Department of Medical Imaging, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Radiology. 2013 Nov;269(2):460-8. doi: 10.1148/radiology.13122482. Epub 2013 Jul 22.
To evaluate the diagnostic performance of gadoxetic acid-enhanced magnetic resonance (MR) imaging in the staging of liver fibrosis in patients with diffuse chronic liver diseases (CLDs) and to investigate the factors that may influence the results.
With the approval of the Hospital Ethics Committee and waiver of the informed consent requirement, data in 102 patients with histologically proven liver fibrosis (classified according to the METAVIR system) of various underlying causes were retrospectively analyzed. Patients underwent 3.0-T MR imaging with gadoxetic acid. The signal intensity of the liver was defined by using region of interest measurements before contrast material injection and in the hepatobiliary phase (20 minutes after contrast material administration), and relative enhancement was calculated. Univariate and multivariate regression analyses were applied to identify variables associated with relative enhancement measurements, and the performance of relative enhancement measurements in the staging of liver fibrosis was assessed by using area under the receiver operating characteristic curve (AUC) analysis.
At analysis of the relationship between enhancement measurements and histologic parameters, the relative enhancement values correlated strongly with liver fibrosis stage (r = -0.65, P < .0001) and moderately with necroinflammatory activity grades (r = -0.41, P = .002) and the presence of iron load (r = -0.21, P = .05). In multivariate analysis, only liver fibrosis stage independently influenced relative enhancement values (P < .001). The measurements performed well in the staging of liver fibrosis, with an AUC of 0.81 for stages of F1 or greater, 0.82 for stages of F2 or greater, 0.85 for stages of F3 or greater, and 0.83 for stage F4. Increased aspartate aminotransferase, gammaglutamyl transpeptidase, and alkaline phosphatase levels were independent predictors of false-negative results.
The presence of hepatic fibrosis can be assessed with good discrimination by using gadoxetic acid-enhanced MR imaging, but assessment can be confounded in the setting of abnormal aspartate aminotransferase, gammaglutamyl transpeptidase, and alkaline phosphatase levels.
评估钆塞酸增强磁共振成像（MR）在弥漫性慢性肝病（CLD）患者肝纤维化分期中的诊断性能，并探讨可能影响结果的因素。
经医院伦理委员会批准，并豁免知情同意要求，回顾性分析了 102 例经组织学证实的肝纤维化（根据 METAVIR 系统分类）不同潜在病因患者的数据。患者行 3.0T MR 成像检查，钆塞酸增强。在注射对比剂前和肝胆期（注射对比剂后 20 分钟）使用感兴趣区测量肝脏信号强度，并计算相对增强。应用单变量和多变量回归分析来确定与相对增强测量相关的变量，并通过受试者工作特征曲线（AUC）分析评估相对增强测量在肝纤维化分期中的性能。
在分析增强测量值与组织学参数之间的关系时，相对增强值与肝纤维化分期呈强相关性（r = -0.65，P <.0001），与坏死性炎症活动度分级呈中度相关性（r = -0.41，P =.002），与铁负荷呈中度相关性（r = -0.21，P =.05）。多变量分析显示，只有肝纤维化分期独立影响相对增强值（P <.001）。该方法在肝纤维化分期中具有良好的诊断性能，AUC 分别为 F1 或更高分期为 0.81，F2 或更高分期为 0.82，F3 或更高分期为 0.85，F4 分期为 0.83。天冬氨酸转氨酶、γ-谷氨酰转肽酶和碱性磷酸酶水平升高是假阴性结果的独立预测因素。
钆塞酸增强磁共振成像可较好地区分肝纤维化的存在，但在天冬氨酸转氨酶、γ-谷氨酰转肽酶和碱性磷酸酶水平异常时，评估结果可能受到干扰。
