肝纤维化的生物标志物：多峰磁共振，血清算法和瞬时弹性

StephenW

Biomarkers of liver fibrosis: prospective comparison of multimodal magnetic resonance, serum algorithms and transient elastography
Mikael F. Forsgren ORCID Icon, Patrik Nasr ORCID Icon, Markus Karlsson ORCID Icon, Nils Dahlström ORCID Icon, Bengt Norén ORCID Icon, Simone Ignatova ORCID Icon, show all
Received 20 May 2020, Accepted 18 Jun 2020, Published online: 20 Jul 2020

    Download citation https://doi.org/10.1080/00365521.2020.1786599 CrossMark Logo CrossMark

Abstract
Background and aims

Accurate biomarkers for quantifying liver fibrosis are important for clinical practice and trial end-points. We compared the diagnostic performance of magnetic resonance imaging (MRI), including gadoxetate-enhanced MRI and 31P-MR spectroscopy, with fibrosis stage and serum fibrosis algorithms in a clinical setting. Also, in a subset of patients, MR- and transient elastography (MRE and TE) was evaluated when available.
Methods

Patients were recruited prospectively if they were scheduled to undergo liver biopsy on a clinical indication due to elevated liver enzyme levels without decompensated cirrhosis. Within a month of the clinical work-up, an MR-examination and liver needle biopsy were performed on the same day . Based on late-phase gadoxetate-enhanced MRI, a mathematical model calculated hepatobiliary function (relating to OATP1 and MRP2). The hepatocyte gadoxetate uptake rate (KHep) and the normalised liver-to-spleen contrast ratio (LSC_N10) were also calculated. Nine serum fibrosis algorithms were investigated (GUCI, King's Score, APRI, FIB-4, Lok-Index, NIKEI, NASH-CRN regression score, Forns' score, and NAFLD-fibrosis score).
Results

The diagnostic performance (AUROC) for identification of significant fibrosis (F2–4) was 0.78, 0.80, 0.69, and 0.78 for MRE, TE, LSC_N10, and GUCI, respectively. For the identification of advanced fibrosis (F3–4), the AUROCs were 0.93, 0.84, 0.81, and 0.82 respectively.
Conclusion

MRE and TE were superior for non-invasive identification of significant fibrosis. Serum fibrosis algorithms developed for specific liver diseases are applicable in this cohort of diverse liver diseases aetiologies. Gadoxetate-MRI was sufficiently sensitive to detect the low function losses associated with fibrosis. None was able to efficiently distinguish between stages within the low fibrosis stages.

    Lay summary

    Excessive accumulation of scar tissue, fibrosis, in the liver is an important aspect in chronic liver disease. To replace the invasive needle biopsy, we have explored non-invasive methods to assess liver fibrosis. In our study we found that elastographic methods, which assess the mechanical properties of the liver, are superior in assessing fibrosis in a clinical setting. Of interest from a clinical trial point-of-view, none of the tested methods was sufficiently accurate to distinguish between adjacent moderate fibrosis stages.

Keywords: Elastography, MRE, Gadoxetate-enhanced MRI, 31P-MR spectroscopy, serum fibrosis algorithms, liver fibrosis

StephenW

肝纤维化的生物标志物：多峰磁共振，血清算法和瞬时弹性成像的前瞻性比较
Mikael F.Forsgren ORCID图标，Patrik Nasr ORCID图标，Markus Karlsson ORCID图标，NilsDahlströmORCID图标，BengtNorénORCID图标，Simone Ignatova ORCID图标，显示全部
2020年5月20日收到，2020年6月18日接受，在线发布：2020年7月20日

    下载引文https://doi.org/10.1080/00365521.2020.1786599 CrossMark徽标CrossMark

抽象
背景和目标

准确定量肝纤维化的生物标志物对于临床实践和试验终点至关重要。我们将磁共振成像（MRI）的诊断性能（包括gadoxetate增强的MRI和31P-MR光谱）与临床环境中的纤维化分期和血清纤维化算法进行了比较。此外，在部分患者中，对MR和瞬时弹性成像（MRE和TE）进行了评估（如果可用）。
方法

如果由于肝酶水平升高而没有失代偿性肝硬化，计划按临床指征进行肝活检，则应按预期招募患者。在临床检查的一个月内，在同一天进行了MR检查和肝穿刺活检。基于晚期gadoxetate增强MRI，一个数学模型计算了肝胆功能（与OATP1和MRP2有关）。还计算了肝细胞牛磺酸盐摄取率（KHep）和归一化肝脾对比率（LSC_N10）。研究了九种血清纤维化算法（GUCI，King's评分，APRI，FIB-4，Lok指数，NIKEI，NASH-CRN回归评分，Forns评分和NAFLD纤维化评分）。
结果

对于MRE，TE，LSC_N10和GUCI，用于识别明显纤维化（F2-4）的诊断性能（AUROC）分别为0.78、0.80、0.69和0.78。为了鉴定晚期纤维化（F3-4），AUROC分别为0.93、0.84、0.81和0.82。
结论

MRE和TE在非侵入性鉴别出明显纤维化方面具有优势。针对特定肝病开发的血清纤维化算法适用于这一组各种肝病病因。加多西汀-MRI足够灵敏，可以检测到与纤维化相关的低功能丧失。没有人能够有效地区分低纤维化阶段。

    放置摘要

    肝脏中瘢痕组织，纤维化的过度积累是慢性肝病的重要方面。为了替代有创针头活检，我们探索了无创方法来评估肝纤维化。在我们的研究中，我们发现，通过弹性成像方法评估肝脏的机械特性，在临床上评估纤维化方面具有优势。从临床试验的角度来看，没有一种测试方法能够足够准确地区分相邻的中度纤维化分期。

关键字：弹性成像，MRE，加多西酯增强MRI，31P-MR光谱，血清纤维化算法，肝纤维化

StephenW

https://www.tandfonline.com/doi/ ... 365521.2020.1786599