成像模式提供NAFLD，NASH的确证结果

StephenW

Imaging modalities provide confirmative results of NAFLD, NASH
March 22, 2017

WASHINGTON — Imaging modalities, such as magnetic resonance imagining and magnetic resonance elastography, provided significantly confirmative results of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in an adult patient cohort, according to study results presented at Emerging Trends in Non-Alcoholic Fatty Liver Disease.

“I think [these tools are] really important, because when we start to look at 100 million Americans with fatty liver, and we know that 75 to 80 million of those are going to grow old with their disease ... how can we get those people out of our clinic?” Stephen A. Harrison, MD, FAASLD, of Pinnacle Clinical Research in San Antonio, said. “We can examine them, we can rule them out as having a disease that’s likely to progress, and this is where I think it’s important to really use a noninvasive assessment tool to look for steatosis.”

Harrison reported recent updates from an ongoing study at the Brooke Army Medical Center. Researchers developed the study to assess the prevalence and severity of both NAFLD and NASH in San Antonio and to evaluate the performance of several imaging modalities, including FibroScan (Echosens), MRI using LiverMultiscan (Perspectum Diagnostics), MRE, controlled attenuated parameter (CAP) and proton density fat fraction (PDFF).

At the time of the update, the study comprised 673 patients, 461 of whom had a full analysis with biomarkers. Of the 461, 315 had normal results, 120 were diagnosed with NAFLD and 26 were diagnosed with NASH.

According to Harrison, the results also showed that, compared with patients with normal results, patients with NAFLD and NASH had increased BMI, were more often Hispanic, more often had diabetes and hypertension, had increased fast food and non-diet soda intake and exercised less.

Results from the FibroScan showed a mean score of 4.6 for normal patients, 5.35 for patients with NAFLD and 8.35 for patients with NASH. MRI using LiverMultiscan showed a mean score of 1 for normal, 2 for NAFLD and 2.81 for NASH. MRE showed a mean score of 2 for normal, 2.2 for NAFLD and 2.65 for NASH. CAP showed a mean score of 2.68 for normal, 3.1 for NAFLD and 3.63 for NASH. PDFF showed a mean score of 2 for normal, 7.4 for NAFLD and nearly 15 for NASH.

Scatter plot results comparing FibroScan liver stiffness scores to MRE liver stiffness scores showed a correlation coefficient of 0.56. Comparing imaging modalities to liver biopsy in patients with stage 1 fibrosis, receiver operating characteristic (ROC) analysis for FibroScan was 0.73 and for MRE was 0.78. For patients with stage 2 fibrosis, ROC analysis for FibroScan was 0.83 and for MRE was 0.67.

“FibroScan liver stiffness and MRE liver stiffness appear to be better at predicting the stage of fibrosis compared to LiverMultiscan, particularly in the more fibrotic phenotypes,” Harrison said. “When you compare CAP and PDFF, CAP is very good based on the ROC, PDFF is excellent at predicting the grade of steatosis in NAFLD patients. For both imaging modalities, sensitivity negative predictive value remains high regardless of the cut off chosen, whereas specificity positive predictive decreases quickly with increasing liver stiffness measurement cut point that are chosen.” – by Talitha Bennett

Reference:

Harrison SA. Predicting the degree of liver-biopsy-confirms steatosis and fibrosis using transient elastography and magnetic resonance imaging-based techniques in adult patients with suspected non-alcoholic fatty liver disease. Presented at: Emerging Trends in Non-Alcoholic Fatty Liver Disease; March 18-19, 2017; Washington.

Disclosure: Harrison reports he is an advisor for Merck, Intercept, CLDF, Zafgen, Nimbus Discovery, Fibrogen, Pfizer and Gilead; is a consultant for Medivation, NGM Biopharmaceuticals and Alexion; is a speaker for Gilead, CLDF, AbbVie, Merck and Alexion; and receives grants or research support from Genfit.

StephenW

成像模式提供NAFLD，NASH的确证结果
2017年3月22日

华盛顿 - 成像模式，如磁共振成像和磁共振弹性成像，根据非酒精性脂肪新兴趋势中提供的研究结果，在成人患者队列中提供非酒精性脂肪性肝病和非酒精性脂肪性肝炎的显着证实结果肝病。

“我认为这些工具真的很重要，因为当我们开始看待1亿美国人患有脂肪肝的时候，我们知道有75-80万人会因为疾病而长大，我们怎么能得到那些人出诊了吗？“圣安东尼奥Pinnacle临床研究公司的FAASLD医生Stephen A. Harrison说。 “我们可以检查一下，我们可以把它们统统认为有可能会有进展的疾病，这就是我认为真正使用非侵入性评估工具来寻找脂肪变性的重要性。”

哈里森报道了布鲁克陆军医疗中心正在进行的一项研究的最新消息。研究人员开发了研究，以评估圣安东尼奥的NAFLD和NASH的患病率和严重程度，并评估几种成像方式的表现，包括使用肝脏多普勒（Perspectum Diagnostics），MRE，受控衰减参数（CAP）的FibroScan（Echosens）和质子密度脂肪分数（PDFF）。

在更新时，该研究包括673例患者，其中461例对生物标志物进行了全面分析。在461人中，315人有正常结果，120人被诊断为NAFLD，26人被诊断为NASH。

据哈里森统计，结果还显示，与正常结果的患者相比，NAFLD和NASH患者的BMI增加，西班牙裔患者更多，糖尿病和高血压患者更多地增加了快餐和非饮食中的钠摄入量减。

FibroScan的结果显示正常患者的平均得分为4.6，NAFLD为5.35，NASH患者为8.35。使用肝脏综合征的MRI显示正常值为1，NAFLD为2，NASH为2.81。 MRE平均得分为2分，NAFLD为2.2分，NASH平均得分为2.65分。 CAP平均得分为2.68，NAFLD为3.1，NASH为3.63。 PDFF平均得分为正常值为2，NAFLD为7.4，NASH为近15。

比较FibroScan肝硬度评分与MRE肝硬度评分的散点图结果相关系数为0.56。将1型纤维化患者的成像模式与肝活检进行比较，FibroScan受体操作特征（ROC）分析为0.73，MRE为0.78。对于2期纤维化患者，FibroScan的ROC分析为0.83，MRE为0.67。

哈里森说：“与肝纤维化相比，纤维蛋白酶肝硬度和MRE肝硬度在预测纤维化阶段似乎更好，特别是在更多的纤维化表型。 “当您比较CAP和PDFF时，CAP基于ROC非常好，PDFF非常适用于预测NAFLD患者脂肪变性等级。对于两种成像方式，敏感性阴性预测值保持高，无论选择的切断，而特异性阳性预测随着选择的肝硬度测量切割点的增加而快速下降。“ - 由Talitha Bennett

参考：

哈里森使用临床弹性成像和基于磁共振成像的技术预测肝活检程度，证明脂肪变性和纤维化在怀疑非酒精性脂肪性肝病的成年患者中。介绍：非酒精性脂肪肝疾病的新兴趋势; 2017年3月18日至19日华盛顿。

披露：哈里森报道他是默克，Intercept，CLDF，Zafgen，Nimbus Discovery，Fibrogen，辉瑞和吉利德的顾问;是Medivation，NGM Biopharmaceuticals和Alexion的顾问;是吉利德，CLDF，AbbVie，Merck和Alexion的演讲嘉宾;并获得Genfit的资助或研究支持。

MP4

MRE问题在于设备成本体积巨大噪音，还需要和MR检查共享
比较好还是硬度超声一体比较实用