Pavlides Michael, Banerjee Rajarshi, Sellwood Joanne, Kelly Catherine J, Robson Matthew D, Booth Jonathan C, Collier Jane, Neubauer Stefan, Barnes Eleanor
Translational Gastroenterology Unit, University of Oxford, UK; Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK.
Perspectum Diagnostics, Oxford, UK.
J Hepatol. 2016 Feb;64(2):308-315. doi: 10.1016/j.jhep.2015.10.009. Epub 2015 Nov 10.
BACKGROUND & AIMS: Multiparametric magnetic resonance (MR) imaging has been demonstrated to quantify hepatic fibrosis, iron, and steatosis. The aim of this study was to determine if MR can be used to predict negative clinical outcomes in liver disease patients.
Patients with chronic liver disease (n=112) were recruited for MR imaging and data on the development of liver related clinical events were collected by medical records review. The median follow-up was 27months. MR data were analysed blinded for the Liver Inflammation and Fibrosis score (LIF; <1, 1-1.99, 2-2.99, and ⩾3 representing normal, mild, moderate, and severe liver disease, respectively), T2∗ for liver iron content and proportion of liver fat. Baseline liver biopsy was performed in 102 patients.
Liver disease aetiologies included non-alcoholic fatty liver disease (35%) and chronic viral hepatitis (30%). Histologically, fibrosis was mild in 54 (48%), moderate in 17 (15%), and severe in 31 (28%) patients. Overall mortality was 5%. Ten patients (11%) developed at least one liver related clinical event. The negative predictive value of LIF<2 was 100%. Two patients with LIF 2-2.99 and eight with LIF⩾3 had a clinical event. Patients with LIF⩾3 had a higher cumulative risk for developing clinical events, compared to those with LIF<1 (p=0.02) and LIF 1-1.99 (p=0.03). Cox regression analysis including all 3 variables (fat, iron, LIF) resulted in an enhanced LIF predictive value.
Non-invasive standardised multiparametric MR technology may be used to predict clinical outcomes in patients with chronic liver disease.
多参数磁共振成像已被证明可用于量化肝纤维化、铁含量和脂肪变性。本研究的目的是确定磁共振成像是否可用于预测肝病患者的不良临床结局。
招募了112例慢性肝病患者进行磁共振成像检查，并通过病历回顾收集与肝脏相关临床事件发生情况的数据。中位随访时间为27个月。对磁共振成像数据进行分析时，不了解肝脏炎症和纤维化评分（LIF；<1、1-1.99、2-2.99和⩾3分别代表正常、轻度、中度和重度肝病）、肝脏铁含量的T2∗以及肝脏脂肪比例。102例患者进行了基线肝活检。
肝病病因包括非酒精性脂肪性肝病（35%）和慢性病毒性肝炎（30%）。组织学上，54例（48%）患者纤维化程度为轻度，17例（15%）为中度，31例（28%）为重度。总死亡率为5%。10例患者（11%）发生了至少1次与肝脏相关的临床事件。LIF<2的阴性预测值为100%。2例LIF为2-2.99的患者和8例LIF⩾3的患者发生了临床事件。与LIF<1（p=0.02）和LIF为1-1.99（p=0.03）的患者相比，LIF⩾3的患者发生临床事件的累积风险更高。包括所有3个变量（脂肪、铁、LIF）的Cox回归分析提高了LIF的预测价值。
非侵入性标准化多参数磁共振成像技术可用于预测慢性肝病患者的临床结局。
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