基于 MRI 的 3T 定量 R2 映射反映了非酒精性脂肪性肝病患者的肝铁过载和发病机制。
MRI-Based Quantitative R2 Mapping at 3 Tesla Reflects Hepatic Iron Overload and Pathogenesis in Nonalcoholic Fatty Liver Disease Patients.
机构信息
Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Department of Gastroenterology, International University of Health and Welfare Atami Hospital, Atami, Japan.
出版信息
J Magn Reson Imaging. 2022 Jan;55(1):111-125. doi: 10.1002/jmri.27810. Epub 2021 Jun 28.
BACKGROUND
The role of hepatic iron overload (HIO) in nonalcoholic fatty liver disease (NAFLD) pathogenesis has not been fully elucidated.
PURPOSE
This study aimed to investigate the effect of HIO and examine the diagnostic usefulness of magnetic resonance imaging (MRI)-based R2 quantification in evaluating hepatic iron content (HIC) and pathological findings in NAFLD.
STUDY TYPE
Prospective and retrospective.
POPULATION
A prospective study of 168 patients (age, 57.2 ± 15.0; male/female, 80/88) and a retrospective validation study of 202 patients (age, 57.0 ± 14.4; male/female, 113/89) with liver-biopsy-confirmed NAFLD were performed.
FIELD STRENGTH/SEQUENCE: 3 T; chemical-shift encoded multi-echo gradient echo.
ASSESSMENT
Using liver tissues obtained by liver biopsy, HIC was prospectively evaluated in 168 patients by atomic absorption spectrometry. Diagnostic accuracies of HIC and R2 for grading hepatic inflammation plus ballooning (HIB) as an indicator of NAFLD activity were assessed.
STATISTICAL TESTS
Student's t-test and analysis of variance (ANOVA) with Scheffe's multiple testing correction for univariate comparisons; multivariate logistic analysis. P-value less than 0.05 is statistically significant.
RESULTS
HIC was significantly correlated with HIB grades (r = 0.407). R2 was significantly correlated with HIC (r = 0.557) and HIB grades (r = 0.569). R2 mapped an area under the receiver operating characteristic (AUROC; 0.774) for HIC ≥808 ng/mL (median value) with cutoff value of 62.5 s . In addition, R2 mapped AUROC of HIB for grades ≥3 was 0.799 with cutoff value of 58.5 s . When R2 was <62.5 s , R2 correlated weakly with HIC (r = 0.372) as it was affected by fat deposition and did not correlate with HIB grades (P = 0.052). Conversely, when R2 was ≥62.5 s , a significant correlation of R2 with HIC (r = 0.556) and with HIB grades was observed (P < 0.0001) with being less affected by fat deposition.
DATA CONCLUSION
R2 ≥ 62.5 s is a promising modality for non-invasive diagnosis of clinically important high grades (≥3) of HIB associated with increased HIC.
LEVEL OF EVIDENCE
1 TECHNICAL EFFICACY STAGE: 2.
背景
肝铁过载（HIO）在非酒精性脂肪性肝病（NAFLD）发病机制中的作用尚未完全阐明。
目的
本研究旨在探讨 HIO 的作用，并研究基于磁共振成像（MRI）的 R2 定量在评估 NAFLD 患者肝铁含量（HIC）和病理发现中的诊断价值。
研究类型
前瞻性和回顾性。
人群
对 168 例经肝活检证实的 NAFLD 患者（年龄 57.2±15.0 岁；男/女 80/88 例）进行前瞻性研究，并对 202 例（年龄 57.0±14.4 岁；男/女 113/89 例）患者进行回顾性验证研究。
磁场强度/序列：3T；化学位移编码多回波梯度回波。
评估
使用肝活检获得的肝组织，前瞻性地评估了 168 例患者的 HIC，通过原子吸收光谱法进行检测。评估了 HIC 和 R2 对肝炎症伴气球样变（HIB）分级（作为 NAFLD 活动的指标）的诊断准确性。
统计检验
学生 t 检验和方差分析（ANOVA），采用 Scheffe 多重比较校正进行单变量比较；多变量逻辑分析。P 值小于 0.05 具有统计学意义。
结果
HIC 与 HIB 分级显著相关（r=0.407）。R2 与 HIC（r=0.557）和 HIB 分级（r=0.569）显著相关。R2 映射出 HIC≥808ng/mL（中位数）的受试者工作特征曲线（AUROC；0.774）的 R2 值，其截断值为 62.5s。此外，R2 映射出 HIB 分级≥3 的 AUROC 为 0.799，截断值为 58.5s。当 R2<62.5s 时，由于 R2 受到脂肪沉积的影响，与 HIC 的相关性较弱（r=0.372），且与 HIB 分级不相关（P=0.052）。相反，当 R2≥62.5s 时，R2 与 HIC（r=0.556）和 HIB 分级显著相关（P<0.0001），受脂肪沉积的影响较小。
数据结论
R2≥62.5s 是一种有前途的非侵入性诊断方法，可用于诊断与 HIC 增加相关的临床重要的 HIB 高分级（≥3）。
证据水平
1 技术功效分期：2。
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