Han Xinjun, Yang Dawei, Xu Hui, Wang Yu, Yin Hongxia, Yang Zhenghan
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Quant Imaging Med Surg. 2024 Feb 1;14(2):1429-1440. doi: 10.21037/qims-22-1415. Epub 2024 Jan 2.
The value of magnetic resonance elastography (MRE) in portal hypertension (PH) has yet to be determined in the context of chronic liver disease (CLD). This study examined the value of MRE for the prediction of hepatic venous pressure gradient (HVPG) and high-risk esophageal varices (EVs) in a CLD cohort with a generally high HVPG.
Patients with CLD who underwent both HVPG measurement and two-dimensional MRE examination at Beijing Friendship Hospital between April 2018 and March 2022 were prospectively included. Two-dimensional MRE was performed within the liver and spleen. Endoscopy results and laboratory parameters were collected. Some selected published serum markers were calculated, including fibrosis 4, aspartate aminotransferase-to-platelet ratio index, and King's score. The efficacy of the parameters for assessing PH was analyzed by using the Pearson correlation coefficient, linear and logistic regression, and receiver operating characteristic curve analyses.
A total of 48 patients were included. The mean HVPG was 16.8±5.8 mmHg. Among these patients, 47 patients had PH (HVPG >5 mmHg), and 43 patients had clinically significant PH (HVPG ≥10 mmHg). Among the parameters associated with HVPG, the strongest correlation was found for spleen stiffness (SS) (R=0.638; P<0.001). In multiple regression analyses, SS was independently associated with an elevated HVPG and high-risk EVs. The areas under the receiver operating characteristic curve of SS for identifying patients with an HVPG ≥16 mmHg, HVPG ≥20 mmHg, and high-risk EVs were 0.790, 0.822, and 0.886, respectively, which were higher than those of liver stiffness (LS) and serum markers but slightly inferior to that of fibrosis 4 (area under the receiver operating characteristic curve =0.844) in identifying an HVPG ≥16 mmHg. SS cutoff values of 9.5, 10.05, and 9.9 kPa were selected to rule out the presence of an HVPG ≥16 mmHg, HVPG ≥20 mmHg, and high-risk EVs (sensitivity: 100%, 100%, and 100%, respectively; specificity: 45.5%, 50%, and 60%, respectively).
In patients with generally high HVPG, SS measured by two-dimensional MRE may be a better predictor of HVPG values and high-risk EVs than LS and serum markers.
在慢性肝病（CLD）背景下，磁共振弹性成像（MRE）在门静脉高压（PH）中的价值尚未确定。本研究探讨了MRE在预测肝静脉压力梯度（HVPG）和高危食管静脉曲张（EVs）方面的价值，该研究队列中的CLD患者HVPG普遍较高。
前瞻性纳入2018年4月至2022年3月在北京友谊医院同时接受HVPG测量和二维MRE检查的CLD患者。在肝脏和脾脏内进行二维MRE检查。收集内镜检查结果和实验室参数。计算一些选定的已发表血清标志物，包括纤维化4、天冬氨酸转氨酶与血小板比值指数和国王评分。采用Pearson相关系数、线性和逻辑回归以及受试者工作特征曲线分析来分析评估PH的参数的有效性。
共纳入48例患者。平均HVPG为16.8±5.8 mmHg。在这些患者中，47例有PH（HVPG>5 mmHg），43例有临床显著PH（HVPG≥10 mmHg）。在与HVPG相关的参数中，脾脏硬度（SS）的相关性最强（R=0.638；P<0.001）。在多元回归分析中，SS与升高的HVPG和高危EVs独立相关。SS用于识别HVPG≥16 mmHg、HVPG≥20 mmHg和高危EVs患者的受试者工作特征曲线下面积分别为0.790、0.822和0.886，在识别HVPG≥16 mmHg方面高于肝脏硬度（LS）和血清标志物，但略低于纤维化4（受试者工作特征曲线下面积=0.844）。选择9.5、10.05和9.9 kPa的SS截断值来排除HVPG≥16 mmHg、HVPG≥20 mmHg和高危EVs的存在（敏感性分别为100%、100%和100%；特异性分别为45.5%、50%和60%）。
在HVPG普遍较高的患者中，二维MRE测量的SS可能比LS和血清标志物更能预测HVPG值和高危EVs。
