儿童非酒精性脂肪性肝病的肝脏组织学和弥散加权 MRI：一项 MAGNET 研究。
Liver histology and diffusion-weighted MRI in children with nonalcoholic fatty liver disease: A MAGNET study.
机构信息
Liver Imaging Group, Department of Radiology, University of California, San Diego, School of Medicine, San Diego, California, USA.
Computational and Applied Statistics Laboratory (CASL), SDSC, University of California, San Diego, La Jolla, California, USA.
出版信息
J Magn Reson Imaging. 2017 Oct;46(4):1149-1158. doi: 10.1002/jmri.25663. Epub 2017 Feb 22.
PURPOSE
To determine potential associations between histologic features of pediatric nonalcoholic fatty liver disease (NAFLD) and estimated quantitative magnetic resonance diffusion-weighted imaging (DWI) parameters.
MATERIALS AND METHODS
This prospective, cross-sectional study was performed as part of the Magnetic Resonance Assessment Guiding NAFLD Evaluation and Treatment (MAGNET) ancillary study to the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN). Sixty-four children underwent a 3T DWI scan (b-values: 0, 100, and 500 s/mm ) within 180 days of a clinical liver biopsy of the right hepatic lobe. Three parameters were estimated in the right hepatic lobe: apparent diffusion coefficient (ADC), diffusivity (D), and perfusion fraction (F); the first assuming exponential decay and the latter two assuming biexponential intravoxel incoherent motion. Grading and staging of liver histology were done using the NASH CRN scoring system. Associations between histologic scores and DWI-estimated parameters were tested using multivariate linear regression.
RESULTS
Estimated means ± standard deviations were: ADC: 1.3 (0.94-1.8) × 10 mm /s; D: 0.82 (0.56-1.0) × 10 mm /s; and F: 17 (6.0-28)%. Multivariate analyses showed ADC and D decreased with steatosis and F decreased with fibrosis (P < 0.05). Associations between DWI-estimated parameters and other histologic features were not significant: ADC: fibrosis (P = 0.12), lobular inflammation (P = 0.20), portal inflammation (P = 0.27), hepatocellular inflammation (P = 0.29), NASH (P = 0.30); D: fibrosis (P = 0.34), lobular inflammation (P = 0.84), portal inflammation (P = 0.76), hepatocellular inflammation (P = 0.38), NASH (P = 0.81); F: steatosis (P = 0.57), lobular inflammation (P = 0.22), portal inflammation (P = 0.42), hepatocellular inflammation (P = 0.59), NASH (P = 0.07).
CONCLUSION
In children with NAFLD, steatosis and fibrosis have independent effects on DWI-estimated parameters ADC, D, and F. Further research is needed to determine the underlying mechanisms and clinical implications of these effects.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1149-1158.
目的
确定儿科非酒精性脂肪性肝病 (NAFLD) 的组织学特征与定量磁共振扩散加权成像 (DWI) 参数之间的潜在关联。
材料与方法
本前瞻性、横断面研究是作为非酒精性脂肪性肝炎临床研究网络 (NASH CRN) 的磁共振评估指导非酒精性脂肪性肝病评估和治疗 (MAGNET) 辅助研究的一部分进行的。64 名儿童在右肝叶临床肝活检后 180 天内接受了 3T DWI 扫描 (b 值：0、100 和 500 s/mm )。在右肝叶中估计了三个参数：表观扩散系数 (ADC)、扩散率 (D) 和灌注分数 (F)；第一个假设指数衰减，后两个假设双指数体素内不相干运动。使用 NASH CRN 评分系统对肝组织学进行分级和分期。使用多元线性回归检验组织学评分与 DWI 估计参数之间的关联。
结果
估计的平均值±标准差分别为：ADC：1.3 (0.94-1.8) × 10 mm /s；D：0.82 (0.56-1.0) × 10 mm /s；F：17 (6.0-28) %。多元分析显示 ADC 和 D 随脂肪变性而降低，F 随纤维化而降低 (P < 0.05)。DWI 估计参数与其他组织学特征之间的关联不显著：ADC：纤维化 (P = 0.12)、小叶炎症 (P = 0.20)、门脉炎症 (P = 0.27)、肝细胞炎症 (P = 0.29)、NASH (P = 0.30)；D：纤维化 (P = 0.34)、小叶炎症 (P = 0.84)、门脉炎症 (P = 0.76)、肝细胞炎症 (P = 0.38)、NASH (P = 0.81)；F：脂肪变性 (P = 0.57)、小叶炎症 (P = 0.22)、门脉炎症 (P = 0.42)、肝细胞炎症 (P = 0.59)、NASH (P = 0.07)。
结论
在患有 NAFLD 的儿童中，脂肪变性和纤维化对 DWI 估计参数 ADC、D 和 F 有独立的影响。需要进一步研究以确定这些影响的潜在机制和临床意义。
证据水平
1 技术功效：第 2 阶段 J. Magn. Reson. Imaging 2017；46:1149-1158.
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