The aim of this proposal is to investigate a novel imaging method to identify patients with non-alcoholic steatohepatitis (NASH) who are at risk for hepatocellular carcinoma (HCC).

NASH is the most common cause of chronic liver disease, and it is estimated that 40-50% of patients with obesity and T2DM have NASH. NASH can lead to HCC with the risk increasing 2-3 fold in patient with poor glycemic control. Unless caught early, HCC has a poor prognosis with no effective therapies. A unique feature of HCC in NASH is that it often arises at a pre-cirrhotic stage, and the prognosis is often dismal. There are no current surveillance strategies for these pre-cirrhotic patients. Based on our animal models and pilot patient studies, we developed a novel paradigm that linked liver matrix changes to a more aggressive HCC phenotype. Our goal is to develop an imaging-based surveillance tool that will identify early matrix changes that may predispose to HCC.

Inclusion Criteria:

1. Male or non-pregnant/non-lactating women ≥ 18 years of age
2. Diagnosis of NASH
3. Diagnosis of pre-cirrhotic fibrosis (F1-F3), diagnosed as per standard of care (history, exam, laboratory tests, Fibroscan, within 6 months of enrollment)
4. Na-MELD < 9: The Na-MELD (sodium-Model for End Stage Liver Disease) score is routinely used to assess liver synthetic function and life expectancy. Patients with Na-MELD<9 have less than 1.9% 3 months liver-related mortality risk, and their liver synthetic function is normal.
5. Groups both with and without T2DM will be enrolled.
6. Women of childbearing potential must agree to at least two methods of contraception.
7. Will not participate in any other clinical trial for the duration of the study
8. Will not consume alcohol for the duration of the study
9. If on vitamin E, pioglitazone or any anti diabetic treatment prior to the study, will have been on stable therapies for 6 months prior to enrolment.
10. Able to undergo 3 Tesla MRI and complete MRI screening form
11. Ability to understand and the willingness to sign a written informed consent document.
12. ECOG or Karnofsky Performance Status will be not be employed

Exclusion Criteria:

1. Presence of any other form of liver disease, including viral hepatitis, autoimmune hepatitis, alcoholic liver disease, genetic causes of chronic liver disease, cardiogenic liver disease, and HIV positivity (can cause liver fibrosis).

2. ALT>300 U/l

3. Total serum bilirubin ≥ to 1.3 mg/dL (Gilbert's Syndrome patients are excepted)

4. International Normalized Ratio (INR) ≥ 1.3

5. MELD>9

6. Serum creatinine >2.0mg/dl

7. Known alcohol abuse or alcohol use disorder (AUDIT profile and/or pos. urine ethylglucuronide):

   • >20 g/day for women
   • >30 g/day for men

8. Active substance abuse

9. Platelet count ≤100//mm3

10. Hemoglobin <11 g/dl in females or <12 g/dl in males

11. Presence/history of HCC, or other primary or metastatic cancer to the liver.

12. History of liver transplantation

13. History of bariatric surgery

14. History of inflammatory bowel disease

15. History of advanced pulmonary disease

16. Any concerns regarding compliance by enrolling physician

17. Pregnant or lactating women.

18. Presence of cardiac implantable electronic device (CIED)

19. History of CIED with retained leads

20. Presence of any metallic foreign body that is unsafe for the MRI environment

21. Inability to undergo MRI based on responses to the MRI screening form

22. History of claustrophobia or the need for sedation to undergo MRI

The study will include one group of healthy subjects and two groups with 15 patients each which will enroll in parallel, one group with type 2 diabetes mellitus (T2DM), and one group without DM.