About

Rashmi Agni is a Professor (CHS) in the Department of Pathology and Laboratory Medicine at the University of Wisconsin School of Medicine and Public Health. Her research interests include Liver Pathology. She has contributed to studies on the safety and efficacy of helminth treatment in relapsing-remitting multiple sclerosis, as well as on hepatic composite tumors in patients with primary sclerosing cholangitis. Her work also includes research on resection of hilar cholangiocarcinoma and its impact on hepatic recurrence, as well as the effects of acute alcoholic hepatitis on outcomes after liver transplantation.

Research topics

• Medicine
• Radiology
• Internal medicine
• Surgery
• Pathology
• General surgery
• Nuclear medicine

Selected publications

• Banff 2024 Pancreas Transplantation Report: Diagnosis and impact of chronic active T cell-mediated allograft rejection and re-evaluation of the indeterminate category with utilization of leukocyte immunostains in biopsies with ambiguous findings

  American Journal of Transplantation · 2026-04-01

  articleOpen access

  The current Banff report summarizes topics central to the pancreas session in the 2024 conference held in Paris (France). The focus of discussion was on diagnostic criteria of chronic active rejection, the indeterminate (IND) category, and the utility of immunostains in pancreas transplant biopsies. Concepts were validated in a retrospective PanTxBx cohort after the meeting. First, chronic active rejection criteria introduced in the 2022 report were confirmed, and recommendations were refined. The clinical relevance of this category, with an increased risk of graft loss, was proven in the retrospective cohort. Second, the so far very narrowly defined IND category was expanded from septal inflammation to also include subthreshold lobular changes and incomplete findings of antibody-mediated rejection. IND cases were evaluated in the context of the clinical findings and CD3 and CD68 immunostaining. This process helped in further subcategorizing the IND diagnoses into rejection and non-rejection events and, third, led to the general recommendations provided for utilization of CD3 and CD68 immunostains to facilitate the histologic diagnosis in unclear biopsies. The working group expects that the current recommendations and refinements will enhance the applicability and reproducibility of the histopathological pancreas schema. Additionally, an outlook is given regarding ongoing projects and future perspectives.

  PublisherDOI

• Baseline predictors of adipose tissue proton density fat fraction (PDFF) reduction in participants undergoing metabolic bariatric surgery

  Proceedings on CD-ROM - International Society for Magnetic Resonance in Medicine. Scientific Meeting and Exhibition/Proceedings of the International Society for Magnetic Resonance in Medicine, Scientific Meeting and Exhibition · 2025-09-16

  article

  Motivation: Visceral (VAT) and subcutaneous (SAT) adipose tissue PDFF are correlated to BMI and decrease with weight loss, however the underlying baseline factors associated with these changes have not yet been elucidated. Goal(s): Our goal was to assess baseline predictors for VAT PDFF and SAT PDFF reduction after weight loss. Approach: Baseline characteristics were assessed in participants and compared to changes in VAT and SAT PDFF 12 months after undergoing metabolic bariatric surgery. Results: Participants with healthier metabolic profiles at baseline had more pronounced reductions in VAT and SAT PDFF 12 months after metabolic bariatric surgery. Impact: Adipose tissue PDFF, with further research and validation, could aid as a novel metric in monitoring metabolic health in patients with obesity and during weight loss.

  PublisherDOI

• Metabolic dysfunction-associated steatohepatitis (MASH) dampens liver fat reduction in participants after metabolic bariatric surgery

  Proceedings on CD-ROM - International Society for Magnetic Resonance in Medicine. Scientific Meeting and Exhibition/Proceedings of the International Society for Magnetic Resonance in Medicine, Scientific Meeting and Exhibition · 2025-09-16

  article

  Motivation: Patients with MASH have increased inflammation and insulin resistance, however whether this translates to dampened liver fat reduction after weight loss is not known. Goal(s): Our goal was to assess if patients with MASH have altered liver fat reduction after weight loss. Approach: Baseline MASH status was determined in participants with obesity via biopsy during metabolic bariatric surgery. Liver PDFF was assessed by MRI pre-op and 12 months post-op and the changes were compared between groups. Results: Participants with MASH had dampened reduction of liver PDFF after metabolic bariatric surgery when controlling for baseline PDFF. Impact: For patients with obesity and MASH, adjuvant treatment may be needed to achieve the same total goal reduction in liver fat as patients without MASH.

  PublisherDOI

• Proton density fat fraction for diagnosis of metabolic dysfunction–associated steatotic liver disease

  Hepatology · 2025-03-25 · 10 citations

  articleOpen access

  BACKGROUND AND AIMS: Prior work has shown that MRI-derived proton density fat fraction (PDFF) can diagnose metabolic dysfunction-associated steatotic liver disease (MASLD) noninvasively, but there is a paucity of data on the performance of PDFF to classify more advanced forms of the MASLD spectrum. The purpose of this study was to assess the diagnostic performance of PDFF for the diagnoses of MASLD, metabolic dysfunction-associated steatohepatitis (MASH), and fibrotic MASH in adults with obesity undergoing bariatric surgery, using contemporaneous intraoperative liver biopsy as a reference. APPROACH AND RESULTS: PDFF was evaluated alone and with other potential classifiers (imaging, serum and anthropometric), using Bayesian Information Criterion-based stepwise logistic regression models. Areas under the receiver operating characteristic (ROC) curves (AUC) were computed for all models and single classifiers. Cross-validated sensitivity and specificity were calculated at Youden-based PDFF classification thresholds. Data analysis from 140 patients demonstrated that PDFF was the most accurate single classifier, with high AUC for MASLD (0.95), MASH (0.85), and fibrotic MASH (0.82) (all p <0.001). Multivariable models, including PDFF, outperformed those without PDFF. The Youden-based threshold for PDFF was 4.4% for MASLD (sensitivity: 87%, specificity: 86%), 6.9% for MASH (sensitivity: 77%, specificity: 66%), and 13.5% for fibrotic MASH (sensitivity: 67%, specificity: 85%). CONCLUSIONS: PDFF was the most accurate single classifier for diagnosing MASLD, MASH, and fibrotic MASH. The most accurate multivariable classification models for MASLD, MASH, and fibrotic MASH included PDFF, demonstrating the central importance of PDFF for noninvasive assessment of the MASLD spectrum.

  PublisherOA PDFDOI

• Endoscopic Ultrasound With Fine-Needle Biopsy for Rare Pancreatic Metastasis: A Case Series of Neuroendocrine Transformation From Primary Prostate Cancer

  ACG Case Reports Journal · 2025-10-30

  articleOpen access

  Metastatic cancer to the pancreas is uncommon, accounting for only 2%-4% of pancreatic malignancies. Prostate cancer spreading to the pancreas is exceptionally rare. We present 2 cases of metastatic castration-resistant prostate cancer with histologic transformation from adenocarcinoma to neuroendocrine prostate cancer. Both patients developed new pancreatic lesions, in which endoscopic ultrasound-guided fine-needle biopsy confirmed the diagnosis. These cases highlight therapy-emergent neuroendocrine prostate cancer with loss of prostate lineage markers (prostate-specific antigen, NKX3.1), positive neuroendocrine markers (synaptophysin, INSM1, chromogranin), very high proliferative indices, and serum marker discordance that can mimic primary pancreatic cancer. These scenarios present a diagnostic challenge with an aggressive and complex nature, requiring multidisciplinary management. With newer therapies and prolonged survival of patients with prostate cancer, clinicians will likely encounter more cases in the future. Gastroenterologists can play a key role in diagnosis and palliative treatment.

  PublisherDOI

• Banff 2024 Pancreas Transplantation Report: Diagnosis and Impact of Chronic Active T-Cell Mediated Allograft Rejection, Re-Evaluation of the Indeterminate Category and Utilization of CD3/CD68 Immunostains in Biopsies with Ambiguous Findings

  SSRN Electronic Journal · 2025-01-01

  preprintOpen access
  PublisherDOI

• Endoscopic Ultrasound With Fine Needle Biopsy Confirming a Diagnosis of Immune Checkpoint Inhibitor‐Related Type 3 Autoimmune Pancreatitis

  Case Reports in Gastrointestinal Medicine · 2025-01-01

  articleOpen access

  Introduction: Immune checkpoint inhibitor-related pancreatitis, also known as type 3 autoimmune pancreatitis (AIP), is uncommon and has a widely ranging clinical presentation. We present the biopsy findings of a case consistent with type 3 AIP-an entity recently described in the literature, the pathologic findings of which have not been well characterized. Case Report: A 71-year-old male with metastatic mucosal melanoma of the urethra was treated with immune checkpoint inhibitor (ICI) therapy (nivolumab/relatlimab) and developed vague epigastric discomfort. He was found to have an elevated lipase, which increased to > 20x the upper limit of normal. Subsequent imaging showed new infiltrative masses in the pancreatic head and distal body/tail. Endoscopic ultrasound with fine needle biopsy (FNB) was performed. This showed T-lymphocyte predominant infiltrates, in the acini and septal areas, with concomitant acinar, duct, and venular damage, including both CD4 and CD8 lymphocytes, which were considered consistent with type 3 AIP. He was treated successfully with prednisone. Discussion: On biopsy, there was no evidence of malignancy or features of type 1 or type 2 AIP. Histologic findings included moderate infiltration and damage to the pancreatic parenchyma, ductal, and vascular structures by CD4 and CD8 lymphocytes, pointing to immune-mediated pancreatic injury, and supportive of ICI-mediated injury to the pancreas of this patient. The clinical presentation of type 3 AIP ranges from asymptomatic lipase elevation to asymptomatic pancreatitis to acute symptomatic pancreatitis. There may be no clear temporal relationship to treatment initiation. Type 3 AIP typically presents along with other immune-related adverse events. Endoscopic ultrasound with FNB contributed to diagnostic certainty in this case and changed our patient's management, allowing for appropriate treatment of his immune-related adverse event.

  PublisherOA PDFDOI

• Quantitative Digital Histological Analysis and Comparison to Proton Density Fat Fraction in Patients Undergoing Weight Loss Surgery

  Proceedings on CD-ROM - International Society for Magnetic Resonance in Medicine. Scientific Meeting and Exhibition/Proceedings of the International Society for Magnetic Resonance in Medicine, Scientific Meeting and Exhibition · 2024-08-14

  article

  The goal of our study was to correlate quantitative digital microscopic histological markers of hepatic steatosis with MRI-PDFF and demonstrate that microenvironment characterization can be used to evaluate hepatic microstructure in NAFLD for future MRI-based studies. Patients were recruited to undergo weight loss surgery during which a liver biopsy was performed. The biopsies were analyzed for steatosis proportionate area (SPA) and characterization of fat droplets. The SPA strongly correlated to the pathologist grading and MRI-PDFF and the liver fat content strongly correlated with the number of fat droplets. Our work demonstrated the feasibility of using MRI to characterize liver microstructure.

  PublisherDOI

• Non-contrast Portal Venous 4D Flow MRI in an Obese Cohort Undergoing Weight Loss Surgery: Feasibility and Correlations with BMI and MASH

  Proceedings on CD-ROM - International Society for Magnetic Resonance in Medicine. Scientific Meeting and Exhibition/Proceedings of the International Society for Magnetic Resonance in Medicine, Scientific Meeting and Exhibition · 2024-11-26

  article

  Motivation: To evaluate the potential of portal flow as a biomarker of metabolic-dysfunction associated steatohepatitis (MASH) in obese patients undergoing weight loss surgery (WLS). Goal(s): Determine feasibility of portal non-contrast 4D Flow in obese patients, to assess whether flow is impacted by BMI and the presence of MASH. Approach: Portal flow was quantified at 5 timepoints before and after WLS. Mass conservation and inter-observer agreement assessed validation. Results were correlated with BMI and presence/absence of biopsy-proven MASH. Results: Non-contrast 4D Flow was successful in 339/382 exams (87%); BMI correlated with portal flow (p=0.010); flow was significantly higher in MASH (p=0.013, AUC=0.706) Impact: Our work demonstrates the feasibility of non-contrast 4D flow in individuals with obesity. Further, it indicates possible effects of obesity on portal venous flow and demonstrates its potential as a treatment monitoring tool in MASH.

  PublisherDOI

• PDFF diagnoses MASH in patients with severe obesity but without known liver disease

  Proceedings on CD-ROM - International Society for Magnetic Resonance in Medicine. Scientific Meeting and Exhibition/Proceedings of the International Society for Magnetic Resonance in Medicine, Scientific Meeting and Exhibition · 2024-11-26 · 1 citations

  article

  Motivation: To address the pressing need for non-invasive diagnosis of metabolic dysfunction-associated steatohepatitis (MASH). Goal(s): To evaluate the potential of proton-density fat-fraction (PDFF), corrected T1 (cT1), liver enzymes, and fibrosis scores to assist in the diagnosis of MASH. Approach: The study included study participants with obesity and at risk for MASH, undergoing bariatric surgery with intraoperative liver biopsy. Potential predictors and predictor combinations were evaluated as classifiers for MASH and steatosis. Results: PDFF distinguished MASH from non-MASH (AUC=0.85; 95%CI 0.79-0.91, p&amp;lt;0.0001). A cutoff of PDFF&amp;ge;13.9% detected MASH with 90% specificity and 59% sensitivity. Neither cT1, liver enzymes, nor fibrosis scores significantly improved diagnostic performance. Impact: Our results suggest that PDFF alone may be sufficient for non-invasive detection of metabolic dysfunction-associated steatohepatitis (MASH). This novel use case for an established method has the potential to transform the diagnostic approach to MASH which currently necessitates invasive biopsy.

  PublisherDOI

Frequent coauthors

• Michael R. Lucey

  169 shared

• David P. Foley

  University of Wisconsin–Madison

  164 shared

• Philip Y. Wai

  Oxford Fertility

  163 shared

• Chen Jh

  162 shared

• Bryan T. Drew

  University of Nebraska at Kearney

  162 shared

• Susan N. Hastings

  Durham VA Health Care System

  162 shared

• Hong Xiao

  Bristol-Myers Squibb (United States)

  162 shared

• Mezrich Fernandez

  University of North Carolina at Chapel Hill

  162 shared

Education

• M.D., Microbiology

  All India Institute of Medical Sciences

• Diplomate of American Board of Pathology (AP/CP), Pathology and Laboratory Medicine

  University of Wisconsin School of Medicine and Public Health

  2001

• M.B.,B.S.

  Maulana Azad Medical College

  1985