利用磁共振弹性成像和肝脏及脾脏 DCE-MRI 无创预测门静脉压力：初步结果。
Noninvasive prediction of portal pressure with MR elastography and DCE-MRI of the liver and spleen: Preliminary results.
机构信息
Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Sorbonne Universités, CNRS, INSERM, LIB, Department of Radiology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
出版信息
J Magn Reson Imaging. 2018 Oct;48(4):1091-1103. doi: 10.1002/jmri.26026. Epub 2018 Apr 11.
BACKGROUND
Portal hypertension (PH), defined by hepatic venous pressure gradient (HVPG) ≥5 mmHg and clinically significant PH, defined by HVPG ≥10 mmHg, are complications of chronic liver disease.
PURPOSE
To assess the diagnostic performance of MR elastography (MRE) and dynamic contrast-enhanced MRI (DCE-MRI) of the liver and spleen for the prediction of PH and clinically significant PH, in comparison with a qualitative PH imaging scoring system.
STUDY TYPE
IRB-approved prospective study.
POPULATION
In all, 34 patients with chronic liver disease who underwent HVPG measurement.
FIELD STRENGTH/SEQUENCE: 1.5/3T examination including 2D-GRE MRE (n = 33) and DCE-MRI of the liver/spleen (n = 28).
ASSESSMENT
Liver and spleen stiffness were calculated from elastogram maps. DCE-MRI was analyzed using model-free parameters and pharmacokinetic modeling. Two observers calculated qualitative PH imaging scores based on routine images.
STATISTICAL TESTS
Imaging parameters were correlated with HVPG. Receiver operating characteristic (ROC) analysis was performed for prediction of PH and clinically significant PH.
RESULTS
There were significant correlations between DCE-MRI parameters (liver time-to-peak, r = 0.517 / P = 0.006, liver distribution volume, r = 0.494 / P = 0.009, liver upslope, r = -0.567 / P = 0.002), liver stiffness (r = 0.478 / P = 0.016), PH imaging score (r = 0.441 / P = 0.009), and HVPG. ROC analysis provided significant area under the ROC (AUROCs) for PH (liver upslope 0.765, liver stiffness 0.809, spleen volume/diameter 0.746-0.731, PH imaging score 0.756) and for clinically significant PH (liver and spleen perfusion parameters 0.733-0.776, liver stiffness 0.742, PH imaging score 0.742). The ratio of liver stiffness to liver upslope had the highest AUROC for diagnosing PH (0.903) and clinically significant PH (0.785).
DATA CONCLUSION
These preliminary results suggest that the combination of liver stiffness and perfusion metrics provide excellent accuracy for diagnosing PH, and fair accuracy for clinically significant PH. Combined MRE and DCE-MRI outperformed qualitative imaging scores for prediction of PH.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1091-1103.
背景
门静脉高压症（PH）定义为肝静脉压力梯度（HVPG）≥5mmHg，且临床显著 PH 定义为 HVPG≥10mmHg，是慢性肝病的并发症。
目的
评估磁共振弹性成像（MRE）和动态对比增强 MRI（DCE-MRI）对肝脏和脾脏 PH 及临床显著 PH 的预测的诊断性能，与定性 PH 成像评分系统进行比较。
研究类型
经机构审查委员会批准的前瞻性研究。
人群
所有接受 HVPG 测量的 34 例慢性肝病患者。
磁场强度/序列：1.5/3T 检查，包括 2D-GRE MRE（n=33）和 DCE-MRI 肝脏/脾脏（n=28）。
评估
从弹性图中计算肝脏和脾脏的硬度。使用无模型参数和药代动力学建模分析 DCE-MRI。两名观察者根据常规图像计算定性 PH 成像评分。
统计检验
对成像参数与 HVPG 进行相关性分析。对 PH 和临床显著 PH 的预测进行接受者操作特征（ROC）分析。
结果
DCE-MRI 参数（肝脏达峰时间，r=0.517 / P=0.006，肝脏分布容积，r=0.494 / P=0.009，肝脏斜率，r=-0.567 / P=0.002）、肝脏硬度（r=0.478 / P=0.016）、PH 成像评分（r=0.441 / P=0.009）与 HVPG 之间存在显著相关性。ROC 分析为 PH（肝脏斜率 0.765，肝脏硬度 0.809，脾脏体积/直径 0.746-0.731，PH 成像评分 0.756）和临床显著 PH（肝脏和脾脏灌注参数 0.733-0.776，肝脏硬度 0.742，PH 成像评分 0.742）提供了显著的 ROC 曲线下面积（AUROCs）。肝脏硬度与斜率的比值对诊断 PH（0.903）和临床显著 PH（0.785）的准确性最高。
数据结论
这些初步结果表明，肝脏硬度和灌注指标的组合对诊断 PH 具有出色的准确性，对临床显著 PH 具有良好的准确性。联合 MRE 和 DCE-MRI 预测 PH 的性能优于定性成像评分。
证据水平
1 技术功效：第 2 阶段 J. Magn. Reson. Imaging 2018;48:1091-1103.
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