钆塞酸增强 MRI 评估肝纤维化：与瞬时弹性成像、ElastPQ 和血清纤维化标志物的比较。
Assessment of liver fibrosis with gadoxetic acid-enhanced MRI: comparisons with transient elastography, ElastPQ, and serologic fibrosis markers.
机构信息
Department of Radiology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351, Republic of Korea.
出版信息
Abdom Radiol (NY). 2019 Aug;44(8):2769-2780. doi: 10.1007/s00261-019-02041-z.
OBJECTIVES
To compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI), ultrasonography (US)-based elastography, and serologic fibrosis markers in assessing the stage of liver fibrosis.
MATERIALS AND METHODS
This retrospective study included 67 patients (55 male and 12 female; mean age 62.5 years) who underwent gadoxetic acid-enhanced MRI and liver stiffness measurements before liver biopsy or surgery between January 2014 and January 2018. Measurements were performed using transient elastography (TE), ultrasound shear wave elastography point quantification (ElastPQ), and blood tests. The following MRI-based fibrosis markers were assessed: contrast enhancement index (CEI), liver-spleen contrast ratio (LSC), liver-portal vein contrast ratio (LPC), and signal intensity ratio (SIR). The diagnostic performances of fibrosis markers were compared using the area under the receiver operating characteristic curve (AUC), with histopathologic fibrosis stage as the reference standard.
RESULTS
The fibrosis stages were F0-F1 (n = 17), F2 (n = 7), F3 (n = 20), and F4 (n = 23). MRI-based fibrosis markers negatively correlated with histologic stage: CEI (r = -0.786); LSC (r = - 0.718); LPC (r = - 0.448); and SIR (r = - 0.617; all P < 0.001). For diagnosis of either significant liver fibrosis (≥ F2) or cirrhosis (F4), the CEI provided better diagnostic accuracy (AUC = 0.898 and 0.881) than the aspartate aminotransferase-to-platelet ratio index (APRI) (AUC = 0.699 and 0.715; all P < 0.05). The CEI displayed similar diagnostic accuracy for ≥ F2 or F4 when using TE (AUC = 0.866 and 0.884, both P > 0.05) or ElastPQ [AUC = 0.751 (P = 0.021) and AUC = 0.786 (P = 0.234)].
CONCLUSIONS
The CEI measured by gadoxetic acid-enhanced MRI allows the staging of liver fibrosis, with a diagnostic accuracy comparable to that of TE and superior to that of ElastPQ or APRI.
目的
比较钆塞酸增强磁共振成像（MRI）、超声弹性成像（US）和血清纤维化标志物在评估肝纤维化分期中的诊断性能。
材料和方法
本回顾性研究纳入了 2014 年 1 月至 2018 年 1 月期间接受钆塞酸增强 MRI 和肝硬度测量的 67 例患者（55 名男性和 12 名女性；平均年龄 62.5 岁）。采用瞬时弹性成像（TE）、超声剪切波弹性成像点量化（ElastPQ）和血液检查进行测量。评估了以下基于 MRI 的纤维化标志物：对比增强指数（CEI）、肝脾对比比（LSC）、肝门静脉对比比（LPC）和信号强度比（SIR）。采用受试者工作特征曲线（ROC）下面积（AUC）比较纤维化标志物的诊断性能，以组织病理学纤维化分期作为参考标准。
结果
纤维化分期为 F0-F1（n=17）、F2（n=7）、F3（n=20）和 F4（n=23）。基于 MRI 的纤维化标志物与组织学分期呈负相关：CEI（r=-0.786）、LSC（r=-0.718）、LPC（r=-0.448）和 SIR（r=-0.617；均 P<0.001）。对于诊断显著的肝纤维化（≥F2）或肝硬化（F4），CEI 提供了比天冬氨酸氨基转移酶-血小板比值指数（APRI）更高的诊断准确性（AUC=0.898 和 0.881）（均 P<0.05）。对于≥F2 或 F4，CEI 与 TE（AUC=0.866 和 0.884，均 P>0.05）或 ElastPQ（AUC=0.751（P=0.021）和 AUC=0.786（P=0.234））的诊断准确性相似。
结论
钆塞酸增强 MRI 测量的 CEI 可用于分期肝纤维化，其诊断准确性与 TE 相当，优于 ElastPQ 或 APRI。
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