Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Department of CT and MRI, Xuzhou Central Hospital, Xuzhou, China.
Korean J Radiol. 2019 May;20(5):773-780. doi: 10.3348/kjr.2018.0767.
To assess segmental liver stiffness (LS) with MRI before and after endovascular intervention in patients with Budd-Chiari syndrome (BCS).
Twenty-three patients (13 males and 10 females; mean age, 42.6 ± 12.6 years; age range, 31-56 years) with BCS as a primary liver disease were recruited for this study. Two consecutive magnetic resonance elastography (MRE) examinations were performed before the endovascular treatment. Fifteen patients who underwent endovascular intervention treatment also had follow-up MRE scans within three days after the procedure. LS was measured in three liver segments: the right posterior, right anterior, and left medial segments. Inter-reader and inter-exam repeatability were analyzed with intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Segmental LS and clinical characteristics before and after the intervention were also compared.
Within three days of the endovascular intervention, all three segmental LS values decreased: LS of the right posterior segment = 7.23 ± 0.88 kPa (before) vs. 4.94 ± 0.84 kPa (after), LS of the right anterior segment = 7.30 ± 1.06 kPa (before) vs. 4.77 ± 0.85 kPa (after), and LS of the left medial segment = 7.22 ± 0.87 kPa (before) vs. 4.87 ± 0.72 kPa (after) (all = 0.001). There was a significant correlation between LS changes and venous pressure gradient changes before and after treatments ( = 0.651, = 0.009). The clinical manifestations of all 15 patients significantly improved after therapy. The MRE repeatability was excellent, with insignificant variations (inter-reader, ICC = 0.839-0.943: inter-examination, ICC = 0.765-0.869). Bland-Altman analysis confirmed excellent agreement (limits of agreement, 13.4-19.4%).
Segmental LS measured by MRE is a promising repeatable quantitative biomarker for monitoring the treatment response to minimally invasive endovascular intervention in patients with BCS.
评估布加综合征（BCS）患者血管内介入前后的节段性肝硬度（LS）。
本研究纳入了 23 名原发性 BCS 患者（男 13 例，女 10 例；平均年龄 42.6±12.6 岁；年龄范围 31-56 岁）。所有患者在血管内治疗前均进行了两次连续的磁共振弹性成像（MRE）检查。15 名接受血管内介入治疗的患者在治疗后 3 天内也进行了随访 MRE 扫描。LS 在三个肝段进行测量：右后段、右前段和左内侧段。采用组内相关系数（ICC）和 Bland-Altman 分析评估了观察者内和观察者间的可重复性。比较了介入前后节段 LS 和临床特征。
血管内介入治疗后 3 天内，所有三个节段的 LS 值均降低：右后段 LS=7.23±0.88 kPa（治疗前）vs.4.94±0.84 kPa（治疗后），右前段 LS=7.30±1.06 kPa（治疗前）vs.4.77±0.85 kPa（治疗后），左内侧段 LS=7.22±0.87 kPa（治疗前）vs.4.87±0.72 kPa（治疗后）（均=0.001）。LS 变化与治疗前后静脉压力梯度变化之间存在显著相关性（=0.651，=0.009）。15 例患者的临床表现均在治疗后明显改善。MRE 具有极好的重复性，变化不显著（观察者内，ICC=0.839-0.943；观察者间，ICC=0.765-0.869）。Bland-Altman 分析证实具有极好的一致性（一致性界限，13.4-19.4%）。
MRE 测量的节段性 LS 是一种有前途的、可重复的定量生物标志物，可用于监测 BCS 患者微创血管内介入治疗的反应。
