Departmento de Anatomia e Imagem, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Av. Professor Alfredo Balena 190, 30130-100, Belo Horizonte, Minas Gerais, Brazil; Instituto Hermes Pardini, Rua dos Aimorés 66, 30140-070, Belo Horizonte, Minas Gerais, Brazil.
Instituto Alfa de Gastroenterologia, Hospital das Clínicas, UFMG, Av. Professor Alfredo Balena, 110, 30130-100, Belo Horizonte, Minas Gerais, Brazil.
Eur J Radiol. 2018 Jan;98:82-89. doi: 10.1016/j.ejrad.2017.11.003. Epub 2017 Nov 11.
To evaluate the performance of magnetic resonance elastography (MRE) in diagnosing and staging hepatic fibrosis in patients with histologically confirmed nonalcoholic fatty liver disease (NAFLD) and in distinguishing simple steatosis from nonalcoholic steatohepatitis (NASH).
Ninety subjects (49 NAFLD patients and 41 healthy volunteers) were prospectively enrolled. Liver stiffness measured by MRE was correlated with the grade of fibrosis and/or inflammation determined by liver biopsy. Correlations, ROC (receiver operator characteristic) curves and diagnostic performance were evaluated. The study was approved by the local ethics committee.
The area under the ROC curve (AUROC) of MRE in discriminating healthy from NAFLD individuals was 0.964 (P<0.0001), and that for distinguishing advanced (F3-F4) from absent/mild fibrosis (F0-F2) was 0.928 (P<0.0001). The use of a threshold >4.39 kPa resulted in a sensitivity of 90.9% and a specificity of 97.3% for diagnosing advanced fibrosis. For discriminating NASH from simple steatosis, the AUROC was 0.783 (P<0.0001), and the threshold, 3.22 kPa.
MRE is an effective, non-invasive method for detecting/staging hepatic fibrosis in NAFLD. This method has good performance in discriminating normal from NAFLD subjects and between the extreme grades of fibrosis. NAFLD patients with inflammation and without fibrosis have higher liver stiffness than those with simple steatosis.
评估磁共振弹性成像（MRE）在诊断和分期组织学证实的非酒精性脂肪性肝病（NAFLD）患者肝纤维化以及鉴别单纯性脂肪变性与非酒精性脂肪性肝炎（NASH）中的作用。
前瞻性纳入 90 例受试者（49 例 NAFLD 患者和 41 例健康志愿者）。MRE 测量的肝硬度与肝活检确定的纤维化和/或炎症程度相关。评估相关性、ROC（接受者操作特征）曲线和诊断性能。本研究获得了当地伦理委员会的批准。
MRE 鉴别健康人与 NAFLD 个体的 ROC 曲线下面积（AUROC）为 0.964（P<0.0001），区分无/轻度纤维化（F0-F2）与进展性纤维化（F3-F4）的 AUROC 为 0.928（P<0.0001）。使用>4.39 kPa 的阈值可使诊断进展性纤维化的敏感性为 90.9%，特异性为 97.3%。鉴别 NASH 与单纯性脂肪变性时，AUROC 为 0.783（P<0.0001），阈值为 3.22 kPa。
MRE 是一种有效、非侵入性的检测/分期 NAFLD 肝纤维化的方法。该方法在鉴别正常人与 NAFLD 患者以及纤维化的极端程度方面具有良好的性能。有炎症而无纤维化的 NAFLD 患者的肝硬度高于单纯性脂肪变性患者。
