Takamura Tomohiro, Motosugi Utaroh, Ichikawa Shintaro, Sano Katsuhiro, Morisaka Hiroyuki, Ichikawa Tomoaki, Enomoto Nobuyuki, Onishi Hiroshi
Department of Radiology, University of Yamanashi, Yamanashi, Japan.
First Department of Internal Medicine, University of Yamanashi, Yamanashi, Japan.
J Magn Reson Imaging. 2016 Sep;44(3):715-22. doi: 10.1002/jmri.25182. Epub 2016 Feb 29.
To evaluate the usefulness of magnetic resonance elastography (MRE) in detecting the clinical progression of cirrhosis from Child-Pugh class A to B in patients with hepatitis C.
We reviewed the data of 101 consecutive patients with type C viral hepatitis and clinically suspected cirrhosis who fulfilled the all following criteria: available MRE at 1.5 Tesla (T) or 3.0T and laboratory tests within a month, Child-Pugh class A, platelet count less than 155 × 10(3) /μL, no clinical history of hepatocellular carcinoma, and ≥6 months of follow-up after MRE. We longitudinally analyzed the incidence of cirrhosis progression as defined by the clinical progression from Child-Pugh class A to B at two subsequent follow-up points. Risk of cirrhosis progression was assessed by Cox analyses and Kaplan-Meyer methods.
Cirrhosis progression was noted in 25 patients during the follow-up period. Liver stiffness (hazard ratio [HR] by 1 kPa increase = 1.397; P = 0.0074), Child-Pugh score of 6 versus score 5 (HR of 3.085; P = 0.0276), and treatment responses to anti-viral therapy versus nonresponse (HR of <0.001, P = 0.0006) were independent risk factors of cirrhosis progression. The 1-year risk (0.7%; 95% confidence interval, 0.1-4.2%) of cirrhosis progression was negligible in patients with liver stiffness of <3.3 kPa or response to anti-viral treatment.
MRE is useful to stratify the risk of cirrhosis progression in patients with hepatitis C. J. Magn. Reson. Imaging 2016;44:715-722.
评估磁共振弹性成像（MRE）在检测丙型肝炎患者肝硬化从Child-Pugh A级进展至B级临床过程中的应用价值。
我们回顾了101例连续的丙型病毒性肝炎且临床怀疑有肝硬化的患者的数据，这些患者均符合以下所有标准：在1.5特斯拉（T）或3.0T条件下可行MRE检查，且在1个月内有实验室检查结果，Child-Pugh A级，血小板计数低于155×10³/μL，无肝细胞癌临床病史，且在MRE检查后有≥6个月的随访。我们纵向分析了在两个后续随访点上，根据从Child-Pugh A级至B级的临床进展所定义的肝硬化进展发生率。通过Cox分析和Kaplan-Meier方法评估肝硬化进展风险。
随访期间有25例患者出现肝硬化进展。肝脏硬度（每增加1 kPa的风险比[HR]=1.397；P=0.0074）、Child-Pugh评分为6分与评分为5分（HR为3.085；P=0.0276）以及抗病毒治疗有反应与无反应（HR<0.001，P=0.0006）是肝硬化进展的独立危险因素。肝脏硬度<3.3 kPa或对抗病毒治疗有反应的患者，其1年肝硬化进展风险（0.7%；95%置信区间，0.1 - 4.2%）可忽略不计。
MRE有助于对丙型肝炎患者肝硬化进展风险进行分层。《磁共振成像杂志》2016年；44:715 - 722。
