous fibrosis testing

    • when transient elastography or acoustic radiation force impulse elastography (ARFI) is unsuitable or has not worked.

    1.2 Further research is recommended (see the section on further research) to determine the accuracy of LiverMultiScan and MRE for assessing NAFLD and how test results affect decisions about care.

    Why the committee made these recommendations

    Assessing the extent of NAFLD can help to make decisions about care, for example, if lifestyle changes are needed or how often to monitor the condition. Sometimes a biopsy is needed, which is invasive and can have severe side effects like bleeding or death. LiverMultiScan and MRE are non-invasive MRI-based tests that aim to assess the extent of liver disease, help make decisions about care, and avoid biopsy use. LiverMultiScan aims to identify a stage of NAFLD called non-alcoholic steatohepatitis (NASH).

    Clinical evidence on test accuracy is uncertain. There is no evidence on how MRE might affect care decisions for the people who would have it in the NHS. It is very unclear how diagnosing NASH with LiverMultiScan would affect care decisions. There are currently no medicines for treating NASH, but this may change in the future. There is only 1 study on the effect of using LiverMultiScan on the number of liver biopsies, which is of low quality.

    MRE may be cost effective but the estimates are uncertain, largely because the cost of using MRE in the NHS is very uncertain. For LiverMultiScan, the cost-effectiveness estimates are higher than what NICE normally considers a cost-effective use of NHS resources.

    More evidence is needed about test accuracy and how results affect decisions about care. Therefore, research is recommended.