Prospective Comparison of DWI ‐Derived Virtual MR Elastography and Conventional MR Elastography in Metabolic Dysfunction‐Associated Steatotic Liver Disease and Healthy Volunteers

ABSTRACT Background Virtual MR elastography (VMRE) and MRE have been proposed for liver fibrosis staging in metabolic dysfunction‐associated steatotic liver disease (MASLD), but VMRE's diagnostic performance remains debated. Purpose To assess the inter‐visit and inter‐reader reproducibility of fat‐uncorrected and fat‐corrected diffusion‐weighted imaging (DWI)‐based VMRE and to compare their diagnostic performance with MRE for liver fibrosis staging in the MASLD population. Study Type Prospective. Population Fifty four participants were enrolled: 43 with biopsy‐proven MASLD (age: 57.0 ± 9.0 years; 26 males) and 11 healthy volunteers (age: 31.0 ± 15.0 years; 4 males). Field Strength/Sequence 3.0T, DWI ( b ‐values of 0, 200, and 1500 s/mm 2 ) for VMRE and phase‐contrast MRE at 60 Hz was performed. Assessment VMRE‐derived shifted apparent diffusion coefficients (sADC) reproducibility and diagnostic performance; MRE‐derived stiffness diagnostic performance. Statistical Tests Reproducibility was evaluated using intraclass correlation coefficients (ICC), within‐subject coefficient of variation (wCV), and bias and limits of agreement (LOA) in Bland–Altman analysis. Diagnostic performance was assessed with areas under the receiver operating characteristic curve (AUC) and compared with DeLong's test. p < 0.05 was considered statistically significant. Results For inter‐visit agreement, the ICC of fat‐uncorrected and fat‐corrected sADC were 0.88 and 0.83; wCV were 0.120 ± 0.30 and 0.141 ± 0.31; bias and 95% LOA were (−0.03 ± 0.18) × 10 −3 mm 2 /s and (−0.05 ± 0.33) × 10 −3 mm 2 /s, respectively. For inter‐reader agreement, the ICC of fat‐uncorrected and fat‐corrected VMRE were 0.99 and 0.99; wCV were 0.028 ± 0.011 and 0.039 ± 0.012, respectively; bias and 95% LOA were (−0.01 ± 0.03) × 10 −3 mm 2 /s and (−0.02 ± 0.05) × 10 −3 mm 2 /s, respectively. AUC of fat‐uncorrected, fat‐corrected sADC, and MRE‐derived stiffness for distinguishing fibrosis stages F0 versus ≥ F1 were 0.70 ± 0.17, 0.56 ± 0.18, and 0.87 ± 0.10; ≤ F1 versus ≥ F2 were 0.61 ± 0.16, 0.49 ± 0.17, and 0.86 ± 0.10; ≤ F2 versus ≥ F3 were 0.54 ± 0.16, 0.50 ± 0.16, and 0.89 ± 0.09; and ≤ F3 versus F4 were 0.58 ± 0.16, 0.55 ± 0.17, and 0.85 ± 0.11, respectively. MRE had significantly higher diagnostic performance than fat‐uncorrected and fat‐corrected VMRE for all fibrosis stages. Data Conclusion VMRE has good reproducibility, but has lower fibrosis staging accuracy than MRE. Evidence Level 1. Technical Efficacy Stage 2.