脾脏T作为门静脉高压症的一种非侵入性生物标志物。
Splenic T as a noninvasive biomarker for portal hypertension.
作者信息
Hectors Stefanie J, Bane Octavia, Stocker Daniel, Carbonell Guillermo, Lewis Sara, Kennedy Paul, Schiano Thomas D, Thung Swan, Fischman Aaron, Taouli Bachir
机构信息
BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
出版信息
J Magn Reson Imaging. 2020 Sep;52(3):787-794. doi: 10.1002/jmri.27087. Epub 2020 Feb 19.
BACKGROUND
There is a need for noninvasive methods for the diagnosis and monitoring of portal hypertension (PH).
PURPOSE
To 1) assess the correlation of liver and spleen T and T measurements with portal pressures in patients with chronic liver disease, and 2) to compare the diagnostic performance of the relaxation parameters with radiological assessment of PH.
STUDY TYPE
Prospective.
SUBJECTS
Twenty-five patients (M/F 16/9, mean age 56 years, range 21-78 years) undergoing portal pressure (hepatic venous pressure gradient [HVPG]) measurements.
FIELD STRENGTH/SEQUENCE: 1.5T abdominal MRI scan, including T and T mapping.
ASSESSMENT
Liver and spleen T and T , radiological PH score, and (normalized) spleen length were evaluated.
STATISTICAL TESTS
Spearman correlation of all MRI parameters with HVPG was assessed. The diagnostic performance of the assessed parameters for prediction of PH (HVPG ≥5 mmHg) and clinically significant PH (CSPH, HVPG ≥10 mmHg) was determined by receiver operating characteristic (ROC) analysis.
RESULTS
The mean HVPG measurement was 7.8 ± 5.3 mmHg (PH, n = 18 [72%] including CSPH, n = 9 [36%]). PH score, (normalized) spleen length and spleen T significantly correlated with HVPG, with the strongest correlation found for spleen T (r = 0.613, P = 0.001). Spleen T was the only parameter that showed significant diagnostic performance for assessment of PH (area under the curve [AUC] 0.817, P = 0.015) and CSPH (AUC = 0.778, P = 0.024). Normalized spleen length also showed significant diagnostic performance for prediction of CSPH, with a slightly lower AUC (= 0.764, P = 0.031). The radiological PH score, T and T of the liver and T of the spleen, did not show significant diagnostic performance for assessment of CSPH (P > 0.075).
DATA CONCLUSION
Spleen T showed a significant correlation with portal pressure and showed improved diagnostic performance for prediction of CSPH compared to radiological assessment. These initial results need confirmation in a larger cohort.
LEVEL OF EVIDENCE
1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;52:787-794.
背景
需要用于门静脉高压症（PH）诊断和监测的非侵入性方法。
目的
1）评估慢性肝病患者肝脏和脾脏T1及T2测量值与门静脉压力的相关性，2）比较弛豫参数与PH的放射学评估的诊断性能。
研究类型
前瞻性研究。
研究对象
25例接受门静脉压力（肝静脉压力梯度[HVPG]）测量的患者（男/女16/9，平均年龄56岁，范围21 - 78岁）。
场强/序列：1.5T腹部MRI扫描，包括T1和T2映射。
评估
评估肝脏和脾脏的T1及T2、放射学PH评分和（标准化）脾脏长度。
统计检验
评估所有MRI参数与HVPG的Spearman相关性。通过受试者操作特征（ROC）分析确定评估参数对PH（HVPG≥5mmHg）和临床显著性PH（CSPH，HVPG≥10mmHg）预测的诊断性能。
结果
平均HVPG测量值为7.8±5.3mmHg（PH患者18例[72%]，包括CSPH患者9例[36%]）。PH评分、（标准化）脾脏长度和脾脏T2与HVPG显著相关，脾脏T2的相关性最强（r = 0.613，P = 0.001）。脾脏T2是唯一对PH评估（曲线下面积[AUC] 0.817，P = 0.015）和CSPH评估（AUC = 0.778，P = 0.024）显示出显著诊断性能的参数。标准化脾脏长度对CSPH预测也显示出显著诊断性能，AUC略低（= 0.764，P = 0.031）。肝脏的放射学PH评分、T1及T2以及脾脏的T1对CSPH评估未显示出显著诊断性能（P > 0.075）。
数据结论
脾脏T2与门静脉压力显著相关，与放射学评估相比显示出对CSPH预测的诊断性能改善。这些初步结果需要在更大队列中得到证实。
证据水平
1 技术效能阶段：2 《磁共振成像杂志》2020；52：787 - 794。
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