Dyvorne Hadrien A, Jajamovich Guido H, Bane Octavia, Fiel M Isabel, Chou Hsin, Schiano Thomas D, Dieterich Douglas, Babb James S, Friedman Scott L, Taouli Bachir
Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Liver Int. 2016 May;36(5):659-66. doi: 10.1111/liv.13058. Epub 2016 Feb 7.
BACKGROUND & AIMS: Establishing accurate non-invasive methods of liver fibrosis quantification remains a major unmet need. Here, we assessed the diagnostic value of a multiparametric magnetic resonance imaging (MRI) protocol including diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE)-MRI and magnetic resonance elastography (MRE) in comparison with transient elastography (TE) and blood tests [including ELF (Enhanced Liver Fibrosis) and APRI] for liver fibrosis detection.
In this single centre cross-sectional study, we prospectively enrolled 60 subjects with liver disease who underwent multiparametric MRI (DWI, DCE-MRI and MRE), TE and blood tests. Correlation was assessed between non-invasive modalities and histopathologic findings including stage, grade and collagen content, while accounting for covariates such as age, sex, BMI, HCV status and MRI-derived fat and iron content. ROC curve analysis evaluated the performance of each technique for detection of moderate-to-advanced liver fibrosis (F2-F4) and advanced fibrosis (F3-F4).
Magnetic resonance elastography provided the strongest correlation with fibrosis stage (r = 0.66, P < 0.001), inflammation grade (r = 0.52, P < 0.001) and collagen content (r = 0.53, P = 0.036). For detection of moderate-to-advanced fibrosis (F2-F4), AUCs were 0.78, 0.82, 0.72, 0.79, 0.71 for MRE, TE, DCE-MRI, DWI and APRI, respectively. For detection of advanced fibrosis (F3-F4), AUCs were 0.94, 0.77, 0.79, 0.79 and 0.70, respectively.
Magnetic resonance elastography provides the highest correlation with histopathologic markers and yields high diagnostic performance for detection of advanced liver fibrosis and cirrhosis, compared to DWI, DCE-MRI, TE and serum markers.
建立准确的肝纤维化定量无创方法仍是一项尚未满足的重大需求。在此，我们评估了一种多参数磁共振成像（MRI）方案的诊断价值，该方案包括扩散加权成像（DWI）、动态对比增强（DCE）-MRI和磁共振弹性成像（MRE），并与瞬时弹性成像（TE）和血液检测[包括增强肝纤维化（ELF）和天冬氨酸氨基转移酶与血小板比值指数（APRI）]用于肝纤维化检测进行比较。
在这项单中心横断面研究中，我们前瞻性纳入了60例患有肝病的受试者，他们接受了多参数MRI（DWI、DCE-MRI和MRE）、TE和血液检测。评估了无创检查方法与组织病理学结果（包括分期、分级和胶原含量）之间的相关性，同时考虑了年龄、性别、体重指数、丙型肝炎病毒状态以及MRI得出的脂肪和铁含量等协变量。ROC曲线分析评估了每种技术检测中度至重度肝纤维化（F2-F4）和重度纤维化（F3-F4）的性能。
磁共振弹性成像与纤维化分期（r = 0.66，P < 0.001）、炎症分级（r = 0.52，P < 0.001）和胶原含量（r = 0.53，P = 0.036）的相关性最强。对于检测中度至重度纤维化（F2-F4），MRE、TE、DCE-MRI、DWI和APRI的曲线下面积（AUC）分别为0.78、0.82、0.72、0.79和0.71。对于检测重度纤维化（F3-F4），AUC分别为0.94、0.77、0.79、0.79和0.70。
与DWI、DCE-MRI、TE和血清标志物相比，磁共振弹性成像与组织病理学标志物的相关性最高，并且在检测重度肝纤维化和肝硬化方面具有较高的诊断性能。
