MRC/University of Edinburgh Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh, EH16 4TJ, UK.
Centre for Liver Research and NIHR Birmingham BRC, University of Birmingham, Birmingham, B15 2TT, UK.
Sci Rep. 2018 Jun 15;8(1):9189. doi: 10.1038/s41598-018-27560-5.
LiverMultiScan is an emerging diagnostic tool using multiparametric MRI to quantify liver disease. In a two-centre prospective validation study, 161 consecutive adult patients who had clinically-indicated liver biopsies underwent contemporaneous non-contrast multiparametric MRI at 3.0 tesla (proton density fat fraction (PDFF), T1 and T2* mapping), transient elastography (TE) and Enhanced Liver Fibrosis (ELF) test. Non-invasive liver tests were correlated with gold standard histothological measures. Reproducibility of LiverMultiScan was investigated in 22 healthy volunteers. Iron-corrected T1 (cT1), TE, and ELF demonstrated a positive correlation with hepatic collagen proportionate area (all p < 0·001). TE was superior to ELF and cT1 for predicting fibrosis stage. cT1 maintained good predictive accuracy for diagnosing significant fibrosis in cases with indeterminate ELF, but not for cases with indeterminate TE values. PDFF had high predictive accuracy for individual steatosis grades, with AUROCs ranging from 0.90-0.94. T2* mapping diagnosed iron accumulation with AUROC of 0.79 (95% CI: 0.67-0.92) and negative predictive value of 96%. LiverMultiScan showed excellent test/re-test reliability (coefficients of variation ranging from 1.4% to 2.8% for cT1). Overall failure rates for LiverMultiScan, ELF and TE were 4.3%, 1.9% and 15%, respectively. LiverMultiScan is an emerging point-of-care diagnostic tool that is comparable with the established non-invasive tests for assessment of liver fibrosis, whilst at the same time offering a superior technical success rate and contemporaneous measurement of liver steatosis and iron accumulation.
LiverMultiScan 是一种新兴的诊断工具，使用多参数 MRI 来量化肝脏疾病。在一项两中心前瞻性验证研究中，161 例有临床指征行肝活检的连续成年患者同时接受了 3.0T 无对比多参数 MRI（质子密度脂肪分数（PDFF）、T1 和 T2* 映射）、瞬时弹性成像（TE）和增强型肝纤维化（ELF）检测。非侵入性肝试验与金标准组织学测量相关。在 22 名健康志愿者中研究了 LiverMultiScan 的可重复性。铁校正 T1（cT1）、TE 和 ELF 与肝胶原比例面积呈正相关（均 P<0.001）。TE 在预测纤维化分期方面优于 ELF 和 cT1。cT1 在 ELF 不确定的情况下对诊断显著纤维化仍具有良好的预测准确性，但在 TE 值不确定的情况下则不然。PDFF 对单个脂肪变性程度具有高预测准确性，AUROCs 范围为 0.90-0.94。T2* 映射诊断铁累积的 AUROC 为 0.79（95%CI：0.67-0.92）和阴性预测值为 96%。LiverMultiScan 显示出良好的测试/再测试可靠性（cT1 的变异系数范围为 1.4%至 2.8%）。总体而言，LiverMultiScan、ELF 和 TE 的失败率分别为 4.3%、1.9%和 15%。LiverMultiScan 是一种新兴的床边诊断工具，与评估纤维化的既定非侵入性试验相当，同时提供更高的技术成功率和同时测量肝脂肪变性和铁积累。
