Liver Research Center, Beijing Friendship Hospital, Key Laboratory on Translational Medicine on Cirrhosis, National Clinical Research Center for Digestive Disease, Capital Medical University, Beijing, China.
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Eur Radiol. 2023 Jan;33(1):666-677. doi: 10.1007/s00330-022-09041-6. Epub 2022 Aug 18.
To identify magnetic resonance imaging (MRI) features associated with injury type, severity, and liver transplantation (LT)/liver-related death (LRD) in drug-induced liver injury (DILI).
The eligible DILI patients (2016 to 2020) who underwent contrast abdominal MRI within 3 months of onset were retrospectively analysed at Beijing Friendship Hospital, Capital Medical University. The MRI features independently associated with severity and prognosis were identified by backwards logistic regression. Unadjusted odds ratios (ORs) and 95% confidence intervals (CIs) are given.
The median age of 180 patients was 55.5 years, with 126 (70.0%) women. The injury types included hepatocellular (135 cases, 75.0%), mixed (23, 12.8%), and cholestatic (22, 12.2%). The proportion of periportal oedema in patients with hepatocellular and mixed injury was significantly higher than that in cholestatic injury (62.2%, 47.8% vs. 18.2%, p < 0.001). For severity, 157 (87.2%) patients had mild to moderate injury, and 23 (12.8%) had severe to fatal/LT. Irregularity of the liver surface (6.56 (95% CI, 1.27-22.84)), transient hepatic attenuation difference (THAD) (3.27 (95% CI, 1.14-9.36)), and splenomegaly (5.86 (95% CI, 1.96-17.53)) were independently associated with severity. Eight (4.4%) patients died/underwent LT. THAD (8.89 (95% CI, 1.35-58.43)), and ascites (64.63 (95% CI, 6.93-602.40)) were independently associated with LT/LRD. The prediction of the new model employing THAD and ascites for LT/LRD within 1 year was 0.959 (95% CI, 0.917-1.000).
Periportal oedema was associated with the type of injury. Irregularity of the liver surface, THAD, and splenomegaly were associated with severity. THAD and ascites may have potential clinical utility in predicting LT/LRD outcomes within 1 year.
• Contrast abdominal magnetic resonance imaging features can help clinicians evaluate the type of injury, severity, and poor prognosis of drug-induced liver injury. • Transient hepatic attenuation difference and ascites have potential clinical utility in the prediction of the poor prognosis of liver transplantation/liver-related death. • The new model predicting poor prognosis has a relatively high sensitivity of 0.875 and a high specificity of 0.919.
确定与药物性肝损伤（DILI）的损伤类型、严重程度和肝移植（LT）/肝相关死亡（LRD）相关的磁共振成像（MRI）特征。
回顾性分析首都医科大学附属北京友谊医院 2016 年至 2020 年期间发病后 3 个月内行对比腹部 MRI 检查的符合条件的 DILI 患者。采用向后逻辑回归确定与严重程度和预后相关的独立 MRI 特征。给出未经调整的优势比（OR）和 95%置信区间（CI）。
180 例患者的中位年龄为 55.5 岁，其中 126 例（70.0%）为女性。损伤类型包括肝细胞型（135 例，75.0%）、混合性（23 例，12.8%）和胆汁淤积性（22 例，12.2%）。肝细胞型和混合性损伤患者门静脉周围水肿的比例明显高于胆汁淤积性损伤（62.2%、47.8% vs. 18.2%，p<0.001）。在严重程度方面，157 例（87.2%）患者为轻至中度损伤，23 例（12.8%）为重度/致命/LT。肝脏表面不规则（6.56（95%CI，1.27-22.84））、一过性肝衰减差异（THAD）（3.27（95%CI，1.14-9.36））和脾肿大（5.86（95%CI，1.96-17.53））与严重程度独立相关。8 例（4.4%）患者死亡/接受 LT。THAD（8.89（95%CI，1.35-58.43））和腹水（64.63（95%CI，6.93-602.40））与 LT/LRD 独立相关。采用 THAD 和腹水对 1 年内 LT/LRD 进行新模型预测的准确率为 0.959（95%CI，0.917-1.000）。
门静脉周围水肿与损伤类型有关。肝脏表面不规则、THAD 和脾肿大与严重程度相关。THAD 和腹水可能具有预测 1 年内 LT/LRD 结局的潜在临床应用价值。
