磁共振波谱质子密度脂肪分数检测与分级肝脂肪变优于衰减参数控制。

MR Spectroscopy-derived Proton Density Fat Fraction Is Superior to Controlled Attenuation Parameter for Detecting and Grading Hepatic Steatosis.

机构信息

From the Departments of Radiology and Nuclear Medicine (J.H.R., A.J.N., J.S.), Vascular Medicine (L.P.S.), Pathology (J.V.), and Gastroenterology and Hepatology (U.B.), Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Slotervaartziekenhuis, Amsterdam, the Netherlands (A.D.); and Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (S.D.K., B.C.B.); and King's College London, Division of Imaging Sciences & Biomedical Engineering, London, England (J.H.R.).

出版信息

Radiology. 2018 Feb;286(2):547-556. doi: 10.1148/radiol.2017162931. Epub 2017 Sep 15.

DOI:10.1148/radiol.2017162931

PMID:28915103

Abstract

Purpose To prospectively compare the diagnostic accuracy of controlled attenuation parameter (CAP) obtained with transient elastography and proton density fat fraction (PDFF) obtained with proton magnetic resonance (MR) spectroscopy with results of liver biopsy in a cohort of adult patients suspected of having nonalcoholic fatty liver disease (NAFLD). Materials and Methods The institutional review board approved this study. Informed consent was obtained from all patients. The authors evaluated 55 patients suspected of having NAFLD (40 men, 15 women). Patients had a median age of 52.3 years (interquartile range [IQR], 43.7-57.6 years) and a median body mass index of 27.8 kg/m (IQR, 26.0-33.1 kg/m). CAP and PDFF measurements were obtained on the same day, within 27 days of biopsy (IQR, 7-44 days). CAP and PDFF were compared between steatosis grades by using the Jonckheere-Terpstra test. Diagnostic accuracies of CAP and PDFF for grading steatosis were assessed with receiver operating characteristic (ROC) analysis. Within-weeks reproducibility (CAP and PDFF) and within-session repeatability were assessed with linear regression analyses, intraclass correlation coefficients, and coefficients of variation. Results Steatosis grades at liver biopsy were distributed as follows: S0, five patients; S1, 24 patients; S2, 17 patients; and S3, nine patients. Both PDFF and CAP helped detect histologically proven steatosis (≥S1), but PDFF showed better diagnostic accuracy than CAP in terms of the area under the ROC curve (0.99 vs 0.77, respectively; P = .0334). PDFF, but not CAP, enabled the grading of steatosis (P < .0001). For within-weeks reproducibility, the intraclass correlation coefficient with PDFF was higher than that with CAP (0.95 vs 0.65, respectively; P = .0015); coefficients of variation were similar (19% vs 11%, P = .55). Within-session repeatability of CAP was good, with a coefficient of variation of 4.5%. Conclusion MR spectroscopy-derived PDFF is superior to CAP in detecting and grading liver steatosis in human NAFLD. RSNA, 2017 Online supplemental material is available for this article.

摘要

目的

前瞻性比较瞬时弹性成像的受控衰减参数（CAP）与质子磁共振（MR）光谱的质子密度脂肪分数（PDFF）在诊断非酒精性脂肪性肝病（NAFLD）患者中的诊断准确性，并将其与肝活检结果进行比较。

材料与方法

本研究经机构审查委员会批准，所有患者均签署知情同意书。作者评估了 55 例疑似 NAFLD 的患者（40 例男性，15 例女性）。患者中位年龄为 52.3 岁（四分位距[IQR]，43.7-57.6 岁），中位体重指数为 27.8kg/m（IQR，26.0-33.1kg/m）。CAP 和 PDFF 测量均在同一天进行，在活检前 27 天内（IQR，7-44 天）完成。采用 Jonckheere-Terpstra 检验比较不同脂肪变性程度的 CAP 和 PDFF 值。采用受试者工作特征（ROC）曲线分析评估 CAP 和 PDFF 对脂肪变性分级的诊断准确性。采用线性回归分析、组内相关系数和变异系数评估 CAP 和 PDFF 的 within-weeks 重复性和 within-session 可重复性。

结果

肝活检的脂肪变性程度分布如下：S0 级 5 例，S1 级 24 例，S2 级 17 例，S3 级 9 例。PDFF 和 CAP 均有助于检测组织学证实的脂肪变性（≥S1），但 PDFF 的 ROC 曲线下面积优于 CAP（分别为 0.99 与 0.77，P =.0334）。PDFF 可以对脂肪变性进行分级（P <.0001），但 CAP 不能。对于 within-weeks 重复性，PDFF 的组内相关系数高于 CAP（分别为 0.95 与 0.65，P =.0015）；变异系数相似（19%与 11%，P =.55）。CAP 的 within-session 重复性较好，变异系数为 4.5%。