多参数核磁共振扫描用于诊断临床显著的门性高血压和预测肝脏减补
Efe Ozkaya1,2, Octavia Bane1,2, Enamul Bhuiyan1,2
1BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
概括
多参数MRI (mpMRI) 有效诊断出临床显著的门高血压 (CSPH),并预测肝脏衰减. 这种先进的成像技术结合了硬度和肝脏吸收,优于基于超声波的剪切波弹性学 (SWE).
科学领域:
- 肝病学和先进的医学成像技术.
- 多参数MRI (mpMRI) 在肝脏疾病的诊断性能.
- 图像化生物标志物的预测能力,用于肝脏脱补偿.
背景情况:
- 临床显著的门性高血压 (CSPH),定义为肝静脉压梯度 (HVPG) ≥10 mmHg,是慢性肝病的严重并发症.
- CSPH增加了水出血和肝脏不补偿 (HVPG ≥12 mmHg) 的风险.
- 准确的诊断和风险分层对于治疗慢性肝病患者至关重要.
研究的目的:
- 为了评估mpMRI对CSPH的诊断性能.
- 评估mpMRI预测肝脏衰竭的能力.
- 为了比较mpMRI与基于超声波的剪切波弹性学 (SWE) 和血液测试的疗效.
主要方法:
- 未来的单一中心研究涉及59名患者 (2018-2022年).
- 患者接受了mpMRI (包括2D/3DMR弹性图,T1/cT1/T1ρ映射,肝脏和脏的DCE-MRI) 和HVPG测量.
- 统计分析包括ROC分析和Cox比例危险模型,以比较诊断和预测性能.
主要成果:
- mpMRI参数显示CSPH的高诊断性能 (AUC≥0.8).
- 硬性 (2D MRE) 和肝吸收 (DCE-MRI) 显示出最佳表现,CSPH诊断的AUC组合为0.93.
- 硬度 (3D MRE) 和肝脏吸收率预测了0.83的AUC,超过SWE.
结论:
- 通过MRE测量脏硬度,结合DCE-MRI的 gadoxetate肝脏吸收,可以准确地诊断CSPH.
- 这种mpMRI组合有效预测肝脏脱补偿.
- 与SWE相比,mpMRI在CSPH和脱补偿风险方面表现出优异的诊断和预测性能.
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