MR Elastography for the Assessment of Hepatic Fibrosis in Patients with Chronic Hepatitis B Infection: Does Histologic Necroinflammation Influence the Measurement of Hepatic Stiffness?
MR Elastography for the Assessment of Hepatic Fibrosis in Patients with Chronic Hepatitis B Infection: Does Histologic Necroinflammation Influence the Measurement of Hepatic Stiffness?
复制标题
磁共振弹性成像评估慢性乙型肝炎感染患者的肝纤维化：组织学坏死性炎症是否影响肝硬度的测量？
DOI：
10.1148/radiol.14132592
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发表时间：
2014-10-01
期刊：
影响因子：
19.7
通讯作者：
Ehman, Richard L.
中科院分区：
文献类型：
--
作者：
Shi, Yu;Guo, Qiyong;Ehman, Richard L.
目的：以组织病理学结果为参考标准，确定磁共振弹性成像（MR）对慢性乙型肝炎病毒（HBV）感染患者肝纤维化分期的诊断价值，评价坏死炎症对肝僵硬度的影响。材料和方法：在2012年3月至2013年10月期间，在提供书面知情同意后，前瞻性地招募了113例连续的慢性HBV感染患者。刚度测量采用二维梯度回波MR弹性成像技术，采用3.0 t MR系统。METAVIR评分系统用于评估纤维化（“F”级）和坏死炎症（“A”级）。采用受试者工作特征曲线（ROC）和ROC曲线下面积（AUC）评价MR弹性成像的预测能力。进行多元线性回归分析，以确定肝僵硬度与单变量分析中显示显着关联的变量或与早期工作比较感兴趣的变量（组织学评分、性别、年龄、天冬氨酸转氨酶水平和天冬氨酸转氨酶/丙氨酸转氨酶比率）之间的关系。结果：MR弹性成像对>= F1、>= F2、>= F3、F4表现出优异的表征效果，AUC值分别为0.961、0.986、1.000、0.998。>= A1、>= A2和A3的坏死炎症活性评价能力中等（AUC分别为0.806、0.834和0.906）。多元线性回归分析显示，纤维化、坏死性炎症和性别与肝僵硬度独立相关（β值分别为0.799、0.277和0.070,P < 0.05）。两两比较，对数转化肝硬度在(a) F0/A2-3组和F1/A0-1组，(b) F1/A2-3组和F2/A0-1组之间无差异（P值分别为0.99和0.486）。结论：磁共振弹性成像在鉴别慢性HBV感染患者肝纤维化分期方面表现优异。对于肝组织
Purpose: To determine the diagnostic performance of magnetic resonance (MR) elastography for the staging of hepatic fibrosis and to evaluate the influence of necroinflammation on hepatic stiffness in patients with chronic hepatitis B virus (HBV) infection by using histopathologic findings as the reference standard.Materials and Methods: One hundred thirteen consecutive patients with chronic HBV infection were recruited prospectively in this institutional review board-approved study after providing written informed consent between March 2012 and October 2013. The stiffness measurements were obtained by using two-dimensional gradient-echo MR elastography with a 3.0-T MR system. The METAVIR scoring system was used for the assessment of fibrosis ("F" stage) and necroinflammation ("A" grade). The predictive ability of MR elastography was evaluated by using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC). Multiple linear regression analyses were conducted to determine the relationship between hepatic stiffness and the variables that showed a significant association in the univariate analysis or those that were of interest for comparison with earlier work (histologic scores, sex, age, aspartate aminotransferase level, and aspartate aminotransferase/alanine aminotransferase ratio).Results: MR elastography showed excellent performance for characterization of >= F1, >= F2, >= F3, and F4 findings, with AUC values of 0.961, 0.986, 1.000, and 0.998, respectively. It showed a moderate capability for evaluation of necroinflammatory activity of >= A1, >= A2, and A3 (AUC = 0.806, 0.834, and 0.906, respectively). Multiple linear regression analysis showed that fibrosis, necroinflammation, and sex were independently associated with hepatic stiffness (beta = 0.799, 0.277, and 0.070, respectively; P < .05). For pairwise comparisons, log-transformed hepatic stiffness showed no difference between (a) groups F0/A2-3 and F1/A0-1 and (b) groups F1/A2-3 and F2/A0-1 (P > .99 and P = .486, respectively).Conclusion: MR elastography demonstrated excellent performance for distinguishing the stages of hepatic fibrosis in patients with chronic HBV infection. For hepatic tissue with