From the Center for Chronically Sick Children.
the Departments of Radiology.
Invest Radiol. 2019 Apr;54(4):198-203. doi: 10.1097/RLI.0000000000000529.
Today, nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and adults alike. Yet, the noninvasive evaluation of disease severity remains a diagnostic challenge. In this study, we apply multifrequency magnetic resonance elastography (mMRE) for the quantification of liver steatosis and fibrosis in adolescents with NAFLD.
Fifty adolescents (age range, 10-17 years; mean BMI, 33.9 kg/m; range, 21.4-42.1 kg/m) with biopsy-proven NAFLD were included in this prospective study. Multifrequency magnetic resonance elastography was performed using external multifrequency vibrations of 30 to 60 Hz and tomoelastography postprocessing, resulting in penetration rate (a) and shear wave speed (c). Hepatic fat fraction was determined using Dixon method. The diagnostic accuracy of mMRE in grading liver steatosis and staging liver fibrosis was assessed by receiver operating characteristic curve analysis.
Multifrequency magnetic resonance elastography parameters c and a were independently sensitive to fibrosis and steatosis, respectively, providing area under the receiver operating characteristic values of 0.79 (95% confidence interval [CI], 0.66-0.92), 0.91 (95% CI, 0.83-0.99), and 0.90 (95% CI, 0.80-0.99) for the detection of any (≥F1), moderate (≥F2), and advanced (≥F3) fibrosis, and 0.87 (95% CI, 0.76-0.97) and 0.87 (95% CI, 0.77-0.96) for the detection of moderate (≥S2) and severe (S3) steatosis.
One mMRE measurement provides 2 independent parameters with very good diagnostic accuracy in detecting moderate and advanced fibrosis as well as moderate and severe steatosis in pediatric NAFLD.
如今，非酒精性脂肪性肝病（NAFLD）是儿童和成人中最常见的慢性肝病。然而，疾病严重程度的非侵入性评估仍然是一个诊断挑战。在这项研究中，我们应用多频磁共振弹性成像（mMRE）来量化青少年非酒精性脂肪性肝病患者的肝脂肪变性和纤维化程度。
本前瞻性研究纳入了 50 名经肝活检证实为非酒精性脂肪性肝病的青少年患者（年龄 10-17 岁；平均 BMI 为 33.9kg/m2，范围为 21.4-42.1kg/m2）。使用 30-60Hz 的外部多频振动和断层弹性成像后处理进行多频磁共振弹性成像，得出穿透率（a）和剪切波速度（c）。使用 Dixon 方法测定肝脂肪分数。通过受试者工作特征曲线分析评估 mMRE 分级肝脂肪变性和分期肝纤维化的诊断准确性。
多频磁共振弹性成像参数 c 和 a 分别独立敏感于纤维化和脂肪变性，提供了用于检测任何（≥F1）、中度（≥F2）和晚期（≥F3）纤维化的受试者工作特征曲线下面积分别为 0.79（95%置信区间[CI]，0.66-0.92）、0.91（95%CI，0.83-0.99）和 0.90（95%CI，0.80-0.99），以及用于检测中度（≥S2）和重度（S3）脂肪变性的受试者工作特征曲线下面积分别为 0.87（95%CI，0.76-0.97）和 0.87（95%CI，0.77-0.96）。
单次 mMRE 测量可提供 2 个独立参数，对儿科非酒精性脂肪性肝病患者中度和晚期纤维化以及中度和重度脂肪变性的诊断具有很好的准确性。
