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 cardiovascular and hepatic outcomes in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).1

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.1

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.1

“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 HCPLive.

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.1,2

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; P <.05).1,2

“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.

References

1. Jackson, E., Dennis, A., Alkhouri, N. et al. Cardiac and liver impairment on multiorgan MRI and risk of major adverse cardiovascular and liver events. Nat Med. https://doi.org/10.1038/s41591-025-03654-2

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