原发性硬化性胆管炎：3T磁共振成像的定性和定量分析对疾病严重程度评估是否有用？
Primary sclerosing cholangitis: Is qualitative and quantitative 3 T MR imaging useful for the evaluation of disease severity?
作者信息
Boraschi Piero, Mazzantini Valentina, Donati Francescamaria, Coco Barbara, Vianello Barbara, Pinna Andrea, Morganti Riccardo, Colombatto Piero, Brunetto Maurizia Rossana, Neri Emanuele
机构信息
2nd Unit of Radiology, Department of Radiological Nuclear and Laboratory Medicine - Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy.
Academic Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, Pisa 56126, Italy.
出版信息
Eur J Radiol Open. 2024 Aug 12;13:100595. doi: 10.1016/j.ejro.2024.100595. eCollection 2024 Dec.
PURPOSE
To analyze the role of qualitative and quantitative 3 T MR imaging assessment as a non-invasive method for the evaluation of disease severity in patients with primary sclerosing cholangitis (PSC).
METHODS
A series of 26 patients, with histological diagnosis of PSC undergoing 3 T MRI and hepatological evaluation, was retrospectively enrolled. All MR examinations included diffusion-weighted imaging (DWI), T2-weighted (T2w) and T1-weighted (T1w) sequences, before and after administration of Gd-EOB-DTPA with the acquisition of both dynamic and hepato-biliary phase (HBP). Qualitative analysis was performed by assessment of liver parenchyma and biliary tract changes, also including biliary excretion of gadoxetic acid on HBP. Quantitative evaluation was conducted on liver parenchyma by measurement of apparent diffusion coefficient (ADC) and relative enhancement (RE) on 3-minute delayed phase and on HBP. Results of blood tests (ALT, ALP, GGT, total and direct bilirubin, albumin, and platelets) and transient elastography-derived liver stiffness measurements (TE-LSM) were collected and correlated with qualitative and quantitative MRI findings.
RESULTS
Among qualitative and quantitative findings, fibrosis visual assessment and RE had the best performance in estimating disease severity, showing a statistically significant correlation with both biomarkers of cholestasis and TE-LSM. Statistical analysis also revealed a significant correlation of gadoxetic acid biliary excretion with ALT and direct bilirubin, as well as of ADC with total bilirubin.
CONCLUSION
Qualitative and quantitative 3 T MR evaluation is a promising non-invasive method for the assessment of disease severity in patients with PSC.
目的
分析定性和定量3T磁共振成像评估作为一种非侵入性方法在评估原发性硬化性胆管炎（PSC）患者疾病严重程度中的作用。
方法
回顾性纳入26例经组织学诊断为PSC且接受3T磁共振成像（MRI）检查和肝病学评估的患者。所有MR检查均包括扩散加权成像（DWI）、T2加权（T2w）和T1加权（T1w）序列，在注射钆塞酸二钠（Gd-EOB-DTPA）前后进行，采集动态期和肝胆期（HBP）图像。通过评估肝实质和胆道变化进行定性分析，包括HBP上钆塞酸的胆汁排泄情况。通过测量3分钟延迟期和HBP上的表观扩散系数（ADC）和相对强化（RE）对肝实质进行定量评估。收集血液检查结果（谷丙转氨酶、碱性磷酸酶、γ-谷氨酰转肽酶、总胆红素和直接胆红素、白蛋白和血小板）以及瞬时弹性成像得出的肝脏硬度测量值（TE-LSM），并将其与定性和定量MRI结果进行关联。
结果
在定性和定量结果中，纤维化视觉评估和RE在估计疾病严重程度方面表现最佳，与胆汁淤积生物标志物和TE-LSM均显示出统计学上的显著相关性。统计分析还显示钆塞酸胆汁排泄与谷丙转氨酶和直接胆红素、ADC与总胆红素之间存在显著相关性。
结论
定性和定量3T MR评估是评估PSC患者疾病严重程度的一种有前景的非侵入性方法。
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