Utility of magnetic resonance imaging versus histology for quantifying changes in liver fat in nonalcoholic fatty liver disease trials.
Utility of magnetic resonance imaging versus histology for quantifying changes in liver fat in nonalcoholic fatty liver disease trials.
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DOI：
10.1002/hep.26455
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发表时间：
2013-12
期刊：
影响因子：
--
通讯作者：
Loomba R
中科院分区：
文献类型：
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作者：
Noureddin M;Lam J;Peterson MR;Middleton M;Hamilton G;Le TA;Bettencourt R;Changchien C;Brenner DA;Sirlin C;Loomba R
磁共振成像估计的质子密度脂肪分数（MRI - PDFF）是一种基于成像的新型生物标志物，可对整个肝脏进行脂肪成像，而磁共振波谱测量的质子密度脂肪分数（MRS - PDFF）可对感兴趣的小区域内的肝脏脂肪进行生化测量。横断面研究表明，MRI - PDFF与MRS - PDFF相关。本研究的目的是通过在非酒精性脂肪性肝病（NAFLD）患者的两个时间点对MRI - PDFF和MRS - PDFF与肝脏组织学确定的脂肪变性等级进行三方比较，展示MRI - PDFF在评估肝脏脂肪定量变化方面的效用。50名经活检证实患有NAFLD且参与一项随机试验的患者在基线和24周时接受了肝脏活检、MRI - PDFF和MRS - PDFF的配对评估。平均年龄为47.8 ± 11.7岁，体重指数为30.7 ± 6.5 kg/m²。在第0周和第24周，MRI - PDFF与MRS - PDFF均显示出强相关性（两者的r = 0.98，P < 0.0001）。在横断面研究中，在第0周和第24周，随着组织学确定的脂肪变性等级升高，MRI - PDFF和MRS - PDFF均升高（所有情况P < 0.05）。在纵向研究中，MRI - PDFF降低（≥1%）或升高（≥1%）（经MRS - PDFF证实）的患者在第24周时体重以及血清丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平出现相应的降低或升高（P < 0.05）。这种肝脏脂肪的微小增减无法通过组织学进行量化。
在这项纵向研究中，MRI - PDFF与MRS - PDFF相关性良好，并且在量化肝脏脂肪含量的增减方面比组织学确定的脂肪变性等级更敏感。因此，它可用于在未来的临床试验中量化肝脏脂肪的变化。
The magnetic resonance imaging–estimated proton density fat fraction (MRI-PDFF) is a novel imaging-based biomarker that allows fat mapping of the entire liver, whereas the magnetic resonance spectroscopy–measured proton density fat fraction (MRS-PDFF) provides a biochemical measure of liver fat in small regions of interest. Cross-sectional studies have shown that MRI-PDFF correlates with MRS-PDFF. The aim of this study was to show the utility of MRI-PDFF in assessing quantitative changes in liver fat through a three-way comparison of MRI-PDFF and MRS-PDFF with the liver histology–determined steatosis grade at two time points in patients with nonalcoholic fatty liver disease (NAFLD). Fifty patients with biopsy-proven NAFLD who participated in a randomized trial underwent a paired evaluation with liver biopsy, MRI-PDFF, and MRS-PDFF at the baseline and 24 weeks. The mean age and body mass index were 47.8 ± 11.7 years and 30.7 ± 6.5 kg/m2, respectively. MRI-PDFF showed a robust correlation with MRS-PDFF both at week 0 and at week 24 (r = 0.98, P < 0.0001 for both). Cross-sectionally, MRI-PDFF and MRS-PDFF increased with increases in the histology-determined steatosis grade both at week 0 and at week 24 (P < 0.05 for all). Longitudinally, patients who had a decrease (≥1%) or increase (≥1%) in MRI-PDFF (confirmed by MRS-PDFF) showed a parallel decrease or increase in their body weight and serum alanine aminotransferase and aspartate aminotransferase levels at week 24 (P < 0.05). This small increase or decrease in liver fat could not be quantified with histology. In this longitudinal study, MRI-PDFF correlated well with MRS-PDFF and was more sensitive than the histology-determined steatosis grade in quantifying increases or decreases in the liver fat content. Therefore, it could be used to quantify changes in liver fat in future clinical trials.