Université de Lyon, CREATIS, CNRS UMR 5220, Inserm U1044, INSA-Lyon, Université Lyon 1, Villeurbanne, France.
J Magn Reson Imaging. 2012 Jun;35(6):1380-7. doi: 10.1002/jmri.23594. Epub 2012 Jan 26.
To evaluate a 1.5T magnetic resonance imaging (MRI) protocol, including a dedicated acquisition sequence and a postprocessing tool for the quantitative analysis of hepatic tissue perfusion. Estimated perfusion parameters and histological results based on the METAVIR classification were prospectively compared for hepatic fibrosis assessment.
The study protocol was approved by the experimentation Ethics Committee and informed consent was obtained. Sixteen patients (6 women, 10 men; average age, 52.4 ± 14.8 years) with chronic liver diseases were prospectively enrolled after a liver biopsy. MS-325 (paramagnetic blood pool agent)-enhanced MRI was performed using a free-breath 3D-VIBE T(1w) sequence. Image volumes were registered by an automatic rigid method. Liver perfusion was modeled by a dual-input-one-compartment model and quantitative perfusion parameters such as arterial, portal, and total perfusion mean transit time (MTT) and hepatic perfusion index (HPI) were obtained using in-house developed software.
Arterial perfusion increased with METAVIR stage, whereas portal perfusion decreased leading to an HPI increase with fibrosis stage. MTT increased with F3, F4. A nonparametric Mann-Whitney test demonstrated that HPI and portal perfusion were relevant in discriminating between advanced and nonadvanced fibrosis, between fibrosis and cirrhosis, then between nonfibrosis and fibrosis (P < 0.01). A strong correlation was found between portal perfusion fall-off and HPI increase (r = -0.97; P < 0.001). HPI and portal perfusion were strongly correlated with fibrosis stage (r = 0.83 and -0.88; P < 0.001, respectively).
HPI and portal perfusion could be relevant indicators for the clinical follow-up in patients with chronic liver diseases.
评估一种 1.5T 磁共振成像（MRI）方案，包括专用采集序列和后处理工具，用于定量分析肝脏组织灌注。前瞻性比较基于 METAVIR 分类的估计灌注参数和组织学结果，以评估肝纤维化。
该研究方案经实验伦理委员会批准，并获得了知情同意。16 例慢性肝病患者（6 名女性，10 名男性；平均年龄 52.4 ± 14.8 岁）在肝活检后被前瞻性纳入研究。使用自由呼吸 3D-VIBE T1w 序列进行 MS-325（顺磁性血池造影剂）增强 MRI。通过自动刚性方法对图像体积进行配准。采用双输入-单室模型对肝脏灌注进行建模，使用内部开发的软件获得动脉、门静脉和总灌注平均通过时间（MTT）和肝灌注指数（HPI）等定量灌注参数。
动脉灌注随 METAVIR 分期增加而增加，而门静脉灌注随纤维化分期降低导致 HPI 增加。MTT 在 F3、F4 时增加。非参数 Mann-Whitney 检验表明，HPI 和门静脉灌注在鉴别进展性和非进展性纤维化、纤维化和肝硬化以及非纤维化和纤维化之间具有相关性（P < 0.01）。门静脉灌注下降与 HPI 增加之间存在很强的相关性（r = -0.97；P < 0.001）。HPI 和门静脉灌注与纤维化分期呈强相关性（r = 0.83 和 -0.88；P < 0.001）。
HPI 和门静脉灌注可能是慢性肝病患者临床随访的相关指标。
