Fig 14.

Hepatic steatosis alone has little effect on liver stiffness. The top row shows images of a patient with biopsy-proven non-alcoholic fatty liver disease (NAFLD) without steatohepatitis. The in-phase and opposed-phase gradient echo images on the left show a drop in the signal relative to in-phase, indicative of significant hepatic steatosis. The corresponding MR elastogram shows normal hepatic stiffness. The lower row shows images of a patient with biopsy-proven non-alcoholic steatohepatitis (NASH). The in-phase and opposed-phase images demonstrate elevated hepatic fat content, similar to the first patient, but the elastogram shows markedly increased hepatic stiffness consistent with the biopsy diagnosis of stage 4 fibrosis.