瞬态，点剪切波和磁共振弹性成像用于分期肝纤维化的前瞻

StephenW

Eur Radiol. 2019 Jul 5. doi: 10.1007/s00330-019-06331-4. [Epub ahead of print]
Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis.
Lefebvre T1,2,3, Wartelle-Bladou C4, Wong P5, Sebastiani G5, Giard JM2,4, Castel H2,4, Murphy-Lavallée J1, Olivié D1, Ilinca A1,2, Sylvestre MP2,6, Gilbert G1,7, Gao ZH8, Nguyen BN9, Cloutier G1,10,11, Tang A12,13,14.
Author information

1
    Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada.
2
    Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.
3
    Medical Physics Unit, McGill University, Montreal, Canada.
4
    Department of Medicine, Division of Hepatology and Liver Transplantation, Université de Montréal, Montreal, Canada.
5
    Department of Medicine, Division of Gastroenterology and Hepatology, McGill University Health Centre (MUHC), Montreal, Canada.
6
    Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal (ESPUM), Montreal, Canada.
7
    MR Clinical Science, Philips Healthcare Canada, Markham, Canada.
8
    Department of Pathology, McGill University, Montreal, Canada.
9
    Service of Pathology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.
10
    Institute of Biomedical Engineering, Université de Montréal, Montreal, Canada.
11
    Laboratory of Biorheology and Medical Ultrasonics (LBUM), Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada.
12
    Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Canada. [email protected].
13
    Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada. [email protected].
14
    Institute of Biomedical Engineering, Université de Montréal, Montreal, Canada. [email protected].

Abstract
OBJECTIVES:

To perform head-to-head comparisons of the feasibility and diagnostic performance of transient elastography (TE), point shear-wave elastography (pSWE), and magnetic resonance elastography (MRE).
METHODS:

This prospective, cross-sectional, dual-center imaging study included 100 patients with known or suspected chronic liver disease caused by hepatitis B or C virus, nonalcoholic fatty liver disease, or autoimmune hepatitis identified between 2014 and 2018. Liver stiffness measured with the three elastographic techniques was obtained within 6 weeks of a liver biopsy. Confounding effects of inflammation and steatosis on association between fibrosis and liver stiffness were assessed. Obuchowski scores and AUCs for staging fibrosis were evaluated and the latter were compared using the DeLong method.
RESULTS:

TE, pSWE, and MRE were technically feasible and reliable in 92%, 79%, and 91% subjects, respectively. At univariate analysis, liver stiffness measured by all techniques increased with fibrosis stages and inflammation and decreased with steatosis. For classification of dichotomized fibrosis stages, the AUCs were significantly higher for distinguishing stages F0 vs. ≥ F1 with MRE than with TE (0.88 vs. 0.71; p < 0.05) or pSWE (0.88 vs. 0.73; p < 0.05), and for distinguishing stages ≤ F1 vs. ≥ F2 with MRE than with TE (0.85 vs. 0.75; p < 0.05). TE, pSWE, and MRE Obuchowski scores for staging fibrosis stages were respectively 0.89 (95% CI 0.85-0.93), 0.90 (95% CI 0.85-0.94), and 0.94 (95% CI 0.91-0.96).
CONCLUSION:

MRE provided a higher diagnostic performance than TE and pSWE for staging early stages of liver fibrosis.
TRIAL REGISTRATION:

NCT02044523 KEY POINTS: • The technical failure rate was similar between MRE and US-based elastography techniques. • Liver stiffness measured by MRE and US-based elastography techniques increased with fibrosis stages and inflammation and decreased with steatosis. • MRE provided a diagnostic accuracy higher than US-based elastography techniques for staging of early stages of histology-determined liver fibrosis.
KEYWORDS:

Classification; Elasticity imaging techniques; Fibrosis; Liver; Prospective studies

PMID:
    31278577
DOI:
    10.1007/s00330-019-06331-4

StephenW

Eur Ra​​diol。 2019年7月5日doi：10.1007 / s00330-019-06331-4。 [印刷前的电子版]
瞬态，点剪切波和磁共振弹性成像用于分期肝纤维化的前瞻性比较。
Lefebvre T1,2,3，Wartelle-Bladou C4，Wong P5，Sebastiani G5，Giard JM2,4，Castel H2,4，Murphy-LavalléeJ1，OliviéD1，Ilinca A1,2，Sylvestre MP2,6，Gilbert G1,7 ，高ZH8，Nguyen BN9，Cloutier G1,10,11，唐A12,13,14。
作者信息

1
    加拿大蒙特利尔蒙特利尔大学放射学，放射肿瘤学和核医学系。
2
    加拿大蒙特利尔蒙特利尔大学中心医院中心（CRCHUM）。
3
    加拿大蒙特利尔麦吉尔大学医学物理系。
4
    加拿大蒙特利尔蒙特利尔分校肝脏与肝脏移植科医学系。
五
    加拿大蒙特利尔麦吉尔大学健康中心（MUHC）消化内科和肝病学系医学系。
6
    加拿大蒙特利尔蒙特利尔大学社会与预防医学系（ESPUM）。
7
    MR Clinical Science，飞利浦医疗保健加拿大，马克姆，加拿大。
8
    加拿大蒙特利尔麦吉尔大学病理学系。
9
    蒙特利尔中央医院（CHUM），加拿大蒙特利尔病理学服务中心。
10
    加拿大蒙特利尔蒙特利尔大学生物医学工程研究所。
11
    加拿大蒙特利尔蒙特利尔大学医学中心（CRCHUM）生物医学和医学超声学实验室（LBUM）。
12
    加拿大蒙特利尔蒙特利尔大学放射学，放射肿瘤学和核医学系。 [email protected]。
13
    加拿大蒙特利尔蒙特利尔大学中心医院中心（CRCHUM）。 [email protected]。
14
    加拿大蒙特利尔蒙特利尔大学生物医学工程研究所。 [email protected]。

抽象
目的：

对瞬态弹性成像（TE），点剪切波弹性成像（pSWE）和磁共振弹性成像（MRE）的可行性和诊断性能进行头对头比较。
方法：

这项前瞻性，横断面，双中心成像研究纳入了100名患有已知或疑似慢性肝病的患者，这些患者由2014年至2018年间确诊的乙型肝炎或丙型肝炎病毒，非酒精性脂肪性肝病或自身免疫性肝炎引起。在肝脏活组织检查的6周内获得弹性成像技术。评估炎症和脂肪变性对纤维化和肝硬度之间关联的混杂影响。评估用于分期纤维化的Obuchowski评分和AUC，并使用DeLong方法比较后者。
结果：

TE，pSWE和MRE在92％，79％和91％的受试者中分别在技术上可行且可靠。在单变量分析中，通过所有技术测量的肝硬度随着纤维化阶段和炎症而增加并且随着脂肪变性而降低。对于二分法纤维化分期的分类，用MRE区分F0与≥F1的AUC显着高于TE（0.88对0.71; p <0.05）或pSWE（0.88对0.73; p <0.05），对于区分阶段≤F1对≥F2与MRE比对TE（0.85对0.75; p <0.05）。分期纤维化分期的TE，pSWE和MRE Obuchowski评分分别为0.89（95％CI 0.85-0.93），0.90（95％CI 0.85-0.94）和0.94（95％CI 0.91-0.96）。
结论：

MRE提供了比TE和pSWE更高的诊断性能，用于分期肝纤维化的早期阶段。
试用注册：

NCT02044523要点：•MRE和美国弹性成像技术之间的技术故障率相似。 •通过MRE和美国弹性成像技术测量的肝硬度随着纤维化阶段和炎症而增加，并且随着脂肪变性而减少。 •MRE提供的诊断准确度高于美国弹性成像技术，用于分期组织学确定的肝纤维化分期。
关键词：

分类;弹性成像技术;纤维化;肝;前瞻性研究

结论：
    31278577
DOI：
    10.1007 / s00330-019-06331-4