1 Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
2 BK21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
AJR Am J Roentgenol. 2018 Jun;210(6):1273-1278. doi: 10.2214/AJR.17.19085. Epub 2018 Apr 9.
The purpose of this study is to evaluate the clinical effect of liver stiffness measured using MR elastography (MRE) in patients with cholestasis due to biliary obstruction.
In this retrospective study, 69 consecutive patients with no history of diffuse liver disease who underwent pancreaticobiliary imaging with MRE were included. Quantitative MRI parameters (i.e., liver stiffness, apparent diffusion coefficient, R2*, and proton density fat fraction) and laboratory results (i.e., aspartate aminotransferase, alanine aminotransferase, and total bilirubin levels) were measured. Patients were classified as having either normal bilirubin (group A; n = 49) or hyperbilirubinemia (group B; n = 20). Continuous variables were compared using the independent t test or Mann-Whitney U test. Correlation between parameters was analyzed using the Pearson correlation coefficient. The ROC curve analysis was used to evaluate the diagnostic performance and clinical effect of MRE.
Liver stiffness was significantly higher in group B (mean ± SD, 3.8 ± 0.7 kPa) than in group A (2.8 ± 0.5 kPa) (p < 0.001); there were no differences in other MRI parameters. There were positive correlations between liver stiffness and total bilirubin (r = 0.609; p < 0.001), aspartate aminotransferase (r = 0.376; p = 0.001), and alanine aminotransferase (r = 0.285; p = 0.017) levels. There was a negative correlation between the degree of biliary decompression 1 week after bile drainage and liver stiffness (r = -0.71; p = 0.003). The sensitivity and specificity for predicting biliary decompression were 83.3% and 100%, respectively, at a liver stiffness cutoff of 4.0 kPa.
Liver stiffness measured by MRE increases as cholestasis increases and can be a predictive factor for the sufficiency of biliary decompression after biliary drainage.
本研究旨在评估磁共振弹性成像（MRE）测量的肝硬度在胆道梗阻性胆汁淤积患者中的临床效果。
本回顾性研究纳入了 69 例无弥漫性肝病病史且接受过 MRE 胰胆管成像的连续患者。测量了定量 MRI 参数（即肝硬度、表观扩散系数、R2*和质子密度脂肪分数）和实验室结果（即天冬氨酸转氨酶、丙氨酸转氨酶和总胆红素水平）。患者分为胆红素正常组（A 组，n=49）和高胆红素血症组（B 组，n=20）。采用独立样本 t 检验或曼-惠特尼 U 检验比较连续变量。采用 Pearson 相关系数分析参数间的相关性。采用 ROC 曲线分析评估 MRE 的诊断性能和临床效果。
B 组的肝硬度（均值±标准差，3.8±0.7kPa）明显高于 A 组（2.8±0.5kPa）（p＜0.001）；其他 MRI 参数无差异。肝硬度与总胆红素（r=0.609；p＜0.001）、天冬氨酸转氨酶（r=0.376；p=0.001）和丙氨酸转氨酶（r=0.285；p=0.017）水平呈正相关。胆道引流后 1 周胆管减压程度与肝硬度呈负相关（r=-0.71；p=0.003）。当肝硬度截取值为 4.0kPa 时，预测胆道减压充足的敏感度和特异度分别为 83.3%和 100%。
MRE 测量的肝硬度随胆汁淤积程度增加而增加，可作为胆道引流后胆管减压充足的预测因素。
