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Periportal thickening on magnetic resonance imaging for hepatic fibrosis in infantile cholestasis.

婴儿胆汁淤积症肝纤维化磁共振成像门静脉周围增厚。

  • 影响因子:3.43
  • DOI:10.3748/wjg.v26.i21.2821
  • 作者列表:"Lee MH","Shin HJ","Yoon H","Han SJ","Koh H","Lee MJ
  • 发表时间:2020-06-07
Abstract

BACKGROUND:Untreated neonatal cholestasis can progress to liver cirrhosis and end stage liver disease in infancy due to prolonged hepatocyte and biliary tree injury and may require liver transplantation. Therefore, non-invasive evaluation of hepatic fibrosis is important in infants with cholestasis. AIM:To investigate the usefulness of periportal thickening (PT) measured on liver magnetic resonance imaging (MRI) for the assessment of hepatic fibrosis in infants with cholestasis including biliary atresia (BA). METHODS:This retrospective study included infants less than 6 mo who underwent liver MRI and biopsy for the evaluation of infantile cholestasis. PT and spleen size were measured on MRI. Serologic assessment was based on aspartate transaminase to platelet ratio index (APRI). The grade of histopathologic fibrosis was assessed by the METAVIR grading system. Correlation and diagnostic performance of PT, normalized spleen size ratio (SR, using the upper normal size limit), and APRI for diagnosing hepatic fibrosis were obtained by receiver-operating characteristic (ROC) curve analysis. RESULTS:A total of 155 patients were included, 110 of which were diagnosed with BA. Mean age at the time of MRI was 57.6 ± 34.4 d. There were positive correlations between fibrosis grade and PT and SR, even after adjusting age (all, P < 0.001). For the diagnosis of significant fibrosis (METAVIR grade F2-F4), the area under the ROC curve was 0.899 (95%CI: 0.840-0.941) for PT (cutoff, 4.2 mm), which was higher than 0.741 (95%CI: 0.664-0.808) for SR and 0.712 (95%CI: 0.634-0.782) for APRI (both, P < 0.001). For the diagnosis of cirrhosis (F4), the area under the ROC curve was the highest with SR as 0.790 (95%CI: 0.718-0.852). CONCLUSION:Liver MRI findings of PT and SR are useful to assess clinically significant hepatic fibrosis (F2 and higher) in infants with cholestasis including BA.

摘要

背景: 未经治疗的新生儿胆汁淤积可在婴儿期因长期肝细胞和胆道树损伤而进展为肝硬化和终末期肝病,可能需要肝移植。因此,无创性评价肝纤维化对婴儿胆汁淤积有重要意义。 目的: 探讨肝脏磁共振成像 (MRI) 测量的门静脉周围增厚 (PT) 在评估胆汁淤积 (包括胆道闭锁) 婴儿肝纤维化中的价值。 方法: 这项回顾性研究包括小于 6 个月的婴儿,他们接受了肝脏 MRI 和活检以评估婴儿胆汁淤积。在 MRI 上测量 PT 和脾脏大小。血清学评估基于天冬氨酸转氨酶/血小板比值指数 (APRI)。通过 METAVIR 分级系统评估组织病理学纤维化的分级。通过受试者工作特征 (ROC) 获得 PT 、标准化脾脏大小比 (SR,使用正常大小上限) 和 APRI 诊断肝纤维化的相关性和诊断性能曲线分析。 结果: 共纳入 155 例患者,其中 110 例诊断为 BA。MRI 检查时的平均年龄为 57.6 ± 34.4 d。纤维化分级与 PT 和 SR 呈正相关,即使调整了年龄后 (均 P <0.001)。对于显著纤维化的诊断 (METAVIR 分级 F2-F4),PT (cutoff,0.899) 的 ROC 曲线下面积为 0.840 (95% CI: 0.941-4.2毫米),SR 高于 0.741 (95% CI: 0.664-0.808),APRI 高于 0.712 (95% CI: 0.634-0.782) (均 P <0.001)。对于肝硬化 (F4) 的诊断,ROC 曲线下面积最高,SR 为 0.790 (95% CI: 0.718-0.852)。 结论: PT 和 SR 的肝脏 MRI 表现有助于评估包括 BA 在内的胆汁淤积婴儿的临床显著肝纤维化 (F2 及以上)。

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DOI:10.1128/mBio.03105-19
作者列表:["Kuehl CJ","D'Gama JD","Warr AR","Waldor MK"]

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影响因子:5.36
发表时间:2020-01-20
DOI:10.1007/s00259-020-04686-1
作者列表:["Willowson KP","Schembri GP","Bernard EJ","Chan DL","Bailey DL"]

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