Kamphues C, Klatt D, Bova R, Yahyazadeh A, Bahra M, Braun J, Klauschen F, Neuhaus P, Sack I, Asbach P
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité, Campus Virchow Klinikum, Berlin, Germany.
Rofo. 2012 Nov;184(11):1013-9. doi: 10.1055/s-0032-1313126. Epub 2012 Aug 14.
Despite advantages in antiviral therapy of hepatitis C (HCV) in recent years, progressing liver fibrosis remains a major problem for patients suffering from hepatitis C after liver transplantation. Therefore, effective non-invasive methods for the assessment of liver fibrosis are needed in order to guide treatment decisions and predict prognosis in these patients. The aim of this study was to prospectively assess the diagnostic accuracy of viscoelasticity-based magnetic resonance (MR) elastography for the assessment of liver fibrosis in HCV patients after liver transplantation.
After IRB approval, a total of 25 patients, who had received a liver graft due to chronic hepatitis C underwent both liver biopsy and MR elastography. Two viscoelastic constants, the shear elasticity μ and the powerlaw exponent α were calculated by fitting the frequency function of the complex shear modulus with the viscoelastic springpot-model.
A strong positive correlation between shear elasticity μ and the stage of fibrosis could be found (R = 0.486, p = 0.0136). The area under the receiver operating curve (AUROC) of MR elastography based on μ for diagnosis of severe fibrosis (F ≥ 3) was 0.87 and 0.65 for diagnosis of significant fibrosis (F ≥ 2). The powerlaw exponent α did not correlate with the stage of fibrosis.
MR elastography represents a promising non-invasive procedure for the assessment of higher grades of fibrosis in HCV patients after liver transplantation. The poor correlation for lower grades of fibrosis suggests unknown mechanical interactions in the transplanted liver.
尽管近年来丙型肝炎（HCV）抗病毒治疗取得了进展，但肝纤维化进展仍是肝移植后丙型肝炎患者的主要问题。因此，需要有效的非侵入性方法来评估肝纤维化，以指导这些患者的治疗决策并预测预后。本研究的目的是前瞻性评估基于粘弹性的磁共振（MR）弹性成像对肝移植后HCV患者肝纤维化评估的诊断准确性。
经机构审查委员会（IRB）批准，共有25例因慢性丙型肝炎接受肝移植的患者接受了肝活检和MR弹性成像检查。通过将复剪切模量的频率函数与粘弹性弹簧模型拟合，计算出两个粘弹性常数，即剪切弹性μ和幂律指数α。
发现剪切弹性μ与纤维化分期之间存在强正相关（R = 0.486，p = 0.0136）。基于μ的MR弹性成像诊断严重纤维化（F≥3）的受试者操作曲线下面积（AUROC）为0.87，诊断显著纤维化（F≥2）的AUROC为0.65。幂律指数α与纤维化分期无关。
MR弹性成像代表了一种有前景的非侵入性方法，可用于评估肝移植后HCV患者的高级别纤维化。较低级别纤维化的相关性较差，提示移植肝中存在未知的机械相互作用。
