Chen Jun, Yin Meng, Talwalkar Jayant A, Oudry Jennifer, Glaser Kevin J, Smyrk Thomas C, Miette Véronique, Sandrin Laurent, Ehman Richard L
From the Departments of Radiology (J.C., M.Y., K.J.G., R.L.E.), Gastroenterology (J.A.T.), and Anatomic Pathology (T.C.S.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Echosens, Paris, France (J.O., V.M., L.S.).
Radiology. 2017 May;283(2):418-428. doi: 10.1148/radiol.2016160685. Epub 2016 Nov 18.
Purpose To evaluate the diagnostic performance and examination success rate of magnetic resonance (MR) elastography and vibration-controlled transient elastography (VCTE) in the detection of hepatic fibrosis in patients with severe to morbid obesity. Materials and Methods This prospective and HIPAA-compliant study was approved by the institutional review board. A total of 111 patients (71 women, 40 men) participated. Written informed consent was obtained from all patients. Patients underwent MR elastography with two readers and VCTE with three observers to acquire liver stiffness measurements for liver fibrosis assessment. The results were compared with those from liver biopsy. Each pathology specimen was evaluated by two hepatopathologists according to the METAVIR scoring system or Brunt classification when appropriate. All imaging observers were blinded to the biopsy results, and all hepatopathologists were blinded to the imaging results. Examination success rate, interobserver agreement, and diagnostic accuracy for fibrosis detection were assessed. Results In this obese patient population (mean body mass index = 40.3 kg/m; 95% confidence interval [CI]: 38.7 kg/m, 41.8 kg/m]), the examination success rate was 95.8% (92 of 96 patients) for MR elastography and 81.3% (78 of 96 patients) or 88.5% (85 of 96 patients) for VCTE. Interobserver agreement was higher with MR elastography than with biopsy (intraclass correlation coefficient, 0.95 vs 0.89). In patients with successful MR elastography and VCTE examinations (excluding unreliable VCTE examinations), both MR elastography and VCTE had excellent diagnostic accuracy in the detection of clinically significant hepatic fibrosis (stage F2-F4) (mean area under the curve: 0.93 [95% CI: 0.85, 0.97] vs 0.91 [95% CI: 0.83, 0.96]; P = .551). Conclusion In this obese patient population, both MR elastography and VCTE had excellent diagnostic performance for assessing hepatic fibrosis; MR elastography was more technically reliable than VCTE and had a higher interobserver agreement than liver biopsy. RSNA, 2016 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on January 25, 2017.
目的 评估磁共振（MR）弹性成像和振动控制瞬时弹性成像（VCTE）在检测重度至病态肥胖患者肝纤维化中的诊断性能和检查成功率。材料与方法 本前瞻性且符合健康保险流通与责任法案（HIPAA）的研究获机构审查委员会批准。共有111例患者（71例女性，40例男性）参与。所有患者均获得书面知情同意。患者接受由两名阅片者进行的MR弹性成像检查以及由三名观察者进行的VCTE检查，以获取肝脏硬度测量值用于肝纤维化评估。将结果与肝活检结果进行比较。每份病理标本由两名肝病病理学家根据METAVIR评分系统或在适当情况下根据Brunt分类进行评估。所有影像观察者对活检结果不知情，所有肝病病理学家对影像结果不知情。评估检查成功率、观察者间一致性以及纤维化检测的诊断准确性。结果 在该肥胖患者群体（平均体重指数 = 40.3 kg/m²；95%置信区间[CI]：38.7 kg/m²，41.8 kg/m²）中，MR弹性成像的检查成功率为95.8%（96例患者中的92例），VCTE的检查成功率为81.3%（96例患者中的78例）或88.5%（96例患者中的85例）。MR弹性成像的观察者间一致性高于活检（组内相关系数，0.95对0.89）。在MR弹性成像和VCTE检查成功的患者中（不包括不可靠的VCTE检查），MR弹性成像和VCTE在检测具有临床意义的肝纤维化（F2 - F4期）方面均具有出色的诊断准确性（曲线下平均面积：0.93[95%CI：0.85，0.97]对0.91[95%CI：0.83，0.96]；P = 0.551）。结论 在该肥胖患者群体中，MR弹性成像和VCTE在评估肝纤维化方面均具有出色的诊断性能；MR弹性成像在技术上比VCTE更可靠，且观察者间一致性高于肝活检。RSNA，2016 本文提供在线补充材料。本文的一个早期错误版本已在线发布。本文于2017年1月25日进行了更正。
