From the Departments of Radiology (J.H.Y., J.M.L., J.K.H., B.I.C.), Surgery (K.S.S., K.W.L., N.J.Y.), and Pathology (K.B.L.), Seoul National University Hospital, Seoul, South Korea; and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea (J.M.L., J.K.H., B.I.C.).
Radiology. 2015 Aug;276(2):453-64. doi: 10.1148/radiol.15140908. Epub 2015 Mar 12.
To evaluate the diagnostic performance of magnetic resonance (MR) fat quantification and MR elastography for the assessment of hepatic steatosis and fibrosis in living liver donor candidates.
This retrospective study was approved by the institutional review board, and the requirement of informed consent was waived. Donors who underwent MR fat quantification and MR elastography at 1.5 T, followed by liver biopsy, were chronologically grouped into test and validation groups. In the test group (n = 362), MR fat fraction and liver stiffness were compared among donors with normal parenchyma (n = 244), simple steatosis (n = 71), steatosis with inflammatory activity (n = 21), nonalcoholic steatohepatitis (n = 17), and fibrosis (n = 9). Diagnostic performance of the two techniques was assessed by using receiver operating characteristic curve analysis for the detection of substantial steatosis (macrovesicular fat ≥ 10%) or fibrosis (≥F1) and was tested in a validation group (n = 34).
In the test group, donors with steatosis showed significantly higher fat fraction than donors without steatosis (P < .0001), and donors with fibrosis and nonalcoholic steatohepatitis showed significantly higher liver stiffness values than donors without fibrosis (P < .0001). Areas under the curve were 0.93 (cutoff value > 5.8%) for MR fat quantification and 0.85 (cutoff value > 1.94 kPa) for MR elastography. By using those values, the combination of the two techniques could be used to detect substantial steatosis or fibrosis with 100% sensitivity (12 of 12 patients, 95% confidence interval: 73.4%, 100%) and 100% negative predictive value (15 of 15 patients, 95% confidence interval: 78.0%, 100%) in the validation group.
A combination of MR fat quantification and MR elastography can provide sufficient sensitivity to detect substantial steatosis or fibrosis (≥F1) in liver donor candidates.
评估磁共振（MR）脂肪定量和 MR 弹性成像在活体肝供体候选人肝脂肪变性和纤维化评估中的诊断性能。
本回顾性研究经机构审查委员会批准，豁免了知情同意书的要求。按时间顺序将在 1.5T 行 MR 脂肪定量和 MR 弹性成像检查并随后行肝活检的供体分为试验组和验证组。在试验组（n=362）中，比较了正常肝实质（n=244）、单纯性脂肪变性（n=71）、脂肪变性伴炎症活动（n=21）、非酒精性脂肪性肝炎（n=17）和纤维化（n=9）供体的 MR 脂肪分数和肝硬度。采用受试者工作特征曲线分析评估两种技术检测大量脂肪变性（大泡性脂肪≥10%）或纤维化（≥F1）的诊断性能，并在验证组（n=34）中进行了测试。
在试验组中，脂肪变性供体的脂肪分数明显高于无脂肪变性供体（P<0.0001），纤维化和非酒精性脂肪性肝炎供体的肝硬度值明显高于无纤维化供体（P<0.0001）。MR 脂肪定量的曲线下面积为 0.93（截断值>5.8%），MR 弹性成像的曲线下面积为 0.85（截断值>1.94kPa）。使用这些值，两种技术的组合可以以 100%的灵敏度（12/12 例患者，95%置信区间：73.4%，100%）和 100%的阴性预测值（15/15 例患者，95%置信区间：78.0%，100%）在验证组中检测到大量脂肪变性或纤维化。
MR 脂肪定量和 MR 弹性成像的组合可以提供足够的灵敏度来检测活体肝供体候选人中的大量脂肪变性或纤维化（≥F1）。
