From the Departments of Radiology (C.B., D.F., A.B.), Gastroenterology (M.P.), Pathology (F.W.), and Nuclear Medicine (S.W.), Medical University of Vienna, General Hospital of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria; Department of Radiology, Medical University of Cluj Napoca, Cluj Napoca, Romania (D.F.); Siemens Healthcare, Erlangen, Germany (B.K.); Siemens Healthcare, Graz, Austria (G.R.); and Siemens Healthcare, Shanghai, China (Y.D.).
Radiology. 2014 Jan;270(1):149-58. doi: 10.1148/radiol.13122440. Epub 2013 Oct 28.
To assess the feasiblity of magnetic resonance (MR) susceptibility-weighted (SW) imaging as a tool to evaluate liver fibrosis grades in patients with chronic liver diseases (CLD) utilizing signal intensity (SI) measurements, with histopathologic findings as the reference standard.
This retrospective study was approved by the local ethics committee. All subjects gave written informed consent. Eighty consecutive patients (mean age, 56.8 years), 60% of whom were male [n = 48] and 40% of whom were female [n = 32], with CLD due to various underlying causes and histopathologically proved liver fibrosis were included. Biopsies were evaluated for liver fibrosis and necroinflammatory activity (according to METAVIR scoring system), iron load, and steatosis. Two radiologists, blinded to the clinical data, assessed regions of interest in the liver and spinal muscle in consensus. Liver-to-muscle SI ratios were calculated and correlated to histopathologic findings and clinical data by using univariate and multivariate regression analysis.
Liver-to-muscle SI ratio decreased in parallel with the increasing grade of liver fibrosis and correlated strongly with liver fibrosis (r = -0.81, P < .0001) and moderately with necroinflammatory activity (r = -0.52, P < .0001) and iron load (r = -0.37, P = .0002) but did not correlate with steatosis (r = -0.18, P = .11). In multiple regression analysis, liver fibrosis and iron load independently influenced SW imaging measurements, explaining 69% of the variance of liver-to-muscle SI ratio (R(2) = 0.69, P < .001). Liver-to-muscle SI ratio performed well in grading liver fibrosis, with an area under the receiver operating characteristic curve of 0.92 for scores of F2 or higher and 0.93 for score of F4 (liver cirrhosis).
SW imaging is a feasible noninvasive tool to detect moderate and advanced liver fibrosis in CLD patients.
利用信号强度（SI）测量值评估磁共振（MR）磁敏感加权（SW）成像作为评估慢性肝病（CLD）患者肝纤维化程度的工具的可行性，以组织病理学发现为参考标准。
本回顾性研究经当地伦理委员会批准，所有患者均签署书面知情同意书。共纳入 80 例连续患者（平均年龄 56.8 岁；60%为男性[n=48]，40%为女性[n=32]），病因包括各种 CLD 和经组织病理学证实的肝纤维化。对活检进行肝纤维化和坏死性炎症活动（根据 METAVIR 评分系统）、铁负荷和脂肪变性的评估。两位放射科医生在不知道临床数据的情况下，对肝脏和脊髓肌肉的感兴趣区域进行盲法评估。计算肝与肌肉的 SI 比值，并通过单变量和多变量回归分析将其与组织病理学发现和临床数据相关联。
肝与肌肉的 SI 比值随肝纤维化程度的增加而平行下降，与肝纤维化（r=-0.81，P<.0001）、坏死性炎症活动（r=-0.52，P<.0001）和铁负荷（r=-0.37，P=.0002）高度相关，与脂肪变性（r=-0.18，P=.11）中度相关。在多元回归分析中，肝纤维化和铁负荷独立影响 SW 成像测量值，解释了肝与肌肉 SI 比值的 69%的方差（R2=0.69，P<.001）。肝与肌肉的 SI 比值在肝纤维化分级中表现良好，F2 或更高评分的受试者工作特征曲线下面积为 0.92，F4（肝硬化）评分的曲线下面积为 0.93。
SW 成像技术是一种可行的非侵入性工具，可用于检测 CLD 患者的中重度肝纤维化。
