MRE与短暂弹性成像相比，纤维化诊断准确性更高

StephenW

Fibrosis diagnostic accuracy higher in MRE vs. transient elastography

Hsu C, et al. Clin Gastroenterol Hepatol. 2018;doi:10.1016/j.cgh.05.059.
July 12, 2018

Magnetic resonance elastography had significantly higher diagnostic accuracy in staging fibrosis compared with transient elastography among patients with biopsy-proven nonalcoholic fatty liver disease, according to a recently published study.

“These results have important implications in developing an optimal approach for noninvasive assessment of the severity of NAFLD,” Cynthia Hsu, MD, from the University of California, San Diego, and colleagues wrote. “Depending on the desirability of accuracy, the need to identify all the individuals or only individuals with a specific disease stage and availability of these two noninvasive modalities, this study provides much needed information that will help define the optimal strategies for the management of NAFLD patients.”

Hsu and colleagues compared the diagnostic accuracies of MRE and TE using data from three studies with a total of 230 patients. The studies had a low risk for bias and a Quality Assessment of Diagnostic Accuracy Studies score of 12 or higher.

The AUROC of TE compared with MRE for detection of fibrosis stages 1 or higher was 0.82 (95% CI, 0.76-0.88) vs. 0.87 (95% CI, 0.82-0.91); for stage 2 or higher it was 0.87 (95% CI, 0.82-0.91) vs. 0.92 (95% CI, 0.88-0.96); for stage 3 or higher it was 0.84 (95% CI, 0.78-0.9) vs. 0.93 (95% CI, 0.89-0.96); and for stage 4 it was 0.84 (95% CI, 0.73-0.94) vs. 0.94 (95% CI, 0.89-0.99).

MRE remained superior to vibration controlled TE after multivariate analysis for stage 1 (P = .0334), stage 2 (P = .0182), stage 3 (P = .0029) and stage 4 (P = .0137).

“Depending on the context of use, MRE and TE can be used either to rule in or rule out the stage of fibrosis,” Hsu and colleagues wrote.

While the negative predictive values were similarly high between MRE (95.8%) and TE (94.3%), positive predictive values were low for both MRE (70.3%) and TE (65.4%), representing a low performance threshold for ruling in the presence of advanced fibrosis.

“In situations where accurate staging of fibrosis is important, MRE may be preferable to TE due to the higher accuracy of MRE, whereas TE may be preferable in routine clinical care to rule out or rule in advanced fibrosis depending on the risk or the population screened,” the researchers wrote. “However, further cost-effectiveness studies are needed to draw more definite conclusions.” – by Talitha Bennett

Disclosure: Hsu reports no relevant financial disclosures. Please see the full study for the other authors' relevant financial disclosures.

StephenW

MRE与短暂弹性成像相比，纤维化诊断准确性更高

Hsu C，et al。 Clin Gastroenterol Hepatol。 2018; DOI：10.1016 / j.cgh.05.059。
2018年7月12日

根据最近发表的一项研究显示，与活检证实的非酒精性脂肪性肝病患者相比，磁共振弹性成像在分期纤维化方面具有明显更高的诊断准确性。

加利福尼亚大学圣地亚哥分校的Cynthia Hsu博士及其同事写道：“这些结果对于开发一种非侵入性评估NAFLD严重程度的最佳方法具有重要意义。” “根据准确性的需要，需要识别所有个体或仅具有特定疾病阶段的个体和这两种非侵入性方式的可用性，本研究提供了非常需要的信息，有助于确定NAFLD患者管理的最佳策略“。

Hsu及其同事使用三项研究的数据比较了MRE和TE的诊断准确性，共有230名患者。这些研究的偏倚风险较低，诊断准确性研究的质量评估得分为12或更高。

TE的AUROC与用于检测纤维化阶段1或更高的MRE相比为0.82（95％CI，0.76-0.88），而0.87（95％CI，0.82-0.91）;对于阶段2或更高阶段，其为0.87（95％CI，0.82-0.91），而0.92（95％CI，0.88-0.96）;对于阶段3或更高阶段，其为0.84（95％CI，0.78-0.9）对比0.93（95％CI，0.89-0.96）;对于阶段4，它是0.84（95％CI，0.73-0.94）对比0.94（95％CI，0.89-0.99）。

在第1阶段（P = .0334），第2阶段（P = .0182），第3阶段（P = .0029）和第4阶段（P = .0137）的多变量分析后，MRE仍然优于振动控制的TE。

“根据使用情况，MRE和TE可用于统治或排除纤维化阶段，”Hsu及其同事写道。

虽然MRE（95.8％）和TE（94.3％）之间的阴性预测值同样较高，但MRE（70.3％）和TE（65.4％）的阳性预测值均较低，这表明存在的性能阈值较低。晚期纤维化

“在纤维化的准确分期很重要的情况下，由于MRE的准确性较高，MRE可能优于TE，而TE在常规临床护理中可能更适合根据风险或筛查的人群排除或治疗晚期纤维化，“研究人员写道。 “然而，需要进一步的成本效益研究才能得出更明确的结论。” - 由Talitha Bennett撰写

披露：Hsu报告没有相关的财务披露。有关其他作者的相关财务披露，请参阅完整的研究。