使用定性和定量磁共振弹性成像检测肝纤维化与肝表面结节度测量、钆塞酸摄取和血清标志物的比较。
Detection of liver fibrosis using qualitative and quantitative MR elastography compared to liver surface nodularity measurement, gadoxetic acid uptake, and serum markers.
机构信息
Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
出版信息
J Magn Reson Imaging. 2018 Jun;47(6):1552-1561. doi: 10.1002/jmri.25911. Epub 2017 Nov 28.
BACKGROUND
Multiparametric magnetic resonance imaging (mpMRI) combining different techniques such as MR elastography (MRE) has emerged as a noninvasive approach to diagnose and stage liver fibrosis with high accuracy allowing for anatomical and functional information.
PURPOSE
To assess the diagnostic performance of mpMRI including qualitative and quantitative assessment of MRE, liver surface nodularity (LSN) measurement, hepatic enhancement ratios postgadoxetic acid, and serum markers (APRI, FIB-4) for the detection of liver fibrosis.
STUDY TYPE
IRB-approved retrospective.
SUBJECTS
Eighty-three adult patients.
FIELD STRENGTH/SEQUENCE: 1.5T and 3.0T MR systems. MRE and T -weighted postgadoxetic acid sequences.
ASSESSMENT
Two independent observers analyzed qualitative color-coded MRE maps on a scale of 0-3. Regions of interest were drawn to measure liver stiffness on MRE stiffness maps and on pre- and postcontrast T -weighted images to measure hepatic enhancement ratios. Software was used to generate LSN measurements. Histopathology was used as the reference standard for diagnosis of liver fibrosis in all patients.
STATISTICAL TESTS
A multivariable logistic analysis was performed to identify independent predictors of liver fibrosis. Receiver operating characteristic (ROC) analysis evaluated the performance of each imaging technique for detection of fibrosis, in comparison with serum markers.
RESULTS
Liver stiffness measured with MRE provided the strongest correlation with histopathologic fibrosis stage (r = 0.74, P < 0.001), and the highest diagnostic performance for detection of stages F2-F4, F3-F4, and F4 (areas under the curve [AUCs] of 0.87, 0.91, and 0.89, respectively, P < 0.001) compared to other methods. Qualitative assessment of MRE maps showed fair to good accuracy for detection of fibrosis (AUC range 0.76-0.84). Multivariable logistic analysis identified liver stiffness and FIB-4 as independent predictors of fibrosis with AUCs of 0.90 (F2-F4), 0.93 (F3-F4) and 0.92 (F4) when combined.
DATA CONCLUSION
Liver stiffness measured with MRE showed the best performance for detection of liver fibrosis compared to LSN and gadoxetic acid uptake, with slight improvement when combined with FIB-4.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1552-1561.
背景
多参数磁共振成像（mpMRI）结合了不同的技术，如磁共振弹性成像（MRE），已经成为一种非侵入性的方法，能够准确地诊断和分期肝纤维化，提供解剖和功能信息。
目的
评估 mpMRI 的诊断性能，包括 MRE 的定性和定量评估、肝表面结节度（LSN）测量、钆塞酸后肝增强比以及血清标志物（APRI、FIB-4）在检测肝纤维化方面的性能。
研究类型
经机构审查委员会批准的回顾性研究。
受试者
83 名成年患者。
磁场强度/序列：1.5T 和 3.0T 磁共振系统。MRE 和钆塞酸后 T1 加权序列。
评估
两名独立观察者对彩色编码的 MRE 图谱进行 0-3 级的定性分析。在 MRE 硬度图谱和对比前后的 T1 加权图像上画出感兴趣区域，以测量肝脏硬度。软件用于生成 LSN 测量值。所有患者均采用组织病理学作为诊断肝纤维化的参考标准。
统计学检验
采用多变量逻辑分析识别肝纤维化的独立预测因素。接收者操作特征（ROC）分析评估了每种成像技术在检测纤维化方面的性能，与血清标志物进行比较。
结果
MRE 测量的肝硬度与组织病理学纤维化分期相关性最强（r=0.74，P<0.001），并且在检测 F2-F4、F3-F4 和 F4 纤维化分期方面具有最高的诊断性能（曲线下面积[AUC]分别为 0.87、0.91 和 0.89，P<0.001），优于其他方法。MRE 图谱的定性评估对纤维化的检测具有良好到中等的准确性（AUC 范围为 0.76-0.84）。多变量逻辑分析确定肝硬度和 FIB-4 是纤维化的独立预测因素，当与 FIB-4 联合使用时，其 AUC 值分别为 0.90（F2-F4）、0.93（F3-F4）和 0.92（F4）。
数据结论
与 LSN 和钆塞酸摄取相比，MRE 测量的肝硬度在检测肝纤维化方面表现最佳，与 FIB-4 联合使用时略有改善。
证据水平
3 级 技术功效：2 级 J. 磁共振成像 2018；47：1552-1561.
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