Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Department of Radiology, Korean Armed Forces Capital Hospital, Gyeonggi-do, Korea.
Sci Rep. 2020 Feb 14;10(1):2671. doi: 10.1038/s41598-020-59601-3.
Non-alcoholic steatohepatitis (NASH) is a complex disease consisting of various components including steatosis, lobular inflammation, and ballooning degeneration, with or without fibrosis. Therefore, it is difficult to diagnose NASH with only one imaging modality. This study was aimed to evaluate the feasibility of magnetic resonance imaging (MRI) for predicting NASH and to develop a non-invasive multiparametric MR index for the detection of NASH in non-alcoholic fatty liver disease (NAFLD) patients. This prospective study included 47 NAFLD patients who were scheduled to undergo or underwent ultrasound-guided liver biopsy within 2 months. Biopsy specimens were graded as NASH or non-NASH. All patients underwent non-enhanced MRI including MR spectroscopy (MRS), MR elastography (MRE), and T1 mapping. Diagnostic performances of MRS, MRE, and T1 mapping for grading steatosis, activity, and fibrosis were evaluated. A multiparametric MR index combining fat fraction (FF), liver stiffness (LS) value, and T1 relaxation time was developed using linear regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the newly devised MR index. Twenty NASH patients and 27 non-NASH patients were included. Using MRS, MRE, and T1 mapping, the mean areas under the curve (AUCs) for grading steatosis, fibrosis, and activity were 0.870, 0.951, and 0.664, respectively. The multiparametric MR index was determined as 0.037 × FF (%) + 1.4 × LS value (kPa) + 0.004 × T1 relaxation time (msec) -3.819. ROC curve analysis of the MR index revealed an AUC of 0.883. The cut-off value of 6 had a sensitivity of 80.0% and specificity of 85.2%. The multiparametric MR index combining FF, LS value, and T1 relaxation time showed high diagnostic performance for detecting NASH in NAFLD patients.
非酒精性脂肪性肝炎（NASH）是一种由多种成分组成的复杂疾病，包括脂肪变性、肝小叶炎症和气球样变性，伴有或不伴有纤维化。因此，仅通过一种成像方式很难诊断 NASH。本研究旨在评估磁共振成像（MRI）预测 NASH 的可行性，并为非酒精性脂肪性肝病（NAFLD）患者中 NASH 的检测开发一种非侵入性的多参数 MR 指数。这项前瞻性研究纳入了 47 名计划在 2 个月内接受或已接受超声引导下肝活检的 NAFLD 患者。活检标本分为 NASH 或非 NASH。所有患者均接受非增强 MRI 检查，包括磁共振波谱（MRS）、磁共振弹性成像（MRE）和 T1 映射。评估了 MRS、MRE 和 T1 映射在评估脂肪变性、活动度和纤维化分级方面的诊断性能。使用线性回归分析建立了一个结合脂肪分数（FF）、肝硬度（LS）值和 T1 弛豫时间的多参数 MR 指数。通过接收者操作特征（ROC）曲线分析评估新设计的 MR 指数的诊断性能。共纳入 20 名 NASH 患者和 27 名非 NASH 患者。使用 MRS、MRE 和 T1 映射，脂肪变性、纤维化和活动度分级的平均曲线下面积（AUC）分别为 0.870、0.951 和 0.664。多参数 MR 指数确定为 0.037×FF（%）+1.4×LS 值（kPa）+0.004×T1 弛豫时间（msec）-3.819。MR 指数的 ROC 曲线分析显示 AUC 为 0.883。截断值为 6 时，灵敏度为 80.0%，特异性为 85.2%。FF、LS 值和 T1 弛豫时间相结合的多参数 MR 指数对检测 NAFLD 患者中的 NASH 具有较高的诊断性能。
