Rajarshi Banerjee, MD, PhD, MSc, is an internist with Oxford University Hospitals with a specific interest in hepatology and is also the founder of Perspectum Diagnostics Ltd. 

Rajarshi Banerjee, MD, PhD, MSc

Understanding MRI cT1’s Value in Liver Disease Care, with Rajarshi Banerjee, MD, PhD

New research is shedding light on the value of iron corrected T1 (cT1) as a reproducible biomarker capable of predicting both 

metabolic dysfunction-associated steatotic liver disease (MASLD)

The study, coined by investigators as the largest prospective analysis of cardiac and liver imaging and cardiac and liver events to date, leveraged MRI data for > 28,000 UK Biobank participants. Results highlight an increased risk of major adverse cardiovascular events with impairment of the heart or liver, major adverse liver events with liver impairment from cT1, and an association between liver impairment by cT1 with risk of all-cause, cardiovascular, and liver mortality.

Early detection, treatment, and prevention of major adverse cardiovascular and liver events are a priority in MASLD, but a major unmet need exists for noninvasive biomarkers that can stratify the increased risk of liver and cardiovascular outcomes due to liver impairment. Research on how integrated imaging metrics of cardiac and liver impairment interact with regard to outcomes is sparse.

“We have known for a long time that patients with liver disease are prone to get cardiovascular disease, but this has been largely anecdotal, because there have not been any good tests for liver disease that are scalable,” Rajarshi Banerjee, MD, PhD, CEO of Perspectum and an author on the study, explained to 

Recognizing the potential relevance of multiorgan MRI of the heart and liver, he and colleagues investigated associations between cardiac and liver impairment on MRI and the following:

Major adverse cardiovascular events and hospitalization

Major adverse liver events and hospitalization

All cause, cardiovascular, and liver-related mortality

Results showed elevated cT1 > 800ms in the liver was associated with a 30% increased risk of experiencing a heart-related hospitalization (hazard ratio [HR], 1.3; 95% CI, 1.1–1.5) and cT1 > 875ms led to a 9-fold increase in the risk of experiencing a serious liver related health outcome within 4 years. Of note, this association was absent with liver fat >10% and reduced ejection fraction, even in those with MASLD.

Further analysis revealed cardiac and liver impairment together accelerated the time to a cardiovascular event by 20 months. Specifically, reduced LVEF (<50%) and cT1 ≥ 800 ms were associated with both cardiovascular events (HR, 2.2; 95% CI, 1.2–4.2) and hospitalization (HR, 2.3; 95% CI, 1.4–3.7) as well as shorter time to cardiovascularly events than those without this combination of reduced LVEF and increased cT1 (0.78 vs 2.4 years; 

“Clinically, if someone has suspected liver disease, rather than biopsying them, now we can offer them a scan, and if that scan is normal, their chance of having clinical events that are worrying, liver decompensation, heart attacks, is low,” Banerjee explained. “On the less reassuring but more precision medicine side, if someone has a positive scan, i.e. they have an elevated corrected t1 score, then we know that these are the patients to prioritize for care and counseling.”

In addition to cT1’s role as a key biomarker for predicting clinical endpoints in liver disease and its potential to replace liver biopsy in clinical trials, Banerjee highlights the newfound ability to include liver disease in integrated metabolic care, something that has historically been difficult to accomplish due to the siloed nature of liver care.

Editors’ note: Banerjee has relevant disclosures with Perspectum.

 Cardiac and liver impairment on multiorgan MRI and risk of major adverse cardiovascular and liver events. 

https://doi.org/10.1038/s41591-025-03654-2

Businesswire. Major Study Shows Liver Health Measured with cT1 Predicts Clinical Outcomes. May 7, 2025. Accessed May 15, 2025. 

https://www.businesswire.com/news/home/20250507699867/en/Major-Study-Shows-Liver-Health-Measured-with-cT1-Predicts-Clinical-Outcomes

Videos

Banerjee describes the value of multiorgan MRI for predicting cardiac and liver outcomes and cT1’s prognostic utility in liver disease.

Multiparametric MRI’s Cost-Effectiveness for MASH, with Rajarshi Banerjee, MD, PhD

New research suggests multiparametric magnetic resonance imaging (mpMRI) with LiverMultiScan is a viable tool for identifying and managing patients with 

metabolic dysfunction-associated steatotic liver disease (MASLD

), offering a cost-effective alternative to liver biopsy and other noninvasive tests.

“Multiparametric MRI is a very great technology for tissue characterization, and since the diagnosis of MASH, metabolic associated steatohepatitis, is a tissue characterization diagnosis… the technology and the disease meet like hand and glove,” Rajarshi Banerjee, MD, PhD, CEO of Perspectum, told 

The RADIcAL-1 trial enrolled more than 800 patients from Germany, the Netherlands, Portugal, and the UK to test the cost-effectiveness and resource use associated with Perspectum’s LiverMultiScan, a commercially available, FDA-cleared software medical device intended for diagnosis, monitoring, and clinical management of patients with liver diseases. The non-invasive, non-contrast technology assesses liver disease activity, fat, and iron using existing MRI infrastructure.

In RADIcAL-1, investigators assessed whether mpMRI with LiverMultiScan plus standard of care (SoC) was more cost-effective than SoC alone for MASLD risk stratification. Results showed mpMRI improved diagnosis rates, reduced the need for specialist consultations, and avoided unnecessary liver biopsies.

Although patients in the SoC arm of the trial had significantly more specialist appointments with healthcare professionals and for patient assessments than those in the imaging arm (

= .015), the imaging arm had a significantly higher percentage of patients with a final diagnosis at the end of the trial compared with SoC (57% vs 48%; 

Additionally, using a QALY loss of 0.03 per patient per missed diagnosis, the use of mpMRI in the imaging arm was deemed to be cost-effective with an incremental cost-effectiveness ratio of €5067.77 ($5,530.28 USD) per 1.02 QALYs gained (€4968.40[$5,421.09 USD]/QALY gained).

“The fact that not only was this the most effective test, but it was cost-effective versus all the cheaper tests, was the real eye opener here. Many found it surprising, including some of the study authors,” Banerjee said. “That should help develop the key pillars to get this into guidelines in different countries.”

Banerjee concluded by saying that he believes patients with liver disease deserve better than what is currently being provided to them.

“We have ways to monitor and manage disease such that you can prevent heart attacks and prevent liver-related outcomes. Whilst you're always in a position where you could do more research, don't let the welfare of the patient be sacrificed for that extra paper or that extra outcome measure,” he said. “I think that's really important to highlight because there is a strong body of evidence that LiverMultiScan should be used clinically, and that's been demonstrated in several settings.”

Brooks A.Multiparametric MRI Cost-Effective for Noninvasively Identifying, Managing MASLD. 

. March 18, 2025. Accessed March 19, 2025. 

https://www.hcplive.com/view/multiparametric-mri-cost-effective-noninvasively-identifying-managing-masld

Perspectum. LiverMultiScan Clinical Primer. Accessed March 19, 2025. 

https://www.perspectum.com/clinical-solutions/livermultiscan-healthcare-professionals

Banerjee explains the need for noninvasive tests for MASH and reviews promising findings from the RADIcAL-1 trial of LiverMultiScan versus standard of care.

Arab and Banerjee discuss how new therapies change discussions around screening, management of MASH

How New Therapies Change Discussions Around Screening, Management of MASH

In the final part of our 5-part video series, Arab and Banerjee discuss how an approval for MASH, such as resmetirom might shift discussions about the need for screening from reactive to proactive. The pair conclude the overall discussion by highlighting the importance of implementing screening strategies for asymptomatic patients with suspected liver disease. Banerjee outlines that establishing outpatient community diagnostic centers, where patients undergo blood tests and scans to determine their eligibility for treatment, will be critical in the UK and elsewhere. He highlights the role of primary care providers in prescribing medications based on recommendations from specialist clinics.

Arab also emphasized the importance of preventive medicine and the need to allocate resources effectively to target high-risk populations. He discusses the triage process in Ontario, Canada, where patients are assessed based on their risk of advanced liver disease and referred for further testing accordingly. Later, the pair agree on the necessity of non-invasive assessments, such as transient elastography, to identify patients who may benefit from treatment.

Before concluding the conversation, Arab and Banerjee touch on the scalability of screening programs, with Banerjee mentioning the increasing accessibility of diagnostic tests like MRI and fibroscan. Both experts commented on the availability of these technologies and emphasize the importance of tailoring screening strategies to each health system's resources and population needs.

Editor’s Note: This conversation was recorded on March 14, 2024 prior to the FDA’s approval of resmetirom.

Arab has no relevant disclosures to report. Banerjee’s disclosures include Perspectum Ltd.

Articles

In the final installment in our 5-part video series, our pair of experts in hepatology touch upon how an approval for MASH would impact conversations around screening for asymptomatic patient populations. 

 How New Therapies Change Discussions Around Screening, Management of MASH

JP Arab, MD, and Rajarshi Banerjee, MD, PhD, MSc, discuss how the study population of MAESTRO-NASH compares to MASH population in real-world settings. 

Comparing MAESTRO-NASH to Real-World MASH Populations

In this portion of the discussion, Arab and Banerjee address how the population and inclusion criteria for MAESTRO-NASH compare to that of real-world populations with MASH, with a specific focus on fibrosis levels. To begin the discussion, Arab notes a substantial proportion of patients in the MAESTRO study had advanced fibrosis (F3 or higher), which may influence the perspectives of clinicians entering the field. Banerjee emphasizes that the distribution of fibrosis severity can vary depending on the clinical setting, with primary care offices likely seeing more patients with early-stage fibrosis (F1 or F2) and liver transplant centers dealing with more advanced cases.

Regarding treatment targets, Banerjee suggests focusing on patients with higher fibrosis scores (F2 or F3) as they are at greater risk of adverse outcomes and may derive the most benefit from treatment. Arab concurs with this sentiment, suggesting an approach targeting this population could help prevent disease progression and associated complications, such as cirrhosis.

When discussing thresholds for initiating treatment, Banerjee mentions the use of transient elastography (Fibroscan) to assess fibrosis levels. He suggests using thresholds such as less than 8 for non-significant fibrosis (F0-F1) and greater than 12 for significant fibrosis (F2-F3), with patients falling between 8 and 12 potentially deriving the greatest magnitude of benefit from treatment.

Editor’s Note: This conversation was recorded on March 14, 2024 prior to the FDA’s approval of resmetirom. 

In part 4 of our 5-part video series, Arab and Banerjee discuss how the study population of MAESTRO-NASH compares to MASH populations in real-world settings. 