Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease - MRI accurately quantifies hepatic steatosis in NAFLD.
Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease - MRI accurately quantifies hepatic steatosis in NAFLD.
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DOI：
10.1111/j.1365-2036.2012.05121.x
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发表时间：
2012-07
影响因子：
7.6
通讯作者：
Loomba R
中科院分区：
文献类型：
--
作者：
Permutt Z;Le TA;Peterson MR;Seki E;Brenner DA;Sirlin C;Loomba R
用于测量肝脏脂肪变性的常规磁共振成像（MRI）技术受到脂肪中质子的T1偏差、T2*衰减以及多频信号干扰效应的限制。对这些因素进行校正的新型磁共振技术，如质子密度脂肪分数（PDFF），尚未在非酒精性脂肪性肝病（NAFLD）成年患者中与肝活检进行专门比较。
为了研究MRI测定的PDFF与组织学确定的脂肪变性等级之间的关联，以及它们与纤维化的关联。
共有51名经活检证实为NAFLD的成年患者接受了代谢生化分析、通过MRI测定肝脏脂肪变性的PDFF以及根据NASH - CRN组织学评分系统进行的肝活检评估。
MRI测定的平均PDFF随着组织学确定的脂肪变性等级升高而显著增加：1级时为8.9%，2级时为16.3%，3级时为25.0%，P≤0.0001（相关性：r² = 0.56，P < 0.0001）。与0 - 3期纤维化患者相比，4期纤维化患者通过MRI测定的PDFF（7.6%对17.8%，P < 0.005）和组织学确定的脂肪变性等级（1.4对2.2，P < 0.05）所确定的肝脏脂肪变性明显更低。患有1级脂肪变性的NAFLD患者更有可能具有晚期肝病的特征，包括更高的平均谷草转氨酶/谷丙转氨酶（AST/ALT）比值（0.87对0.60，P < 0.02）、γ - 谷氨酰转肽酶（GGT）（140对67，P < 0.01）和国际标准化比值（INR）（1.06对0.99，P < 0.01），更高的纤维化分期以及肝细胞气球样变。
在NAFLD成年患者中，MRI测定的质子密度脂肪分数与组织学确定的脂肪变性等级相关。脂肪变性与纤维化进展呈非线性关系。在NAFLD患者中，影像学上肝脏脂肪变性程度低并不一定表明病情轻微。
Conventional magnetic resonance imaging (MRI) techniques that measure hepatic steatosis are limited by T1 bias, T2* decay and multi-frequency signal-interference effects of protons in fat. Newer MR techniques such as the proton density-fat fraction (PDFF) that correct for these factors have not been specifically compared to liver biopsy in adult patients with non-alcoholic fatty liver disease (NAFLD). To examine the association between MRI-determined PDFF and histology-determined steatosis grade, and their association with fibrosis. A total of 51 adult patients with biopsy-confirmed NAFLD underwent meta-bolic-biochemical profiling, MRI-determined PDFF measurement of hepatic steatosis and liver biopsy assessment according to NASH-CRN histological scoring system. The average MRI-determined PDFF increased significantly with increasing histology-determined steatosis grade: 8.9% at grade-1, 16.3% at grade-2, and 25.0% at grade-3 with P ≤ 0.0001 (correlation: r2 = 0.56, P < 0.0001). Patients with stage-4 fibrosis, when compared with patients with stage 0–3 fibrosis, had significantly lower hepatic steatosis by both MRI-determined PDFF (7.6% vs. 17.8%, P < 0.005) and histology-determined steatosis grade (1.4 vs. 2.2, P < 0.05). NAFLD patients with grade 1 steatosis were more likely to have characteristics of advanced liver disease including higher average AST:ALT (0.87 vs. 0.60, P < 0.02), GGT (140 vs. 67, P < 0.01), and INR (1.06 vs. 0.99, P < 0.01), higher stage of fibrosis and hepatocellular ballooning. MRI-determined proton density-fat fraction correlates with histology-determined steatosis grade in adults with NAFLD. Steatosis is non-linearly related to fibrosis progression. In patients with NAFLD, a low amount of hepatic steatosis on imaging does not necessarily indicate mild disease.
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