*3.5. Magnetic Resonance Elastography*

A meta-analysis including retrospective studies showed that magnetic resonance elastography (MRE) is particularly useful to determine liver stiffness and has high accuracy for the diagnosis of significant or advanced fibrosis and cirrhosis [124]. Therefore, this imaging modality may be highly suitable to detect progression and treatment response in patients with chronic liver disease. This imaging technique is complementary to ultrasound-based elastography techniques and is highly accurate in diagnosing advances fibrosis in patients suffering from NAFLD [125]. This was documented in a prospective study in which the accuracy of 3D-MRE and 2D-MRE was compared in a cohort of 100 consecutive patients with biopsy-proven NAFLD [126]. This study further revealed that 3D-MRE is significantly more accurate than 2D-MRE for diagnosis of advanced fibrosis in NAFLD patients.

MRE was also found to be more accurate than ultrasound-based transient elastography in a cross-sectional study of more than 100 NAFLD patients in which fibrosis were detected with an AUROC of 0.82 (95% confidence interval, 0.74–0.91) [122]. Also, for classification of steatosis and necroinflammtory activity, MRE showed higher diagnostic performance than transient elastography in patients with NAFLD [121,127].
