Magnetic Resonance Elastography: A Novel Technique for the Detection of Hepatic Fibrosis and Hepatocellular Carcinoma After the Fontan Operation.
Magnetic Resonance Elastography: A Novel Technique for the Detection of Hepatic Fibrosis and Hepatocellular Carcinoma After the Fontan Operation.
复制标题
磁共振弹性图：一种新的技术，用于检测Fontan操作后肝纤维化和肝细胞癌。
DOI：
10.1016/j.mayocp.2015.04.020
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发表时间：
2015-07
影响因子：
8.9
通讯作者：
Cetta F
中科院分区：
文献类型：
--
作者：
Poterucha JT;Johnson JN;Qureshi MY;O'Leary PW;Kamath PS;Lennon RJ;Bonnichsen CR;Young PM;Venkatesh SK;Ehman RL;Gupta S;Smyrk TC;Dearani JA;Warnes CA;Cetta F
评价磁共振弹性成像（MRE）在筛查Fontan术后肝纤维化、肝硬化和肝细胞癌患者中的效用。 2010 年至 2014 年间，对既往接受过 Fontan 手术的患者进行了肝脏 MRE 结合心脏磁共振成像。使用先前报道的技术计算肝脏硬度。与现有的临床、实验室、影像和组织病理学数据进行了比较。总体而言，对 50 名年龄 25 (21-33) 岁的 Fontan 患者进行了评估。 Fontan 创建和 MRE 之间的中位间隔为 22 (16-26) 年。平均肝脏硬度值增加；相对于正常人为 5.5±1.4 千帕。肝硬度与肝活检总纤维化评分、术后时间直接相关；平均 Fontan 压力； γ-谷氨酰转移酶（GGT）； MELD 分数；肌酐;和肺血管阻力指数（PVR）。肝脏硬度与心脏指数（CI）呈负相关。所有 3 名患有肝结节的受试者在延迟对比后成像中表现出对比剂摄取减少和结节硬度升高的情况，经活检证实患有肝细胞癌。肝硬度与纤维化评分、MELD 评分和 GGT 之间的关联表明，MRE 可能有助于检测（并可能量化）Fontan 患者的肝硬化。硬度与 Fontan 后时间间隔、平均 Fontan 压力、PVR 和 CI 降低之间的相关性表明长期肝充血在造成这些肝脏异常中发挥了作用。 MRE 可用于检测最终诊断为肝细胞癌的异常结节。僵硬与晚期纤维化和肝细胞癌之间的关系为 MRE 在这些患者中的进一步研究和更广泛的应用提供了有力的论据。
To evaluate the utility of magnetic resonance elastography (MRE) in screening patients for hepatic fibrosis, cirrhosis, and hepatocellular carcinoma after Fontan operation. Hepatic MRE was performed in conjunction with cardiac magnetic resonance imaging in patients with prior Fontan operation between 2010-2014. Liver stiffness was calculated using previously reported techniques. Comparisons to available clinical, laboratory, imaging, and histopathologic data were made. Overall, 50 Fontan patients aged 25 (21-33) years were evaluated. The median interval between Fontan creation and MRE was 22 (16-26) years. Mean liver stiffness values were increased; 5.5±1.4 kilopascals relative to normal subjects. Liver stiffness directly correlated with liver biopsy total fibrosis score, time since operation; mean Fontan pressure; γ-glutamyl transferase (GGT); MELD score; creatinine; and pulmonary vascular resistance index (PVR). Liver stiffness was inversely correlated with cardiac index (CI). All 3 subjects with hepatic nodules exhibiting decreased contrast uptake on delayed post-contrast imaging and elevated nodule stiffness had biopsy-proven hepatocellular carcinoma. The association between hepatic stiffness and fibrosis scores, MELD scores, and GGT, suggests that MRE may be useful to detect (and possibly quantify) hepatic cirrhosis in Fontan patients. Correlation between stiffness and post-Fontan time interval, mean Fontan pressure, PVR and reduced CI suggests a role for long term hepatic congestion in creating these hepatic abnormalities. MRE was useful in detecting abnormal nodules ultimately diagnosed as hepatocellular carcinoma. The relationship between stiffness with advanced fibrosis and hepatocellular carcinoma provides a strong argument for additional study and broader application of MRE in these patients.