Comparison of whole liver and small region-of-interest measurements of MRI liver R2* in children with iron overload.
Comparison of whole liver and small region-of-interest measurements of MRI liver R2* in children with iron overload.
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DOI：
10.1007/s00247-010-1596-8
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发表时间：
2010-08
影响因子：
2.3
通讯作者：
Hankins JS
中科院分区：
文献类型：
--
作者：
McCarville MB;Hillenbrand CM;Loeffler RB;Smeltzer MP;Song R;Li CS;Hankins JS
肝脏MRI T2*和R2*的测量正在成为肝脏活检的一种可靠的替代方法，用于定量测定肝脏的铁含量。尚未对感兴趣区域的大小和位置的影响进行系统调查。比较小肝感兴趣区(ROI)和全肝感兴趣区(ROI)MRI R2*值之间的差异，并对铁超载患者的肝脏铁含量进行活检。41例铁负荷过高的患者，年龄7-35岁，在30天内接受了肝脏铁含量定量和MRI检测肝脏R2*的活检。三位评价者独立使用小的和全肝ROI来测量R2*。评价者间的一致性用组内相关系数(ICC)进行评估。用Spearman的秩次相关和蒙特卡罗估计的精确P值来研究R2*与肝脏铁含量之间的关系。活组织检查的肝脏铁含量与小的和全肝的ROIR2*测量对于所有的评价者都有很强的相关性(所有P<；0.0001)。尽管两种ROI方法的评价者间一致性都很好(ICC=0.98-0.99)，但小ROI技术更常导致评价者间的差异大于75赫兹，R2*值略高，标准误差更大，取值范围更大。小肝和全肝ROI技术与肝组织铁含量密切相关。我们发现，使用小ROI技术的R2*值的评审者间变异性稍大。因为当R2*值接近铁螯合疗法的阈值时，这种变异性可能会对患者的管理产生不利影响，我们建议使用全肝ROI。
Measurement of liver MRI T2* and R2* is emerging as a reliable alternative to liver biopsy for the quantitation of liver iron content. A systematic investigation of the influence of the region of interest size and placement has not been conducted. To compare small and whole liver region of interest (ROI) MRI R2* values to each other and to biopsy liver iron content in patients with iron overload. Forty-one iron-overloaded patients, ages 7 to 35 years, underwent biopsy for liver iron content quantitation and MRI for liver R2* measurement, within 30 days. Three reviewers independently used small and whole liver ROIs to measure R2*. Inter-reviewer agreement was assessed with the intra-class correlation coefficient (ICC). Associations between R2* and liver iron content were investigated using Spearman's rank-order correlation and Monte Carlo estimated exact P-values. Biopsy liver iron content and small and whole liver ROI R2* measurements were strongly associated for all reviewers (all P < 0.0001). Although inter-reviewer agreement was excellent for both ROI methods (ICC = 0.98 – 0.99), the small ROI technique more frequently led to inter-reviewer differences larger than 75 Hz, slightly higher R2* values, larger standard errors and greater range in values. Small and whole liver ROI techniques are strongly associated with biopsy liver iron content. We found slightly greater inter-reviewer variability in R2* values using the small ROI technique. Because such variability could adversely impact patient management when R2* values are near a threshold of iron chelation therapy, we recommend using a whole liver ROI.
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