Digital liver scanning technology could halve the number of liver biopsies needed in the NHS

A study jointly led by the University of Birmingham and University of Edinburgh has revealed that a new scanning technology could almost halve the number of liver biopsies carried out on people with fatty liver disease.

The authors of the study, also carried out in collaboration with the Universities of Liverpool and Oxford, concluded that 458 out of every 1,000 liver biopsies could be avoided if people are first assessed using scanning technology.

The study, published in Alimentary Pharmacology & Therapeutics, provides evidence that using the non-invasive technology as a first-line test can rule out the need for further liver tests, and could stop patients having unnecessary biopsies. The researchers calculated it could potentially save the NHS around £150,000 per 1,000 patients.

Liver biopsy is the current gold standard for assessing liver disease, however a global rising prevalence of non-alcoholic fatty liver disease (NAFLD) means there is a need to develop fast, non-invasive and cost-effective ways for assessment and diagnoses.

In this study, 50 patients and six healthy volunteers at Queen Elizabeth Hospital in Birmingham and Royal Infirmary of Edinburgh underwent digital image scanning, and the results were processed by clinical and imaging specialists. A summary of three biochemical characteristics of the liver as well as the images were then used as a new way of helping doctors to diagnose fatty liver disease.

Professor Philip Newsome, Director of the University of Birmingham’s Centre for Liver Research, said: “Non-alcoholic fatty liver disease is on the increase – the prevalence is estimated at around 20-30% in the UK.

“As numbers are expected to grow, this will undoubtedly have a major impact on the nation’s health, and will place a significant demand on NHS resources.

“The rising burden of non-alcoholic fatty liver disease calls for simpler and low risk strategies to manage this clinical problem that meet the needs of both clinicians and patients.”

Professor Gideon Hirschfield, also of the University of Birmingham, said: “It is clear that there is a rising burden of liver disease, particularly from non-alcoholic fatty liver disease. Our study is of importance to evaluating the best pathways to offer patients who need evaluation of their liver health.

“Whilst liver biopsy remains an important part of advanced Hepatology practice, clearly we need better non-invasive tools at our disposal to evaluate the nature and severity of liver disease.

“In this work we were able to compare and contrast different approaches to this challenging problem and show where scanning technology could help contribute to optimised diagnostic, prognostic and treatment pathways.”

The new scanning technology used in this research was called LiverMultiScan™ and was developed by Perspectum Diagnostics.

CEO of Perspectum Diagnostics Dr Rajarshi Banerjee said: “A LiverMultiScan can help a patient see liver disease and act on it. Digital health will improve the way we practice medicine; in this case, a painless scan is clearly safer than a biopsy needle, and is far better suited to monitoring patients.

“We are proud to be leading the way in providing more patient-centric solutions for people with liver disease that helps them and their doctors make informed decisions about their care.”

LiverMultiScan can be used to help doctors diagnose liver disease, even at the early stages, and can also help to predict those people whose liver disease is going to progress more quickly. In this study LiverMultiScan was superior for grading disease severity and excluding people at increased risk of disease progression, compared to the other tests evaluated. In practice this means that management of patients’ liver disease can be optimised, saving on healthcare resources and minimising risk to the patient.

For further information, contact Emma McKinney, Communications Manager (Health Sciences), University of Birmingham, tel: +44 (0) 121 414 6681. For out of hours enquiries contact the press office on +44 (0) 7789 921 165.

• The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 5,000 international students from over 150 countries.
• Eddowes et al (2018). ‘Utility and cost evaluation of multiparametric magnetic resonance imaging for the assessment of non-alcoholic fatty liver disease’. Alimentary Pharmacology & Therapeutics. DOI: 10.1111/apt.14469
• Read the paper here.
• This research was supported by a grant from Innovate-UK (101679). The study sponsor was the University of Birmingham. Researchers Peter Eddowes, Phillip Newsome and Gideon Hirschfield were supported by the National Institute of Health Research Birmingham Biomedical Research Centre. The paper presents independent research supported by the NIHR Birmingham Biomedical Research Centre (NIHR Birmingham BRC). The NIHR Birmingham BRC brings together the expertise of University Hospitals Birmingham NHS Foundation Trust (UHB) and the University of Birmingham, both members of Birmingham Health Partners (BHP).
• The is an example of research being carried out by Birmingham Health Partners - a strategic alliance between the University of Birmingham, University Hospitals Birmingham NHS Foundation Trust and Birmingham Women’s and Children’s NHS Foundation Trust. BHP’s mission is to harness research strengths between the University and NHS to deliver better treatments and care to patients. Together, they deliver research that matters.
• The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research. Established by the Department of Health, the NIHR:

1. funds high quality research to improve health
2. trains and supports health researchers
3. provides world-class research facilities
4. works with the life sciences industry and charities to benefit all
5. involves patients and the public at every step
6. For further information, visit the NIHR website 

• Excess body weight causes liver fat deposition and chronic inflammation, which can lead to liver cirrhosis as well as diabetes, accelerated heart disease and early death. Fatty liver disease doubles the risk of heart attack.
• Up to 25% of patients with non-alcoholic fatty liver disease (NAFLD) have liver cell injury and inflammation in addition to excessive fat, a condition designated as non-alcoholic steatohepatitis (NASH). Up to 40% of these patients will progress to cirrhosis, liver failure, and hepatocellular carcinoma (HCC).
• NASH is widely considered to be the liver expression of the metabolic syndrome, that is, diseases related to diabetes mellitus type 2, insulin resistance, central obesity, hyperlipidemia, and hypertension.
• There is already a worldwide epidemic of diabetes and obesity and the figure shows the expected increases of diabetes in different parts of the world, which will closely correlate with rates of NASH.
• LiverMultiScan™ is FDA 510(k) cleared in the U.S. and CE marked in Europe. It enables non-invasive and quantitative liver tissue characterisation to quickly and consistently quantify liver fat, as well as biomarkers which have been shown to correlates with iron and fibro-inflammation. It is a rapid and scalable technology that can be seamlessly integrated into existing MR examinations, without the need for contrast agent.
• How LiverMultiScan works:

1. Patients undergo an MRI scan on a compatible scanner – this takes about 15 mins and no contrast agent is required.
2. The scans are sent electronically to a secure reporting laboratory to be quantified using a proprietary AI-based algorithm. The results are processed by clinical and imaging specialists. 
3. The report is usually sent back to the referring doctor within 24 hours. It provides summary values of three biochemical characteristics of the liver as well as images that depict the health of the whole organ.