Nojiri Shunsuke, Fujiwara Kei, Shinkai Noboru, Endo Mio, Joh Takashi
Shunsuke Nojiri, Kei Fujiwara, Noboru Shinkai, Mio Endo, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan.
World J Hepatol. 2014 Dec 27;6(12):930-8. doi: 10.4254/wjh.v6.i12.930.
To evaluate the efficacy of ethoxibenzyl-magnetic resonance imaging (EOB-MRI) as a predictor of hepatocellular carcinoma (HCC) development.
Between August 2008 and 2009, we studied 142 hepatitis C virus-infected patients (male 70, female 72), excluding those with HCC or a past history, who underwent EOB-MRI in our hospital. The EOB-MRI index [liver-intervertebral disc ratio (LI)] was calculated as: (post-liver intensity/post-intervertebral disc intensity)/(pre-liver intensity/pre-intervertebral disc intensity).
The median follow-up period was 3.1 years and the patients were observed until the end of the study period (31 December, 2012). In the follow-up period, HCC occurred in 21 patients. The cumulative occurrence rates were 2.1%, 9.1%, and 14.1% at 1, 2, and 3 years, respectively. Using the optimal cut-off value of LI 1.46, on univariate analysis, age, aspartate amino transferase (AST), α-fetoprotein (AFP) ≥ 10, albumin, total cholesterol, prothrombin time, platelets, and LI < 1.46 were identified as independent factors, but on multivariate analysis, LI < 1.46: risk ratio 6.05 (1.34-27.3, P = 0.019) and AFP ≥ 10: risk ratio 3.1 (1.03-9.35, P = 0.045) were identified as independent risk factors. LI and Fib-4 index have higher area under the receiver operating characteristic curves than other representative fibrosis evaluation methods, such as Forn's index and AST-to-platelet ratio index.
LI is associated with the risk of HCC occurrence in hepatitis C patients. LI may be a substitute for liver biopsy when evaluating this risk and its combined use with Fib-4 is a better predictive method of HCC progression.
评估乙氧基苄基磁共振成像（EOB-MRI）作为肝细胞癌（HCC）发生预测指标的有效性。
2008年8月至2009年期间，我们研究了142例丙型肝炎病毒感染患者（男性70例，女性72例），排除了患有HCC或有既往病史的患者，这些患者在我院接受了EOB-MRI检查。EOB-MRI指数[肝脏-椎间盘比值（LI）]计算为：（肝脏强化后强度/椎间盘强化后强度）/（肝脏强化前强度/椎间盘强化前强度）。
中位随访期为3.1年，患者观察至研究期末（2012年12月31日）。随访期间，21例患者发生了HCC。1年、2年和3年的累积发生率分别为2.1%、9.1%和14.1%。使用LI 1.46的最佳截断值，单因素分析显示，年龄、天冬氨酸转氨酶（AST）、甲胎蛋白（AFP）≥10、白蛋白、总胆固醇、凝血酶原时间、血小板以及LI<1.46被确定为独立因素，但多因素分析显示，LI<1.46：风险比6.05（1.34 - 27.3，P = 0.019）和AFP≥10：风险比3.1（1.03 - 9.35，P = 0.045）被确定为独立危险因素。LI和Fib-4指数在受试者工作特征曲线下的面积高于其他代表性纤维化评估方法，如Forn指数和AST-血小板比值指数。
LI与丙型肝炎患者发生HCC的风险相关。在评估这种风险时，LI可能替代肝活检，并且其与Fib-4联合使用是预测HCC进展的更好方法。
