磁共振参数图对原发性硬化性胆管炎患者肝纤维化无创评估的诊断价值。
Diagnostic value of magnetic resonance parametric mapping for non-invasive assessment of liver fibrosis in patients with primary sclerosing cholangitis.
机构信息
Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland.
出版信息
BMC Med Imaging. 2021 Apr 7;21(1):65. doi: 10.1186/s12880-021-00598-0.
BACKGROUND
Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease, characterized by bile duct inflammation and destruction, leading to biliary fibrosis and cirrhosis. The purpose of this study was to investigate the utility of T1 and T2 mapping parameters, including extracellular volume fraction (ECV) for non-invasive assessment of fibrosis severity in patients with PSC.
METHODS
In this prospective study, patients with PSC diagnosis were consecutively enrolled from January 2019 to July 2020 and underwent liver MRI. Besides morphological sequences, MR elastography (MRE), and T1 and T2 mapping were performed. ECV was calculated from T1 relaxation times. The presence of significant fibrosis (≥ F2) was defined as MRE-derived liver stiffness ≥ 3.66 kPa and used as the reference standard, against which the diagnostic performance of MRI mapping parameters was tested. Student t test, ROC analysis and Pearson correlation were used for statistical analysis.
RESULTS
32 patients with PSC (age range 19-77 years) were analyzed. Both, hepatic native T1 (r = 0.66; P < 0.001) and ECV (r = 0.69; P < 0.001) correlated with MRE-derived liver stiffness. To diagnose significant fibrosis (≥ F2), ECV revealed a sensitivity of 84.2% (95% confidence interval (CI) 62.4-94.5%) and a specificity of 84.6% (CI 57.8-95.7%); hepatic native T1 revealed a sensitivity of 52.6% (CI 31.7-72.7%) and a specificity of 100.0% (CI 77.2-100.0%). Hepatic ECV (area under the curve (AUC) 0.858) and native T1 (AUC 0.711) had an equal or higher diagnostic performance for the assessment of significant fibrosis compared to serologic fibrosis scores (APRI (AUC 0.787), FIB-4 (AUC 0.588), AAR (0.570)).
CONCLUSIONS
Hepatic T1 and ECV can diagnose significant fibrosis in patients with PSC. Quantitative mapping has the potential to be a new non-invasive biomarker for liver fibrosis assessment and quantification in PSC patients.
背景
原发性硬化性胆管炎（PSC）是一种慢性胆汁淤积性肝病，其特征为胆管炎症和破坏，导致胆管纤维化和肝硬化。本研究旨在探讨 T1 和 T2 弛豫时间mapping 参数（包括细胞外容积分数 [ECV]）在非侵入性评估 PSC 患者纤维化严重程度中的应用价值。
方法
本前瞻性研究纳入了 2019 年 1 月至 2020 年 7 月期间连续就诊的 PSC 患者，并进行了肝脏 MRI 检查。除形态学序列外，还进行了磁共振弹性成像（MRE）和 T1 和 T2 mapping。ECV 由 T1 弛豫时间计算得出。存在显著纤维化（≥F2）定义为 MRE 检测到的肝硬度≥3.66kPa，并将其作为参考标准，以测试 MRI mapping 参数的诊断性能。采用学生 t 检验、ROC 分析和 Pearson 相关进行统计学分析。
结果
分析了 32 例 PSC 患者（年龄 19-77 岁）。肝脏 T1 弛豫时间（r=0.66；P<0.001）和 ECV（r=0.69；P<0.001）均与 MRE 检测到的肝硬度相关。诊断显著纤维化（≥F2）时，ECV 的敏感性为 84.2%（95%置信区间 [CI] 62.4-94.5%），特异性为 84.6%（CI 57.8-95.7%）；肝脏 T1 弛豫时间的敏感性为 52.6%（CI 31.7-72.7%），特异性为 100.0%（CI 77.2-100.0%）。与血清纤维化评分相比，肝脏 ECV（曲线下面积 [AUC] 0.858）和 T1 弛豫时间（AUC 0.711）在评估显著纤维化方面具有同等或更高的诊断性能（APRI（AUC 0.787），FIB-4（AUC 0.588），AAR（0.570））。
结论
肝脏 T1 和 ECV 可诊断 PSC 患者的显著纤维化。定量 mapping 有可能成为 PSC 患者肝纤维化评估和定量的新型非侵入性生物标志物。
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