Diagnostic performance of tomoelastography of the liver and spleen for staging hepatic fibrosis
Diagnostic performance of tomoelastography of the liver and spleen for staging hepatic fibrosis
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DOI：
10.1007/s00330-019-06471-7
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发表时间：
2019-11-11
影响因子：
5.9
通讯作者：
Asbach, Patrick
中科院分区：
文献类型：
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作者：
Reiter, Rolf;Tzschaetzsch, Heiko;Asbach, Patrick
目的探讨肝脏和脾脏多频磁共振弹性成像断层弹性成像对肝纤维化分期的诊断性能、临界值和最佳驱动频率范围。该前瞻性研究于2014年6月至2017年4月期间连续招募了61名受试者：45名慢性肝病和已证实纤维化阶段的患者和16名健康志愿者。层析弹性成像在1.5 T下进行，使用6个驱动频率从35到60 Hz。计算截止值和AUC。肝脏和脾脏的横波速度（m/s）分别评估，并联合评估作为刚度的替代。结果肝脏复合多频处理各纤维化分期的截止值和AUC分别为：F1、1.52 m/s和0.89；F2分别为1.55 m/s和0.94；F3分别为1.67 m/s和0.98；F4为1.72 m/s和0.98 m/s。最佳单驱动频率（45 Hz, 55 Hz, 60 Hz）的诊断性能相似（平均AUC分别= 0.95）。肝脾联合分析可略微改善F4患者在60 Hz时的表现（平均AUC = 0.97 vs. 0.95, p = 0.03）。全视场弹性图不仅显示肝脏和脾脏，还显示包括胰腺和主要血管在内的小解剖结构。结论层析弹性成像提供了全视场弹性图，具有前所未有的细节分辨率和出色的肝纤维化分期诊断准确性。我们对单频断层弹性成像的分析表明，在未来的研究中，扫描时间可以进一步缩短，使断层弹性成像更容易在临床常规中实施。
Objectives To determine the diagnostic performance, cut-off values, and optimal drive frequency range for staging hepatic fibrosis using tomoelastography by multifrequency MR elastography of the liver and spleen. Methods This prospective study consecutively enrolled a total of 61 subjects between June 2014 and April 2017: 45 patients with chronic liver disease and proven stage of fibrosis and 16 healthy volunteers. Tomoelastography was performed at 1.5 T using six drive frequencies from 35 to 60 Hz. Cut-off values and AUC were calculated. Shear wave speed (in m/s) of the liver and spleen was assessed separately and in combination as a surrogate of stiffness. Results For compound multifrequency processing of the liver, cut-off and AUC values by fibrosis stage were as follows: F1, 1.52 m/s and 0.89; F2, 1.55 m/s and 0.94; F3, 1.67 m/s and 0.98; and F4, 1.72 m/s and 0.98. Diagnostic performance of the best single drive frequencies (45 Hz, 55 Hz, 60 Hz) was similar (mean AUC = 0.95, respectively). Combined analysis of the liver and spleen slightly improved performance at 60 Hz in F4 patients (mean AUC = 0.97 vs. 0.95, p = 0.03). Full-field-of-view elastograms displayed not only the liver and spleen but also small anatomical structures including the pancreas and major vessels. Conclusion Tomoelastography provides full-field-of-view elastograms with unprecedented detail resolution and excellent diagnostic accuracy for staging hepatic fibrosis. Our analysis of single-frequency tomoelastography suggests that scan time can be further reduced in future studies, making tomoelastography easier to implement in clinical routine.