无肝脏疾病儿童的磁共振弹性成像测量肝脏硬度的正常范围。
Normal range for MR elastography measured liver stiffness in children without liver disease.
作者信息
Sawh Mary Catherine, Newton Kimberly P, Goyal Nidhi P, Angeles Jorge Eduardo, Harlow Kathryn, Bross Craig, Schlein Alexandra N, Hooker Jonathan C, Sy Ethan Z, Glaser Kevin J, Yin Meng, Ehman Richard L, Sirlin Claude B, Schwimmer Jeffrey B
机构信息
The Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California, USA.
Department of Gastroenterology, Rady Children's Hospital, San Diego, California, USA.
出版信息
J Magn Reson Imaging. 2020 Mar;51(3):919-927. doi: 10.1002/jmri.26905. Epub 2019 Aug 27.
BACKGROUND
Magnetic resonance elastography (MRE) can determine the presence and stage of liver fibrosis. Data on normative MRE values, while reported in adults, are limited in children.
PURPOSE
To determine the distribution of MRE-measured liver stiffness in children without liver disease.
STUDY TYPE
Prospective, observational.
POPULATION
Eighty-one healthy children (mean 12.6 ± 2.6 years, range 8-17 years).
FIELD STRENGTH/SEQUENCE: 3.0T Signa HDxt, General Electric MR Scanner; 2D GRE MRE sequence.
ASSESSMENT
History, examination, laboratory evaluation, and (MR) exams (proton density fat fraction, PDFF, and MRE) were performed. MR elastograms were analyzed manually at two reading centers and compared with each other for agreement and with published values in healthy adults and thresholds for fibrosis in adult and pediatric patients.
STATISTICAL TESTS
Descriptive statistics, Bland-Altman analysis, t-test to compare hepatic stiffness values with reference standards.
RESULTS
Stiffness values obtained at both reading centers were similar, without significant bias (P = 0.362) and with excellent correlation (intraclass correlation coefficient [ICC] = 0.782). Mean hepatic stiffness value for the study population was 2.45 ± 0.35 kPa (95 percentile 3.19 kPa), which was significantly higher than reported values for healthy adult subjects (2.10 ± 0.23 kPa, P < 0.001). In all, 74-85% of subjects had stiffness measurements suggestive of no fibrosis.
DATA CONCLUSION
Mean liver stiffness measured with MRE in this cohort was significantly higher than that reported in healthy adults. Despite rigorous screening, some healthy children had stiffness measurements suggestive of liver fibrosis using current published thresholds. Although MRE has the potential to provide noninvasive assessment in patients with suspected hepatic disease, further refinement of this technology will help advance its use as a diagnostic tool for evidence of fibrosis in pediatric populations.
LEVEL OF EVIDENCE
1 Technical Efficacy: 5 J. Magn. Reson. Imaging 2020;51:919-927.
背景
磁共振弹性成像（MRE）可确定肝纤维化的存在及分期。关于MRE正常数值的数据，虽在成人中有报道，但在儿童中却很有限。
目的
确定无肝脏疾病儿童中MRE测量的肝脏硬度分布情况。
研究类型
前瞻性观察性研究。
研究对象
81名健康儿童（平均年龄12.6±2.6岁，范围8 - 17岁）。
场强/序列：3.0T Signa HDxt通用电气磁共振扫描仪；二维梯度回波MRE序列。
评估
进行病史采集、体格检查、实验室评估以及（磁共振）检查（质子密度脂肪分数、PDFF和MRE）。在两个读片中心对磁共振弹性图进行人工分析，并相互比较一致性，同时与健康成人的已发表数值以及成人和儿童患者的纤维化阈值进行比较。
统计检验
描述性统计、布兰德 - 奥特曼分析、t检验以将肝脏硬度值与参考标准进行比较。
结果
两个读片中心获得的硬度值相似，无显著偏差（P = 0.362）且具有极好的相关性（组内相关系数[ICC] = 0.782）。研究人群的平均肝脏硬度值为2.45±0.35 kPa（第95百分位数为3.19 kPa），显著高于健康成人受试者的报道值（2.10±0.23 kPa，P < 0.001）。总体而言，74% - 85%的受试者硬度测量结果提示无纤维化。
数据结论
该队列中用MRE测量的平均肝脏硬度显著高于健康成人报道值。尽管进行了严格筛查，但一些健康儿童使用当前已发表的阈值进行硬度测量时提示有肝纤维化。虽然MRE有潜力为疑似肝脏疾病患者提供无创评估，但该技术的进一步完善将有助于推动其作为儿科人群纤维化证据诊断工具的应用。
证据水平
1 技术效能：5 《磁共振成像杂志》2020年；51:919 - 927
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