Feasibility of in vivo MR elastographic splenic stiffness measurements in the assessment of portal hypertension.
Feasibility of in vivo MR elastographic splenic stiffness measurements in the assessment of portal hypertension.
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DOI：
10.2214/ajr.07.3504
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发表时间：
2009-07
期刊：
影响因子：
--
通讯作者：
Ehman RL
中科院分区：
文献类型：
--
作者：
Talwalkar JA;Yin M;Venkatesh S;Rossman PJ;Grimm RC;Manduca A;Romano A;Kamath PS;Ehman RL
在慢性肝病患者中，肝脏硬度测量与门脉高压有关。然而，脾僵硬与临床意义上的门静脉高压症之间的关系仍不清楚。确定磁共振(MR)弹性成像测量脾硬度的可行性，并在健康志愿者和肝纤维化患者中前瞻性地测试这项技术。根据机构审查委员会的批准，12名健康志愿者(平均年龄37岁，年龄范围25-82岁)和38名慢性肝病患者(平均年龄56岁，年龄范围36-60岁)用磁共振弹性成像测量了脾硬度。进行了各种统计分析以评估所有测量结果。所有志愿者和患者都成功地进行了脾的MR弹性成像。受试者的平均脾硬度(平均值3.6kPa±0.3)显著低于肝纤维化患者(平均值5.6kPa±5.0，范围2.7-19.2kPa；p<；.001)。此外，在整个队列中观察到了肝和脾硬度之间的显著相关性(R2=0.75，p<；0.001)。预测脾僵硬的指标是脾大小、脾体积和血小板计数。在肝硬化组，平均脾硬度≥为10.5kpa的患者中，100%观察到食道静脉曲张的存在。脾MR弹性成像是可行的，有望成为预测晚期肝纤维化患者是否存在食道静脉曲张的定量方法。
Liver stiffness measurement is associated with portal hypertension in patients with chronic liver disease. However, the relationship between spleen stiffness and clinically significant portal hypertension remains unknown. To determine the feasibility of measuring spleen stiffness with magnetic resonance (MR) elastography and to prospectively test this technique in healthy volunteers and patients with liver fibrosis. Following Institutional Review Board approval, spleen stiffness was measured with MR elastography in 12 healthy volunteers (mean age, 37 years; age range, 25-82 years) and 38 patients with various etiologies of chronic liver disease (mean age, 56 years; age range, 36–60 years). Various statistical analyses were performed to assess all measurements. MR elastography of the spleen was successfully performed in all volunteers and patients. The mean spleen stiffness was significantly lower in volunteers (mean, 3.6 kPa ± 0.3) than it was in patients with liver fibrosis (mean, 5.6 kPa ± 5.0, range, 2.7–19.2 kPa; p < .001). In addition, a significant correlation between liver and spleen stiffness was observed for the entire cohort (r2=.75, p<0.001). Predictors of spleen stiffness were splenomegaly, spleen volume, and platelet count. In the setting of cirrhosis, the presence of esophageal varices was observed in 100% of patients with mean spleen stiffness values ≥ 10.5 kPa. MR elastography of the spleen is feasible and shows promise as a quantitative method for predicting the presence of esophageal varices in patients with advanced hepatic fibrosis.