Specialist commentator comments

Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All 3 specialists were familiar with or had used this technology before.

Level of innovation

One specialist said LiverMultiScan was innovative compared with the current care pathway. One specialist noted that other non-invasive measures of liver function such as blood tests and transient elastography were available in the NHS. These were commonly used for staging liver disease in the NHS but none of these measures had the ability to adequately distinguish different stages of liver disease (liver fibrosis) and to capture or track any change in liver tissue. This specialist thought that the technology provided similar modalities to other non-invasive tests, and that MRI-based measures including MRI elastography and MRI-derived proton density fat fraction are becoming available in some specialist centres. Another specialist suggested the novel aspect of LiverMultiScan was for the iron-corrected T1 (cT1) measurement, which was a patented correction technique that removed the biasing effect of iron from the T1 measurement.

Potential patient impact

One specialist thought that LiverMultiScan would provide comprehensive evaluation of liver health and may reduce the need for a liver biopsy when results of other conventional non-invasive tests were indeterminate. This specialist suggested that LiverMultiScan's quantification and assessment of fibro-inflammation could be useful in the stratification of patients with non-alcoholic fatty liver disease, especially in identifying high-risk non-alcoholic steatohepatitis patients who were at high risk of liver disease progression. Another specialist said that the technology would produce a liver heat map which provided the distribution of disease within the liver, which may have a positive effect on patients' management. One specialist did not think that there was any benefit to patients that was supported by the evidence.

Potential system impact

One specialist said LiverMultiScan may lead to reductions in the number of liver biopsies, but further evidence was needed to support its prognostic capability. This specialist also thought LiverMultiScan may need extra resources in radiology departments such as additional time for an MRI scan, initial set up and staff training. One specialist agreed that the technology could reduce the need for liver biopsies and may detect disease early to improvement the monitoring and management of patients. Another specialist did not think there would be any benefit to the health system; on the contrary, the use of the technology would add substantial demand on the system because of the potential increase in the number of patients having MRI scanning.

General comments

All specialists thought the technology was unlikely to replace current standard of care and felt the technology could be used as well as current tests. Specialists agreed that more high-quality evidence was needed to evaluate clinical effectiveness of LiverMultiScan.