Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
Bundang Jesaeng General Hospital, Hepatology Center.
Clin Transl Gastroenterol. 2020 Apr;11(4):e00157. doi: 10.14309/ctg.0000000000000157.
Because nonalcoholic fatty liver disease (NAFLD) is becoming a leading cause of chronic liver disease, noninvasive evaluations of its severity are immediately needed. This prospective cross-sectional study evaluated the effectiveness of noninvasive assessments of hepatic steatosis, fibrosis, and steatohepatitis.
Patients underwent laboratory tests, liver biopsy, transient elastography, and MRI. Multiparametric MR was used to measure MRI proton density fat fraction, MR spectroscopy, T1 mapping, and MR elastography (MRE).
We enrolled 130 patients between October 2016 and July 2019. For the diagnosis of moderate-to-severe steatosis (grade ≥ 2), the area under the receiver operating characteristic curve (AUROC) was lower in controlled attenuation parameter (0.69; 95% confidence interval [CI], 0.60-0.76) than MRI proton density fat fraction (0.82; 95% CI, 0.75-0.89; P = 0.008) and MR spectroscopy (0.83; 95% CI, 0.75-0.89; P = 0.006). For the diagnosis of advanced fibrosis (stage ≥ 3), the AUROC of MRE (0.89; 95% CI, 0.83-0.94) was superior compared with those of the Fibrosis-4 index (0.77; 95% CI, 0.69-0.84; P = 0.010), NAFLD fibrosis score (0.81; 95% CI, 0.73-0.87; P = 0.043), and transient elastography (0.82; 95% CI, 0.74-0.88; P = 0.062). For detecting advanced fibrosis or nonalcoholic steatohepatitis, the AUROC of MRE (0.86; 95% CI, 0.79-0.91) was higher than that of TE (0.76; 95% CI, 0.68-0.83) with statistical significance (P = 0.018).
Multiparametric MR accurately identified a severe form of NAFLD. Multiparametric MR can be a valuable noninvasive method for evaluating the severity of NAFLD.
由于非酒精性脂肪性肝病（NAFLD）正在成为慢性肝病的主要病因，因此急需对其严重程度进行非侵入性评估。本前瞻性横断面研究评估了肝脂肪变性、纤维化和脂肪性肝炎的非侵入性评估的有效性。
患者接受了实验室检查、肝活检、瞬时弹性成像和 MRI 检查。多参数 MRI 用于测量 MRI 质子密度脂肪分数、磁共振波谱、T1 映射和 MRI 弹性成像（MRE）。
我们于 2016 年 10 月至 2019 年 7 月期间纳入了 130 名患者。对于中重度脂肪变性（等级≥2）的诊断，受控衰减参数的受试者工作特征曲线下面积（AUROC）低于 MRI 质子密度脂肪分数（0.82；95%置信区间 [CI]，0.75-0.89；P=0.008）和磁共振波谱（0.83；95%CI，0.75-0.89；P=0.006）。对于晚期纤维化（分期≥3）的诊断，MRE 的 AUROC（0.89；95%CI，0.83-0.94）优于 Fibrosis-4 指数（0.77；95%CI，0.69-0.84；P=0.010）、NAFLD 纤维化评分（0.81；95%CI，0.73-0.87；P=0.043）和瞬时弹性成像（0.82；95%CI，0.74-0.88；P=0.062）。对于检测晚期纤维化或非酒精性脂肪性肝炎，MRE 的 AUROC（0.86；95%CI，0.79-0.91）高于 TE 的 AUROC（0.76；95%CI，0.68-0.83），差异有统计学意义（P=0.018）。
多参数 MRI 能准确识别严重的 NAFLD 形式。多参数 MRI 可能是评估 NAFLD 严重程度的一种有价值的非侵入性方法。
