Roy Akash, Verma Nipun, Jajodia Surabhi, Goenka Usha, Tiwari Awanish, Sonthalia Nikhil, Goenka Mahesh
Department of Gastroenterology, Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, West Bengal, India.
Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Abdom Radiol (NY). 2024 Sep;49(9):3088-3095. doi: 10.1007/s00261-024-04309-5. Epub 2024 Apr 23.
Liver stiffness measurement (LSM) by transient elastography has been shown to underperform in high-risk varices (HRVs) prediction in obese non-alcoholic fatty liver disease (NAFLD) compensated cirrhosis (CC). LSM by magnetic resonance elastography (MRE) and acoustic force radiation impulse (ARFI) has been shown to be useful in prediction of oesophageal varices (EVs), but has limited evidence in obese NAFLD-CC.
Obese patients with NAFLD-CC who underwent MRE and ARFI for LSM and endoscopy for screening of varices were enrolled. Performance of MRE and ARFI for predicting EVs or HRVs was evaluated using area under receiver operating characteristics (AUROC) curves and regression analyses were performed for predictor variables.
One hundred eight patients [mean age 54.7 ± 9.6 years, median BMI, 28.5 (26.4-30.0) kg/m. 72.2% diabetics, 45.4% hypertensive] were enrolled. Fifty-two (48.1%) had no varices, while 29 (26.8%) and 27 (25%) had low-risk varices (LRVs) and HRVs, respectively. MRE-LSM was higher in patients with LRVs (p = 0.01) or HRVs (p = 0.001) against those without varices. ARFI-LSM did not differ significantly between those without and with LRVs or HRVs (p > 0.05 for all). There was a low correlation between ARFI-LSM and MRE-LSM in the overall cohort (r = 0.19). Only platelet count (PC) [0.98 (0.97-0.99)] and MRE-LSM [1.8 (1.26-2.79)] were predictors of HRVs. At a cut-off of 4.75, MRE showed a sensitivity of 96.3%. Model combining MRE-LSM with PC had a diagnostic AUROC of 0.77 and 0.76 for EVs and HRVs.
In obese NAFLD-CC, MRE-LSM is significantly higher in patients with varices. MRE combined with PC predicts EVs and HRVs with better accuracy than ARFI.
经瞬时弹性成像测量肝脏硬度（LSM）在预测肥胖型非酒精性脂肪性肝病（NAFLD）代偿期肝硬化（CC）患者的高危静脉曲张（HRV）方面表现不佳。经磁共振弹性成像（MRE）和声辐射力脉冲（ARFI）测量LSM已被证明对预测食管静脉曲张（EV）有用，但在肥胖型NAFLD-CC患者中的证据有限。
纳入接受MRE和ARFI测量LSM以及内镜检查以筛查静脉曲张的肥胖型NAFLD-CC患者。使用受试者操作特征曲线下面积（AUROC）评估MRE和ARFI预测EV或HRV的性能，并对预测变量进行回归分析。
共纳入108例患者[平均年龄54.7±9.6岁，体重指数中位数为28.5（26.4-30.0）kg/m²。72.2%为糖尿病患者，45.4%为高血压患者]。52例（48.1%）无静脉曲张，29例（26.8%）和27例（25%）分别有低危静脉曲张（LRV）和HRV。与无静脉曲张的患者相比，有LRV（p = 0.01）或HRV（p = 0.001）的患者MRE-LSM更高。无LRV或HRV与有LRV或HRV的患者之间ARFI-LSM差异无统计学意义（所有p>0.05）。在整个队列中，ARFI-LSM与MRE-LSM之间的相关性较低（r = 0.19）。只有血小板计数（PC）[0.98（0.97-0.99）]和MRE-LSM[1.8（1.26-2.79）]是HRV的预测因素。在截断值为4.75时，MRE的敏感性为96.3%。将MRE-LSM与PC相结合的模型对EV和HRV的诊断AUROC分别为0.77和0.76。
在肥胖型NAFLD-CC患者中，有静脉曲张的患者MRE-LSM显著更高。与ARFI相比，MRE联合PC预测EV和HRV的准确性更高。
