Direct Comparison of US and MR Elastography for Staging Liver Fibrosis in Patients With Nonalcoholic Fatty Liver Disease
Direct Comparison of US and MR Elastography for Staging Liver Fibrosis in Patients With Nonalcoholic Fatty Liver Disease
复制标题
超声与磁共振弹性成像对非酒精性脂肪性肝病肝纤维化分期的直接比较
DOI：
10.1016/j.cgh.2020.12.016
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发表时间：
2022-03-11
影响因子：
12.6
通讯作者：
Nakajima, Atsushi
中科院分区：
文献类型：
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作者：
Imajo, Kento;Honda, Yasushi;Nakajima, Atsushi
背景和目标：作为昂贵的肝活检评估非酒精性脂肪肝（NAFLD）患者肝纤维化分期的替代方法，我们直接比较了磁共振弹性成像（MRE）、振动控制瞬态弹性成像（VCTE）和二维剪切波弹性成像（2D-SWE）的诊断能力。在70名参与者的亚组中使用组内相关系数分析观察者内和观察者间的再现性，其中肝脏硬度测量（LSM）由弹性成像专家和超声专家在同一天进行，超声专家是弹性成像培训生。分别使用MRE、VCTE、2D-SWE和所有三种模式组合获得了227、220、204和201例患者的有效LSM。尽管检测阶段>= 1、>= 2和>= 3肝纤维化的模式之间的曲线下面积没有差异，但对于阶段4，MRE的曲线下面积高于VCTE和2D-SWE。性别是VCTE与肝纤维化分期不一致的重要预测因素。皮肤-被膜距离和肝硬度四分位距与中位数的比值与2D-SWE和肝纤维化分期之间的不一致性显著相关。然而，没有任何因素与MRE和肝纤维化分期之间的不一致性相关。MRE检测肝纤维化的观察者内和观察者间重现性高于VCTE和2D-SWE.CONCLUSIONS：MRE，VCTE和2D-SWE在检测NAFLD患者肝纤维化方面表现出出色的诊断准确性。MRE证明了第4阶段检测的最高诊断准确性以及观察者内和观察者间的再现性。
BACKGROUND & AIMS: As alternatives to the expensive liver biopsy for assessing liver fibrosis stage in patients with nonalcoholic fatty liver disease (NAFLD), we directly compared the diagnostic abilities of magnetic resonance elastography (MRE), vibration-controlled transient elastography (VCTE), and two-dimensional shear wave elastography (2D-SWE).METHODS: Overall, 231 patients with biopsy-proven NAFLD were included. Intra- and inter-observer reproducibility was analyzed using intraclass correlation coefficient in a sub-group of 70 participants, in whom liver stiffness measurement (LSM) was performed by an elastography expert and an ultrasound expert who was an elastography trainee on the same day.RESULTS: Valid LSMs were obtained for 227, 220, 204, and 201 patients using MRE, VCTE, 2D-SWE, and all three modalities combined, respectively. Although the area under the curve did not differ between the modalities for detecting stage >= 1, >= 2, and >= 3 liver fibrosis, it was higher for MRE than VCTE and 2D-SWE for stage 4. Sex was a significant predictor of discordance between VCTE and liver fibrosis stage. Skin-capsule distance and the ratio of the interquartile range of liver stiffness to the median were significantly associated with discordance between 2D-SWE and liver fibrosis stage. However, no factors were associated with discordance between MRE and liver fibrosis stage. Intra- and inter-observer reproducibility in detecting liver fibrosis was higher for MRE than VCTE and 2D-SWE.CONCLUSIONS: MRE, VCTE, and 2D-SWE demonstrated excellent diagnostic accuracy in detecting liver fibrosis in patients with NAFLD. MRE demonstrated the highest diagnostic accuracy for stage 4 detection and intra- and inter-observer reproducibility.