Evaluation of Pretreatment Magnetic Resonance Elastography for the Prediction of Radiation-Induced Liver Disease

Trey C. Mullikin, Kay M. Pepin, Jaden E. Evans, Sudhakar K. Venkatesh, Richard L. Ehman, Kenneth W. Merrell, Michael G. Haddock, William S. Harmsen, Michael G. Herman, Christopher L. Hallemeier

Research output: Contribution to journalArticlepeer-review


Purpose: Magnetic resonance (MR) elastography (E) is a noninvasive technique for quantifying liver stiffness (LS) for fibrosis. This study evaluates whether LS is associated with risk of developing radiation-induced liver disease (RILD) in patients receiving liver-directed radiation therapy (RT). Methods and Materials: Based on prior studies, LS ≤3 kPa was considered normal and LS >3.0 kPa as representing fibrosis. RILD was defined as an increase in Child-Pugh (CP) score of ≥2 from baseline within 1 year of RT. Univariate and multivariate Cox models were used to assess correlation. Results: One hundred two patients, 51 with primary liver tumors and 51 with liver metastases, were identified with sufficient follow-up. In univariate models, pre-RT LS >3.0 kPa (hazard ratio [HR] 4.9; 95% confidence interval [CI], 1.6-14; P =.004), body mass index (BMI), clinical cirrhosis, CP score, albumin-bilirubin (ALBI) grade 2, primary liver tumor, and mean liver dose were significantly associated with risk of post-RT RILD. In a multivariate analysis, LS >3.0 and mean liver dose both were significantly associated with RILD risk. Conclusions: Elevated pre-RT LS is associated with an increased risk of RILD in patients receiving liver-directed RT.

Original languageEnglish (US)
Article number100793
JournalAdvances in Radiation Oncology
Issue number6
StatePublished - Nov 1 2021

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging


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