Chronic Liver Disease: Systemic and Splanchnic Venous Flow Mapping with Optimized Cine Phase-Contrast MR Imaging Validated in a Phantom Model and Prospectively Evaluated in Patients
Chronic Liver Disease: Systemic and Splanchnic Venous Flow Mapping with Optimized Cine Phase-Contrast MR Imaging Validated in a Phantom Model and Prospectively Evaluated in Patients
复制标题
DOI：
10.1148/radiol.11101541
复制
发表时间：
2011-10-01
期刊：
影响因子：
19.7
通讯作者：
Legmann, Paul
中科院分区：
文献类型：
--
作者：
Gouya, Herve;Vignaux, Olivier;Legmann, Paul
目的：验证磁共振（MR）成像电影相位对比血流图在体外和慢性肝病患者（伴或不伴门脉高压）中的应用，评估MR成像测量奇静脉、内脏和全身血流检测高危食管静脉曲张的准确性，并将这些测量结果与内镜评价（参考标准）进行比较。材料和方法：当地伦理委员会批准了这项研究。患者提供了书面知情同意书。使用两个模型来验证MR成像相位对比流序列。包括肝硬化患者（n = 59）、慢性肝病无肝硬化患者（n = 12）和结节性再生性增生（NRH）患者（n = 11）以及无肝病的健康对照受试者（n = 25）。所有患者均行上消化道内镜检查。在MR图像上测量平均腹主动脉、门静脉和奇静脉血流量，由两名盲法观察者进行审查，以确定食管静脉曲张的存在和分级。用组内相关系数（ICC）评估血流测量的重现性和观察者内和观察者间变异性。通过受试者工作特征曲线分析确定MR血流测量在高危静脉曲张分期中的性能。结果：MR流速测量值与体外实际流速值具有良好的相关性（模型1和2的ICC > 0.990）。肝硬化患者的平均主动脉血流量明显高于对照组（P < .001）。肝硬化患者的平均奇静脉血流量显著高于无肝硬化的慢性肝病患者（P = 0.005）和对照组（P <0.001）。低的观察者内和观察者间变异性（每种血流类型的ICC > 0.990）和高的再现性（每种血流类型的ICC > 0.850）被证明。最佳截止平均奇静脉血流值为2.3 mL/sec的静脉曲张等级为2或更高。结论：磁共振成像奇静脉血流测量似乎是一种很有前途的技术，用于检测高危食管静脉曲张患者门脉高压症。
Purpose: To validate magnetic resonance (MR) imaging cine phase-contrast blood flow mapping in vitro and in patients with chronic liver disease, with or without portal hypertension, and to assess the accuracy of azygos, splanchnic, and systemic blood flow measured with MR imaging in the detection of high-risk esophageal varices and compare these measurements with endoscopic evaluation, the reference standard.Materials and Methods: The local ethics committee approved this study. Patients gave written informed consent. Two phantoms were used to validate the MR imaging phase-contrast flow sequence. Patients with liver cirrhosis (n = 59), chronic liver disease without cirrhosis (n = 12), and nodular regenerative hyperplasia (NRH) (n = 11), and healthy control subjects with no liver disease (n = 25) were included. The patients underwent upper digestive system endoscopy. Mean abdominal aorta, portal venous, and azygos blood flow was measured on MR images, which were reviewed by two blinded observers to determine the presence and grade of esophageal varices. The reproducibility and intra-and interobserver variability of the blood flow measurements were assessed with intra-class correlation coefficients (ICCs). The performance of the MR blood flow measurements in staging high-risk varices was determined with receiver operating characteristic curve analysis. The correlation between MR visual analysis and endoscopic grading was assessed by using kappa statistics.Results: MR flow rate measurements had excellent correlations with actual flow values in vitro (ICC > 0.990 for phantoms 1 and 2). Mean aortic flow was significantly higher in patients with cirrhosis than in control subjects (P < .001). Mean azygos flow was significantly higher in patients with cirrhosis than in patients with chronic liver disease without cirrhosis (P = .005) and control subjects (P < .001). Low intra-and interobserver variability (ICC > 0.990 for each blood flow type) and high reproducibility (ICC > 0.850 for each blood flow type) were demonstrated. The optimal cutoff mean azygos flow value was 2.3 mL/sec for varices with grades of 2 or higher.Conclusion: MR imaging azygos flow measurement appears to be a promising technique for detecting high-risk esophageal varices in patients with portal hypertension.