肝硬变中心肌纤维化和炎症：肝心轴的 MRI 研究。
Myocardial Fibrosis and Inflammation in Liver Cirrhosis: MRI Study of the Liver-Heart Axis.
机构信息
From the Departments of Radiology (A.I., A.F., A.M.S., C.C.P., C.M., D.D., D.T., U.A., D.K., J.A.L.) and Internal Medicine I (M.P., C.J., J.C.), University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany; Quantitative Imaging Laboratory Bonn (QILaB), Bonn, Germany (A.I., A.F., A.M.S., D.D., D.T., D.K., J.A.L.); Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University of Bonn, Bonn, Germany (R.F.); Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany (J.T.).
出版信息
Radiology. 2020 Oct;297(1):51-61. doi: 10.1148/radiol.2020201057. Epub 2020 Aug 18.
Background Cardiac involvement in liver cirrhosis in the absence of underlying cardiac disease is termed . The pathophysiology of this condition is still poorly understood. Purpose To investigate the extent of subclinical imaging changes in terms of fibrosis and inflammation and to explore the relationship between the severity of liver disease and the degree of myocardial involvement. Materials and Methods In this prospective study from November 2018 to December 2019, participants with liver cirrhosis and healthy control participants underwent hepatic and cardiac MRI. The multiparametric scan protocol assessed hepatic (T1 and T2 relaxation times, extracellular volume [ECV], and MR elastography-based liver stiffness) and cardiac (T1 and T2 relaxation times, ECV, myocardial edema, late gadolinium enhancement [LGE], and myocardial strain) parameters. Student tests, one-way analysis of variance, Pearson correlation, and multivariable binary regression analysis were used for statistical analyses. Results A total of 42 participants with liver cirrhosis (mean age ± standard deviation, 57 years ± 11; 23 men) and 18 control participants (mean age, 54 years ± 19; 11 men) were evaluated. Compared with control participants, the participants with liver cirrhosis displayed reduced longitudinal strain and elevated markers of myocardial disease (T1 and T2 relaxation times, ECV, and qualitative and quantitative LGE). Myocardial T1 (978 msec ± 23 vs 1006 msec ± 29 vs 1044 msec ± 14; < .001) and T2 relaxation times (56 msec ± 4 vs 59 msec ± 3 vs 62 msec ± 8; = .04) and ECV (30% ± 5 vs 33% ± 5 vs 38% ± 7; = .009) were higher depending on Child-Pugh class (A vs B vs C). Positive LGE lesions (three of 11 [27%] vs 10 of 19 [53%] vs nine of 11 [82%]; = .04) were more prevalent in advanced Child-Pugh classes. MR elastography-based liver stiffness was an independent predictor for LGE (odds ratio, 1.6; 95% confidence interval: 1.2%, 2.1%; = .004) and correlated with quantitative LGE ( = 0.67; < .001), myocardial T1 relaxation times ( = 0.55; < .001), and ECV ( = 0.39; = .01). Conclusion In participants with liver cirrhosis, systolic dysfunction and elevated parameters of myocardial edema and fibrosis were observed at MRI, which were more abnormal with greater severity of liver disease. © RSNA, 2020 See also the editorial by de Roos and Lamb in this issue.
背景 在没有基础心脏疾病的情况下，肝脏疾病导致的心脏受累被称为“非酒精性脂肪性肝病相关心肌病”。这种疾病的病理生理学仍未被充分理解。目的 研究在纤维化和炎症方面的亚临床影像学改变的程度，并探讨肝脏疾病严重程度与心肌受累程度之间的关系。材料与方法 本前瞻性研究于 2018 年 11 月至 2019 年 12 月进行，纳入了患有肝硬化的患者和健康对照参与者，他们均接受了肝脏和心脏 MRI 检查。多参数扫描方案评估了肝脏（T1 和 T2 弛豫时间、细胞外容积 [ECV] 和基于磁共振弹性成像的肝硬度）和心脏（T1 和 T2 弛豫时间、ECV、心肌水肿、晚期钆增强 [LGE] 和心肌应变）参数。采用学生 t 检验、单因素方差分析、Pearson 相关分析和多变量二元回归分析进行统计学分析。结果 共评估了 42 名患有肝硬化的患者（平均年龄±标准差，57 岁±11 岁；23 名男性）和 18 名对照参与者（平均年龄，54 岁±19 岁；11 名男性）。与对照参与者相比，肝硬化患者的纵向应变降低，并且存在心肌疾病的标志物升高（T1 和 T2 弛豫时间、ECV 以及定性和定量 LGE）。心肌 T1（978 毫秒±23 比 1006 毫秒±29 比 1044 毫秒±14；<.001）和 T2 弛豫时间（56 毫秒±4 比 59 毫秒±3 比 62 毫秒±8；=.04）以及 ECV（30%±5 比 33%±5 比 38%±7；=.009）均随 Child-Pugh 分级（A 级比 B 级比 C 级）而升高。高级别 Child-Pugh 分级中阳性 LGE 病变（3 个[27%]比 10 个[53%]比 9 个[82%]；=.04）更为常见。基于磁共振弹性成像的肝硬度是 LGE 的独立预测因子（比值比，1.6；95%置信区间：1.2%，2.1%；=.004），并且与定量 LGE（ = 0.67；<.001）、心肌 T1 弛豫时间（ = 0.55；<.001）和 ECV（ = 0.39；=.01）相关。结论 在患有肝硬化的患者中，MRI 显示存在收缩功能障碍和心肌水肿及纤维化的参数升高，且随着肝脏疾病严重程度的增加，这些参数更为异常。© RSNA，2020 本期杂志还刊登了 de Roos 和 Lamb 的相关述评。
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