Comparative diagnostic accuracy of magnetic resonance elastography vs. eight clinical prediction rules for non-invasive diagnosis of advanced fibrosis in biopsy-proven non-alcoholic fatty liver disease: a prospective study
Comparative diagnostic accuracy of magnetic resonance elastography vs. eight clinical prediction rules for non-invasive diagnosis of advanced fibrosis in biopsy-proven non-alcoholic fatty liver disease: a prospective study
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DOI：
10.1111/apt.13196
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发表时间：
2015-06-01
影响因子：
7.6
通讯作者：
Loomba, R.
中科院分区：
文献类型：
--
作者：
Cui, J.;Ang, B.;Loomba, R.
研究背景二维磁共振弹性成像（2D-MRE）是一种先进的磁共振检查方法，对非酒精性脂肪性肝病（NAFLD）患者晚期肝纤维化的预测具有较高的诊断准确性。然而，在活检证实的NAFLD患者中，2D-MRE和临床预测规则（CPR）之间没有前瞻性的头对头比较。（AST：ALT比值、APRI、BARD、FIB-4、NAFLD纤维化评分、Bonacini肝硬化判别评分，Lok指数和NASH CRN模型）预测以配对肝活检为金标准的前瞻性队列中的晚期纤维化（58.8%的女性）在活检后90天内患有活检证实的NAFLD、2D-MRE和临床研究评估。进行受试者工作特征（ROC）分析以评估2D-MRE和CPR预测晚期纤维化的性能。年龄和BMI分别为51.3（+/- 14.0）岁和31.7（+/- 5.5）kg/m2。肝纤维化0、1、2、3、4期分别为48、26、9、13、6例。2D-MRE的ROC曲线下面积（AUROC）为0.957，CPR为0.796 - 0.861。FIB-4是预测晚期纤维化的最佳CPR，AUROC为0.861。在使用DeLong检验的头对头比较中，2D-MRE具有显著更好的AUROC（P
BackgroundTwo-dimensional magnetic resonance elastography (2D-MRE) is an advanced magnetic resonance method with high diagnostic accuracy for predicting advanced fibrosis in non-alcoholic fatty liver disease (NAFLD) patients. However, no prospective, head-to-head comparisons between 2D-MRE and clinical prediction rules (CPRs) have been performed in patients with biopsy-proven NAFLD.AimTo compare the diagnostic utility of 2D-MRE against that of eight CPRs (AST:ALT ratio, APRI, BARD, FIB-4, NAFLD Fibrosis Score, Bonacini cirrhosis discriminant score, Lok Index and NASH CRN model) for predicting advanced fibrosis in a prospective cohort with paired liver biopsy as the gold standard.MethodsThis is a cross-sectional analysis of a prospective study of 102 patients (58.8% women) with biopsy-proven NAFLD, 2D-MRE and clinical research assessment within 90days of biopsy. Receiver operating characteristic (ROC) analysis was performed to assess the performance of 2D-MRE and CPRs for predicting advanced fibrosis.ResultsThe mean (s.d.) age and BMI were 51.3 (+/- 14.0) years and 31.7 (+/- 5.5)kg/m(2) respectively. 48, 26, 9, 13 and 6 patients had stage 0, 1, 2, 3 and 4 fibrosis respectively. The area under ROC curve (AUROC) was 0.957 for 2D-MRE and between 0.796 and 0.861 for the CPRs. FIB-4 was the best-performing CPR at predicting advanced fibrosis with AUROC of 0.861. In head-to-head comparisons using the DeLong test, 2D-MRE had significantly better AUROC (P