Assessment of hepatic fibrosis with magnetic resonance elastography
Assessment of hepatic fibrosis with magnetic resonance elastography
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DOI：
10.1016/j.cgh.2007.06.012
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发表时间：
2007-10-01
影响因子：
12.6
通讯作者：
Ehman, Richard L.
中科院分区：
文献类型：
--
作者：
Yin, Meng;Talwalkar, Jayant A.;Ehman, Richard L.
背景和目标：准确检测肝纤维化对于评估慢性肝病患者的预后和治疗候选人至关重要。磁共振（MR）弹性成像是一种定量评估软组织力学特性的技术，以前已被证明具有无创检测肝纤维化的潜力。这项工作的目的是获得该技术在诊断肝纤维化方面的敏感性和特异性的初步估计，并评估其识别可能避免活检程序的患者的潜力。方法：对35例正常志愿者和50例慢性肝病患者进行MR弹性成像。获得肝脏脂肪与水比率的MR成像测量值，以评估脂肪浸润影响基于硬度的纤维化检测的可能性。结果：肝硬度随肝纤维化分期系统性增加。受试者工作曲线分析显示，剪切刚度临界值为2.93 kPa，预测检测所有级别肝纤维化的灵敏度和特异性分别为98%和99%。受试者工作曲线分析也提供了证据，证明MR弹性成像可以区分中度和重度纤维化（2- 4级）患者和轻度纤维化患者（敏感性，86%;特异性，85%）。肝硬度似乎不受脂肪变性程度的影响。结论：磁共振弹性成像是一种安全、无创的技术，对肝纤维化的诊断准确性很高。基于MR弹性成像的高阴性预测值，最初的临床应用可能是对正在考虑进行活检检查的患者进行分类，以评估可能的肝纤维化。
Background & Aims: Accurate detection of hepatic fibrosis is crucial for assessing prognosis and candidacy for treatment in patients with chronic liver disease. Magnetic resonance (MR) elastography, a technique for quantitatively assessing the mechanical properties of soft tissues, has been shown previously to have potential for noninvasively detecting liver fibrosis. The goal of this work was to obtain preliminary estimates of the sensitivity and specificity of the technique in diagnosing liver fibrosis, and to assess its potential for identifying patients who potentially can avoid a biopsy procedure. Methods: MR elastography was performed in 35 normal volunteers and 50 patients with chronic liver disease. MR imaging measurements of hepatic fat to water ratios were obtained to assess the potential for fat infiltration to affect stiffness-based detection of fibrosis. Results: Liver stiffness increased systematically with fibrosis stage. Receiver operating curve analysis showed that, with a shear stiffness cut-off value of 2.93 kilopascals, the predicted sensitivity and specificity for detecting all grades of liver fibrosis is 98% and 99%, respectively. Receiver operating curve analysis also provided evidence that MR elastography can discriminate between patients with moderate and severe fibrosis (grades 2- 4) and those with mild fibrosis (sensitivity, 86%; specificity, 85%). Hepatic stiffness does not appear to be influenced by the degree of steatosis. Conclusions: MR elastography is a safe, noninvasive technique with excellent diagnostic accuracy for assessing hepatic fibrosis. Based on the high negative predictive value of MR elastography, an initial clinical application may be to triage patients who are under consideration for biopsy examination to assess possible hepatic fibrosis.