Torres Ulysses S, Gomes Natália B N, Caiado Angela H M, Fucuta Patricia S, Ferraz Maria Lucia C G, D'Ippolito Giuseppe
Grupo Fleury, São Paulo, Brazil.
Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Abdom Radiol (NY). 2025 Jul 21. doi: 10.1007/s00261-025-05129-x.
Autoimmune hepatitis (AIH) is an immune-mediated liver disease that may progress to cirrhosis if untreated. Liver biopsy is the gold standard for assessing fibrosis and inflammation, but it is invasive and prone to sampling errors. This prospective study evaluated whether MRI T1 mapping with gadoxetic acid (Gd-EOB-DTPA) can noninvasively predict fibrosis stage and inflammatory activity in AIH. We compared several post-contrast T1 mapping-derived formulas to determine accuracy in detecting significant (F2-F4) and advanced (F3-F4) fibrosis and higher inflammatory activity (PPA 2-4).
MATERIALS & METHODS: Over three years, 33 AIH patients underwent a multiparametric liver MRI protocol with post-Gd-EOB-DTPA T1 mapping. Biopsies were performed up to three months prior. We measured standard pre- and post-contrast T1, adjusted liver T1 formulas, and hepatic uptake rates (Khep). Independent t-tests, Mann-Whitney U-tests, and ROC curves compared these indices against Metavir (F0-F4) and Desmet inflammatory grading (PPA 0-4).
Post-contrast T1 at 20 min (AUC 0.822; 95% CI 0.674-0.970) and a mathematical formula (Adjusted T1 Liver B) (AUC 0.815; 95% CI 0.660-0.970) distinguished advanced (F3-F4) from non-advanced (F0-F2) fibrosis. However, none of the MRI-based parameters differentiated significant fibrosis (F2-F4) or higher inflammatory grades (PPA 2-4) from lower ones. Post-contrast T1 mapping did not outperform simpler pre-contrast T1 measurements (p > 0.05).
In AIH, post-Gd-EOB-DTPA T1 mapping within a standard liver MRI protocol can identify advanced fibrosis, correlating well with the histopathological gold standard. However, it does not outperform simpler pre-contrast T1 measurements or reliably distinguish significant fibrosis or severe inflammation.
自身免疫性肝炎（AIH）是一种免疫介导的肝脏疾病，若不治疗可能进展为肝硬化。肝活检是评估纤维化和炎症的金标准，但具有侵入性且容易出现抽样误差。这项前瞻性研究评估了使用钆塞酸二钠（Gd-EOB-DTPA）的MRI T1 mapping能否无创预测AIH的纤维化阶段和炎症活动。我们比较了几种对比剂增强后T1 mapping衍生公式，以确定检测显著（F2-F4）和晚期（F3-F4）纤维化以及更高炎症活动（PPA 2-4）的准确性。
在三年时间里，33例AIH患者接受了包含Gd-EOB-DTPA增强后T1 mapping的多参数肝脏MRI检查。活检在检查前三个月内进行。我们测量了标准的对比剂增强前后T1、调整后的肝脏T1公式以及肝脏摄取率（Khep）。采用独立t检验、曼-惠特尼U检验和ROC曲线，将这些指标与梅塔维（Metavir）纤维化分级（F0-F4）和德斯梅特炎症分级（PPA 0-4）进行比较。
20分钟时的对比剂增强后T1（AUC 0.822；95% CI 0.674-0.970）和一个数学公式（调整后的肝脏T1 B）（AUC 0.815；95% CI 0.660-0.970）能够区分晚期（F3-F4）和非晚期（F0-F2）纤维化。然而，基于MRI的参数均无法区分显著纤维化（F2-F4）或更高炎症分级（PPA 2-4）与较低分级。对比剂增强后T1 mapping并不优于更简单的对比剂增强前T1测量值（p＞0.05）。
在AIH中，标准肝脏MRI检查中的Gd-EOB-DTPA增强后T1 mapping能够识别晚期纤维化，与组织病理学金标准相关性良好。然而，它并不优于更简单的对比剂增强前T1测量值，也无法可靠地区分显著纤维化或严重炎症。
