Korean Journal of Radiology

  • 제20권5호
  • /
  • Pages.773-780
  • /
  • 2019
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Segmental Liver Stiffness Evaluated with Magnetic Resonance Elastography Is Responsive to Endovascular Intervention in Patients with Budd-Chiari Syndrome

  • Peng Xu (Department of Radiology, Affiliated Hospital of Xuzhou Medical University) ;
  • Lulu Lyu (Department of CT and MRI, Xuzhou Central Hospital) ;
  • HaitaoGe (Department of Radiology, Affiliated Hospital of Xuzhou Medical University) ;
  • Muhammad Umair Sami (Department of Radiology, Affiliated Hospital of Xuzhou Medical University) ;
  • Panpan Liu (Department of Radiology, Affiliated Hospital of Xuzhou Medical University) ;
  • Chunfeng Hu (Department of Radiology, Affiliated Hospital of Xuzhou Medical University) ;
  • Kai Xu (Department of Radiology, Affiliated Hospital of Xuzhou Medical University)
  • 투고 : 2018.11.09
  • 심사 : 2019.01.18
  • 발행 : 2019.05.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To assess segmental liver stiffness (LS) with MRI before and after endovascular intervention in patients with Budd-Chiari syndrome (BCS). Materials and Methods: Twenty-three patients (13 males and 10 females; mean age, 42.6 ± 12.6 years; age range, 31-56 years) with BCS as a primary liver disease were recruited for this study. Two consecutive magnetic resonance elastography (MRE) examinations were performed before the endovascular treatment. Fifteen patients who underwent endovascular intervention treatment also had follow-up MRE scans within three days after the procedure. LS was measured in three liver segments: the right posterior, right anterior, and left medial segments. Inter-reader and inter-exam repeatability were analyzed with intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Segmental LS and clinical characteristics before and after the intervention were also compared. Results: Within three days of the endovascular intervention, all three segmental LS values decreased: LS of the right posterior segment = 7.23 ± 0.88 kPa (before) vs. 4.94 ± 0.84 kPa (after), LS of the right anterior segment = 7.30 ± 1.06 kPa (before) vs. 4.77 ± 0.85 kPa (after), and LS of the left medial segment = 7.22 ± 0.87 kPa (before) vs. 4.87 ± 0.72 kPa (after) (all p = 0.001). There was a significant correlation between LS changes and venous pressure gradient changes before and after treatments (r = 0.651, p = 0.009). The clinical manifestations of all 15 patients significantly improved after therapy. The MRE repeatability was excellent, with insignificant variations (inter-reader, ICC = 0.839-0.943: inter-examination, ICC = 0.765-0.869). Bland-Altman analysis confirmed excellent agreement (limits of agreement, 13.4-19.4%). Conclusion: Segmental LS measured by MRE is a promising repeatable quantitative biomarker for monitoring the treatment response to minimally invasive endovascular intervention in patients with BCS.

키워드

과제정보

Authors gratitude to Mr. Weiqiang Dou (GE Healthcare, MR Research China) for optimization of MRI scanning parameters.

참고문헌

  1. Plessier A, Rautou PE, Valla DC. Management of hepatic vascular diseases. J Hepatol 2012;1:S25-S38 https://doi.org/10.1016/S0168-8278(12)60004-X
  2. Copelan A, Remer EM, Sands M, Nghiem H, Kapoor B. Diagnosis and management of Budd Chiari syndrome: an update. Cardiovasc Intervent Radiol 2015;38:1-12 https://doi.org/10.1007/s00270-014-0919-9
  3. Tang A, Cloutier G, Szeverenyi NM, Sirlin CB. Ultrasound elastography and MR elastography for assessing liver fibrosis: part 2, diagnostic performance, confounders, and future directions. AJR Am J Roentgenol 2015;205:33-40 https://doi.org/10.2214/AJR.15.14553
  4. Han KH, Yoon KT. New diagnostic method for liver fibrosis and cirrhosis. Intervirology 2008;51 Suppl 1:11-16 https://doi.org/10.1159/000122594
  5. Srinivasa Babu A, Wells ML, Teytelboym OM, Mackey JE, Miller FH, Yeh BM, et al. Elastography in chronic liver disease: modalities, techniques, limitations, and future directions. Radiographics 2016;36:1987-2006 https://doi.org/10.1148/rg.2016160042
  6. Yoon JH, Lee JM, Woo HS, Yu MH, Joo I, Lee ES, et al. Staging of hepatic fibrosis: comparison of magnetic resonance elastography and shear wave elastography in the same individuals. Korean J Radiol 2013;14:202-212 https://doi.org/10.3348/kjr.2013.14.2.202
  7. Mukund A, Pargewar SS, Desai SN, Rajesh S, Sarin SK. Changes in liver congestion in patients with Budd-Chiari Syndrome following endovascular interventions: assessment with transient elastography. J Vasc Interv Radiol 2017;28:683-687 https://doi.org/10.1016/j.jvir.2016.11.091
  8. Huwart L, Sempoux C, Vicaut E, Salameh N, Annet L, Danse E, et al. Magnetic resonance elastography for the noninvasive staging of liver fibrosis. Gastroenterology 2008;135:32-40 https://doi.org/10.1053/j.gastro.2008.03.076
  9. Huwart L, Sempoux C, Salameh N, Jamart J, Annet L, Sinkus R, et al. Liver fibrosis: noninvasive assessment with MR elastography versus aspartate aminotransferase-to-platelet ratio index. Radiology 2007;245:458-466 https://doi.org/10.1148/radiol.2452061673
  10. Trout AT, Sheridan RM, Serai SD, Xanthakos SA, Su W, Zhang B, et al. Diagnostic performance of MR elastography for liver fibrosis in children and young adults with a spectrum of liver diseases. Radiology 2018;287:824-832 https://doi.org/10.1148/radiol.2018172099
  11. Lee JE, Lee JM, Lee KB, Yoon JH, Shin CI, Han JK, et al. Noninvasive assessment of hepatic fibrosis in patients with chronic hepatitis B viral infection using magnetic resonance elastography. Korean J Radiol 2014;15:210-217 https://doi.org/10.3348/kjr.2014.15.2.210
  12. Yoshimitsu K, Mitsufuji T, Shinagawa Y, Fujimitsu R, Morita A, Urakawa H, et al. MR elastography of the liver at 3.0 T in diagnosing liver fibrosis grades; preliminary clinical experience. Eur Radiol 2016;26:656-663 https://doi.org/10.1007/s00330-015-3863-4
  13. Rouviere O, Yin M, Dresner MA, Rossman PJ, Burgart LJ, Fidler JL, et al. MR elastography of the liver: preliminary results. Radiology 2006;240:440-448 https://doi.org/10.1148/radiol.2402050606
  14. Venkatesh SK, Wang G, Lim SG, Wee A. Magnetic resonance elastography for the detection and staging of liver fibrosis in chronic hepatitis B. Eur Radiol 2014;24:70-78 https://doi.org/10.1007/s00330-013-2978-8
  15. Tan CH, Venkatesh SK. Magnetic resonance elastography and other magnetic resonance imaging techniques in chronic liver disease: current status and future directions. Gut Liver 2016;10:672-686 https://doi.org/10.5009/gnl15492
  16. Lee YJ, Lee JM, Lee JE, Lee KB, Lee ES, Yoon JH, et al. MR elastography for noninvasive assessment of hepatic fibrosis: reproducibility of the examination and reproducibility and repeatability of the liver stiffness value measurement. J Magn Reson Imaging 2014;39:326-331 https://doi.org/10.1002/jmri.24147
  17. Noone TC, Semelka RC, Siegelman ES, Balci NC, Hussain SM, Kim PN, et al. Budd-Chiari syndrome: spectrum of appearances of acute, subacute, and chronic disease with magnetic resonance imaging. J Magn Reson Imaging 2000;11:44-50 https://doi.org/10.1002/(SICI)1522-2586(200001)11:1<44::AID-JMRI6>3.0.CO;2-O
  18. Cai SF, Gai YH, Liu QW. Computed tomography angiography manifestations of collateral circulations in Budd-Chiari syndrome. Exp Ther Med 2015;9:399-404 https://doi.org/10.3892/etm.2014.2125
  19. Cho OK, Koo JH, Kim YS, Rhim HC, Koh BH, Seo HS. Collateral pathways in Budd-Chiari syndrome: CT and venographic correlation. AJR Am J Roentgenol 1996;167:1163-1167 https://doi.org/10.2214/ajr.167.5.8911174
  20. Wagner M, Corcuera-Solano I, Lo G, Esses S, Liao J, Besa C, et al. Technical failure of MR elastography examinations of the liver: experience from a large single-center study. Radiology 2017;284:401-412 https://doi.org/10.1148/radiol.2016160863
  21. Huang Q, Shen B, Zhang Q, Xu H, Zu M, Gu Y, et al. Comparison of long-term outcomes of endovascular management for membranous and segmental inferior vena cava obstruction in patients with primary Budd-Chiari Syndrome. Circ Cardiovasc Interv 2016;9:e003104
  22. Lee BB, Villavicencio L, Kim YW, Do YS, Koh KC, Lim HK, et al. Primary Budd-Chiari syndrome: outcome of endovascular management for suprahepatic venous obstruction. J Vasc Surg 2006;43:101-108 https://doi.org/10.1016/j.jvs.2005.09.003