Ichikawa Shintaro, Motosugi Utaroh, Nakazawa Tadao, Morisaka Hiroyuki, Sano Katsuhiro, Ichikawa Tomoaki, Enomoto Nobuyuki, Matsuda Masanori, Fujii Hideki, Onishi Hiroshi
Department of Radiology, University of Yamanashi, Yamanashi, Japan.
J Magn Reson Imaging. 2015 May;41(5):1203-8. doi: 10.1002/jmri.24666. Epub 2014 Jun 3.
To evaluate the effect of hepatitis activity on liver stiffness measurements and the role of serum alanine aminotransferase (ALT) in liver fibrosis staging by MR elastography (MRE).
We measured liver stiffness (kPa) in 135 patients by MRE and histologically assessed fibrosis and hepatitis activity within 2 months. Stepwise multiple linear regression was performed to determine the maximum adjusted R(2) against liver stiffness, after adjusting for nothing (model 1), ALT/upper limit of normal categories (model 2), and hepatitis activity (A grade) by METAVIR (model 3). Logistic regression was used to identify independent factors associated with pathologically proven cirrhosis.
Platelet count and METAVIR F score were strongly associated with liver stiffness. The adjusted R(2) value of model 3 (0.7026) was higher than those of models 1 (0.6472) and 2 (0.6564), showing that hepatitis activity affected liver stiffness measurement. High ALT levels (odds ratio, 0.0066; P = 0.0003) as well as MRE (odds ratio, 9.91; P < 0.0001) were independently associated with cirrhosis.
Hepatitis activity may be a confounder of liver stiffness measurement during liver fibrosis staging using MRE. MRE can potentially make an overdiagnosis of liver cirrhosis if the patient has high ALT levels.
通过磁共振弹性成像（MRE）评估肝炎活动对肝脏硬度测量的影响以及血清丙氨酸氨基转移酶（ALT）在肝纤维化分期中的作用。
我们通过MRE测量了135例患者的肝脏硬度（kPa），并在2个月内对纤维化和肝炎活动进行了组织学评估。进行逐步多元线性回归以确定在未进行调整（模型1）、按ALT/正常上限分类进行调整（模型2）以及按METAVIR评估的肝炎活动（A分级）进行调整（模型3）后，与肝脏硬度相关的最大调整R²。使用逻辑回归来确定与病理证实的肝硬化相关的独立因素。
血小板计数和METAVIR F分级与肝脏硬度密切相关。模型3的调整R²值（0.7026）高于模型1（0.6472）和模型2（0.6564），表明肝炎活动会影响肝脏硬度测量。高ALT水平（比值比，0.0066；P = 0.0003）以及MRE（比值比，9.91；P < 0.0001）与肝硬化独立相关。
在使用MRE进行肝纤维化分期时，肝炎活动可能是肝脏硬度测量的一个混杂因素。如果患者ALT水平高，MRE可能会导致对肝硬化的过度诊断。
