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Quantitative liver MRI including extracellular volume fraction for non-invasive quantification of liver fibrosis: a prospective proof-of-concept study
  1. Julian A Luetkens1,
  2. Sabine Klein2,
  3. Frank Traeber1,
  4. Frederic C Schmeel1,
  5. Alois M Sprinkart1,
  6. Daniel L R Kuetting1,
  7. Wolfgang Block1,
  8. Kanishka Hittatiya3,
  9. Frank E Uschner2,
  10. Robert Schierwagen2,
  11. Juergen Gieseke1,4,
  12. Hans H Schild1,
  13. Jonel Trebicka2,5,6,7,
  14. Guido M Kukuk1
  1. 1Department of Radiology, University of Bonn, Bonn, Germany
  2. 2Department of Internal Medicine I, University of Bonn, Bonn, Germany
  3. 3Institute of Pathology, University of Bonn, Bonn, Germany
  4. 4Philips Research, Hamburg, Germany
  5. 5European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain
  6. 6Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
  7. 7Institute for Bioengineering of Catalonia, Barcelona, Spain
  1. Correspondence to Dr Jonel Trebicka; jonel.trebicka{at}

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We read with interest the recent reviews published in Gut, emphasising that even though the understanding of the pathobiology of liver fibrosis has been improved in the last three decades,1 novel and easy to implement diagnostic and therapeutic approaches are required.2 Indeed, fibrosis is the most important histological feature of patients with chronic liver disease (CLD), such as non-alcoholic fatty liver disease, and is associated with long-term overall mortality, liver transplantation and liver-related events.3 Diagnostic and therapeutic approaches,2 therefore, require accurate measurements that ideally allow non-invasive fibrosis quantification, representing the whole liver free of bias and easily integrated in clinical routine.

A liver biopsy, still the reference standard, has substantial drawbacks (complications, intraobserver and interobserver variabilities).4 Transient elastography (TE), suggested for population-wide screens (eg, patients with diabetes),5 requires additional expensive devices and trained personnel. However, contrast-enhanced MRI is …

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