Magnetic Resonance Elastography for the Evaluation of Liver Fibrosis in Chronic Hepatitis B and C by Using Both Gradient-Recalled Echo and Spin-Echo Echo Planar Imaging: A Prospective Study
Magnetic Resonance Elastography for the Evaluation of Liver Fibrosis in Chronic Hepatitis B and C by Using Both Gradient-Recalled Echo and Spin-Echo Echo Planar Imaging: A Prospective Study
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使用梯度回波和自旋回波平面成像评估慢性乙型和丙型肝炎肝纤维化的磁共振弹性成像：一项前瞻性研究
DOI：
10.1038/ajg.2016.56
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发表时间：
2016-06-01
影响因子：
9.8
通讯作者：
Guo, Qi-yong
中科院分区：
文献类型：
--
作者：
Shi, Yu;Xia, Fei;Guo, Qi-yong
目的：磁共振弹性成像（MRE）结合三维自旋回波回波平面成像（3D-SE-EPI）是一种新的无创性评价肝纤维化的方法。我们假设，3D-SE-EPI可能有更好的诊断准确性比传统的二维梯度回波（2D-GRE）methods：我们前瞻性地纳入了179例慢性乙型肝炎B（CH B）或C（CHC）谁接受了磁共振成像和肝活检。通过3D-SE-EPI和2D-GRE测量肝硬度，以分期活检证实的肝纤维化（使用METAVIR评分）。使用受试者操作特征曲线（AUC）下的面积的受试者操作特征分析被用来比较这两种技术之间的诊断性能在预测肝纤维化，并比较他们的血清标志物fibrosis.Results：3D-SE-EPI的技术失败率（2.2%，n= 4/179）低于2D-GRE（8.3%，n= 15/179）。3D-SE-EPI测量的刚度略低于2D-GRE，平均差异为0.57 kPa（Bland和Altman图，95%一致性限值：-0.32和1.45 kPa）。≥ F1、≥ F2、≥ F3和F4表征的AUC为0.957（95%置信区间（CI）：0.913-0.983），0.971（0.932-0.991），0.991（0.961-0.999）和0.979（0.942-0.995），与2D-GRE在各纤维化阶段的AUC相比略高（分别为0.948（0.901-0.977）、0.959（0.915-0.981）、0.979（0.943-0.995）和0.976（0.938-0.994）），但无统计学显著性（P= 0.160-0.585）。在“意向诊断”分析中，在应用最佳截止值后，EPI（86.7- 91.3%，n= 169）的诊断准确性（分类良好的患者比例）高于GRE（80.9- 82.1%，n= 158）。结论：与2D-GRE相比，3D-SE-EPI对CHB/CHC患者肝纤维化分期的诊断准确率较高，但失败率较低，因此对2D-GRE有挑战性的病例更有帮助。
Objectives:Magnetic resonance elastography (MRE) with three-dimensional spin-echo echo planar imaging (3D-SE-EPI) is a newly emerging noninvasive method for assessing liver fibrosis. We hypothesized that 3D-SE-EPI might have better diagnostic accuracy than conventional two-dimensional gradient-recalled echo (2D-GRE).Methods:We prospectively included 179 consecutive patients with chronic hepatitis B (CHB) or C (CHC) who underwent both MRE and liver biopsy. Liver stiffness was measured by both 3D-SE-EPI and 2D-GRE for staging biopsy-proven liver fibrosis (using METAVIR scores). A receiver-operating characteristic analysis using the area under the receiver-operating characteristic curve (AUC) was used to compare the diagnostic performance in predicting liver fibrosis between these two techniques, and compared them to serum markers of fibrosis.Results:The technical failure rate of 3D-SE-EPI (2.2%, n= 4/179) was lower compared with 2D-GRE (8.3%, n= 15/179). The stiffness measured by 3D-SE-EPI was slightly lower compared with 2D-GRE, with the mean difference of 0.57 kPa (Bland and Altman plot, 95% limits of agreement:− 0.32 and 1.45 kPa). AUCs for the characterization of≥ F1,≥ F2,≥ F3, and F4 were 0.957 (95% confidence interval (CI): 0.913–0.983), 0.971 (0.932–0.991), 0.991 (0.961–0.999), and 0.979 (0.942–0.995) for 3D-SE-EPI, which was slightly higher compared with the AUCs for 2D-GRE at each fibrosis stage (0.948 (0.901–0.977), 0.959 (0.915–0.981), 0.979 (0.943–0.995), and 0.976 (0.938–0.994), respectively), although none reached statistical significance (P= 0.160–0.585). In an “intention-to-diagnose” analysis, the diagnostic accuracy (the proportion of well-classified patients) by EPI (86.7–91.3%, n= 169) was higher compared with GRE (80.9–82.1%, n= 158) after applying optimal cutoffs. Both 3D-SE-EPI and 2D-GRE performed better than serum fibrosis markers.Conclusions:With respect to 2D-GRE, 3D-SE-EPI has the advantage of lower failure rate with equivalent high diagnostic performance for staging liver fibrosis in CHB/CHC patients, and thus more helpful for those challenging cases in 2D-GRE.