Chronic Liver Disease: Assessing Inflammation and Fibrosis Using Three‐Dimensional <scp>MR</scp> Elastography With Same‐Day Biopsy in a Prospective Cohort

ABSTRACT Background Three‐dimensional (3D) MR elastography (MRE) derives viscoelastic parameters that may reflect inflammation, but their frequency dependence and the influence of steatosis on inflammation grading and fibrosis staging remain unclear. Purpose To investigate 3D multifrequency MRE for assessing hepatic inflammation, fibrosis stage across frequencies, and the influence of steatosis. Study Type Prospective. Population Sixty‐four (40 men, median age: 58 years) participants with chronic liver disease (CLD); 21 (8 men, median age: 28 years) healthy volunteers. Field Strength/Sequence 3‐T; gradient‐echo sequence with mechanical vibrations at low (16.7 and 18 Hz), medium (33.4 and 36 Hz), and high (50.1 and 54 Hz) frequencies. Assessment In CLD participants, MRE‐derived viscoelastic parameters, shear stiffness, storage modulus, loss modulus, and damping ratio were compared with histologically assessed fibrosis, inflammation, and steatosis. MRE test–retest repeatability over 10 min was evaluated in healthy volunteers. Statistical Tests Wilcoxon rank sum test, Spearman's correlation, multivariable regression analysis, and area under the receiver operating curve (AUROC). A p value of &lt; 0.05 was considered statistically significant. Results Inflammation was significantly independently associated with damping ratio at medium frequency, which showed moderate performance for grading inflammation (AUROC = 0.76–0.83, sensitivity = 0.83–0.84, specificity = 0.70–0.79). Fibrosis staging using shear stiffness and moduli showed high diagnostic performance (AUROC = 0.82–0.95), with comparable accuracy between medium and high frequencies ( p = 0.327–0.896). Steatosis was not significantly correlated with MRE overall ( p = 0.212–0.459), but was significantly associated with 19% higher stiffness and 20% higher loss modulus at medium frequency in CLD participants without fibrosis or inflammation. Data Conclusion Medium frequency 3D MRE demonstrated an independent association with inflammation while preserving accurate fibrosis assessment. Steatosis seemed not to confound MRE‐based evaluation. Level of Evidence 1. Technical Efficacy Stage 2.