Runge Jurgen H, Bohte Anneloes E, Verheij Joanne, Terpstra Valeska, Nederveen Aart J, van Nieuwkerk Karin M J, de Knegt Rob J, Baak Bert C, Jansen Peter L M, Sinkus Ralph, Stoker Jaap
Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,
Abdom Imaging. 2014 Apr;39(2):283-90. doi: 10.1007/s00261-013-0063-z.
MR elastography (MRE) can serve as an accurate surrogate marker of liver fibrosis. For any diagnostic test that is to replace the current reference standard, interobserver agreement should be at least as good and preferably better. The objective of this study was to perform a head-to-head comparison of the interobserver agreements of MRE and liver fibrosis staging on biopsy in a single cohort of hepatitis patients.
One hundred and three patients with viral hepatitis B or C who had a liver biopsy underwent MRE. Two readers independently selected a region-of-interest (ROI) in the liver to derive elasticity values. Two pathologists first independently staged fibrosis on biopsies using the METAVIR classification and subsequently held a consensus meeting. Interobserver agreements of elasticity values and fibrosis stages were assessed with intraclass correlation coefficients (ICC).
MRE and biopsy data were available for 85/103 patients. ICC of pathologists staging fibrosis was almost perfect at 0.91 (95% CI 0.86-0.94). ICC for MRE readers was significantly (P < 0.0001) higher at 0.99 (95% CI 0.98-1.00).
Interobserver agreement for liver fibrosis staging was almost perfect for both histopathology and MRE, with a significant higher agreement for MRE. Its high interobserver agreement and reliable accuracy support the use of MRE as a non-invasive screening tool for liver fibrosis.
磁共振弹性成像（MRE）可作为肝纤维化的准确替代标志物。对于任何要取代当前参考标准的诊断测试，观察者间的一致性应至少同样好，最好更好。本研究的目的是在一组肝炎患者中对MRE和肝活检纤维化分期的观察者间一致性进行直接比较。
103例接受肝活检的乙型或丙型病毒性肝炎患者接受了MRE检查。两名阅片者独立在肝脏中选择感兴趣区域（ROI）以得出弹性值。两名病理学家首先使用METAVIR分类法独立对活检标本的纤维化进行分期，随后召开共识会议。使用组内相关系数（ICC）评估弹性值和纤维化分期的观察者间一致性。
85/103例患者获得了MRE和活检数据。病理学家对纤维化分期的ICC几乎完美，为0.91（95%CI 0.86-0.94）。MRE阅片者的ICC显著更高（P<0.0001），为0.99（95%CI 0.98-1.00）。
组织病理学和MRE对肝纤维化分期的观察者间一致性都几乎完美，MRE的一致性显著更高。其高观察者间一致性和可靠的准确性支持将MRE用作肝纤维化的非侵入性筛查工具。
