From the Department of Radiology (A.T.T., S.D.S.), Division of Pathology and Laboratory Medicine (R.M.S.), Division of Gastroenterology, Hepatology and Nutrition (S.A.X.), and Division of Biostatistics and Epidemiology (B.Z.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 5031, Cincinnati, OH 45299; Department of Mathematical Sciences, University of Cincinnati, Cincinnati, Ohio (W.S.); and Levine Children's Hospital, Charlotte, NC (D.B.W.).
Radiology. 2018 Jun;287(3):824-832. doi: 10.1148/radiol.2018172099. Epub 2018 Feb 22.
Purpose To assess the diagnostic performance of magnetic resonance (MR) elastography-derived liver stiffness to detect liver fibrosis in a pediatric and young adult population with a spectrum of liver diseases. Materials and Methods This retrospective study included patients younger than 21 years of age who underwent MR elastography and liver biopsy within 3 months of one another between January 2012 and September 2016 for indications other than liver transplantation or Fontan palliation of congenital heart disease. MR elastography examinations were reprocessed by a single observer, blinded to pathologic findings. Pathology specimens were reviewed by a single pathologist who scored steatosis (lipid in ≥ 5% of hepatocytes) and staged fibrosis. Receiver operating characteristic (ROC) curves were used to assess diagnostic performance. Results A total of 86 patients, 49 (57%) male with a median age of 14.2 years (range, 0.3-20.6 years), were included. Fifty-one patients (59.3%) had Ludwig stage 2 or higher fibrosis; 44 patients (51.2%) had hepatic steatosis. The area under the ROC curve for Ludwig stage 0-1 versus stage 2 or higher fibrosis was 0.70 (95% confidence interval [CI]: 0.59, 0.81) for the whole population and was significantly lower for patients with steatosis versus those without (0.53 [95% CI: 0.35, 0.71] vs 0.82 [95% CI: 0.67, 0.96], P = .014). Optimal stiffness cut-offs for the entire population were 2.27 kPa with 68.6% sensitivity (95% CI: 57.2%, 80.1%) and 74.3% specificity (95% CI: 63.5%, 85.1%) or 1.67 kPa with 35.3% sensitivity (95% CI: 23.5%, 47.1%) and 91.4% specificity (95% CI: 84.5%, 98.3%). Conclusion In children and young adults, MR elastography performs significantly better for distinguishing stage 0-1 versus stage 2 or higher fibrosis in patients without steatosis than in those with steatosis. This suggests a confounding effect of steatosis or inflammation in the population with nonalcoholic fatty liver disease. RSNA, 2018.
目的 在患有各种肝脏疾病的儿科和年轻成人患者中，评估磁共振弹性成像（MR 弹性成像）衍生的肝脏硬度检测用于诊断肝纤维化的性能。
材料与方法 本回顾性研究纳入了 2012 年 1 月至 2016 年 9 月期间，因非肝移植或先天性心脏病 Fontan 姑息术指征而在 3 个月内接受了 MR 弹性成像和肝活检的年龄小于 21 岁的患者。MR 弹性成像检查由一位观察者重新处理，该观察者对病理结果不知情。病理标本由一位病理学家进行审查，该病理学家对脂肪变性（≥ 5%的肝细胞中存在脂质）和纤维化分期进行评分。使用受试者工作特征（ROC）曲线评估诊断性能。
结果 共纳入 86 例患者，49 例（57%）为男性，中位年龄为 14.2 岁（范围：0.3-20.6 岁）。51 例（59.3%）患者为 Ludwig 分期 2 期或更高期纤维化；44 例（51.2%）患者存在肝脂肪变性。Ludwig 分期 0-1 与 2 期或更高期纤维化的 ROC 曲线下面积在全人群中为 0.70（95%置信区间[CI]：0.59，0.81），在存在脂肪变性的患者中明显低于不存在脂肪变性的患者（0.53[95%CI：0.35，0.71] vs 0.82[95%CI：0.67，0.96]，P =.014）。全人群的最佳硬度截断值为 2.27 kPa，其敏感性为 68.6%（95%CI：57.2%，80.1%），特异性为 74.3%（95%CI：63.5%，85.1%）；或 1.67 kPa，其敏感性为 35.3%（95%CI：23.5%，47.1%），特异性为 91.4%（95%CI：84.5%，98.3%）。
结论 在儿童和年轻成人中，MR 弹性成像在无脂肪变性患者中区分 Ludwig 分期 0-1 与 2 期或更高期纤维化的性能明显优于有脂肪变性的患者。这表明在非酒精性脂肪性肝病患者中，脂肪变性或炎症存在混杂影响。
RSNA，2018 年。
