대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제81권2호
  • /
  • Pages.365-378
  • /
  • 2020
  • /
  • 1738-2637(pISSN)
  • /
  • 2288-2928(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Fibroscan과 비교를 통한 T1 MR Relaxometry를 이용한 간섬유화의 정량적 평가

Quantitative Evaluation of Liver Fibrosis on T1 Relaxometry in Comparison with Fibroscan

  • 심병학 (전남대학교 의과대학 전남대학교병원 영상의학과) ;
  • 허숙희 (전남대학교 의과대학 화순전남대학교병원 영상의학과) ;
  • 신상수 (전남대학교 의과대학 전남대학교병원 영상의학과) ;
  • 조성범 (전남대학교 의과대학 화순전남대학교병원 소화기내과) ;
  • 정용연 (전남대학교 의과대학 화순전남대학교병원 영상의학과)
  • Byeong Hak Sim (Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Suk Hee Heo (Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • Sang Soo Shin (Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Seong Beom Cho (Department of Gastroenterology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School) ;
  • Yong Yeon Jeong (Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School)
  • 투고 : 2019.01.21
  • 심사 : 2019.08.24
  • 발행 : 2020.03.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목적 본 연구는 gadoxetic acid 조영증강 간 자기공명영상에서 T1 이완시간이 만성간질환을 가진 환자에서 간섬유화의 발견과 병기설정에 유용한지 알아보고자 한다. 대상과 방법 국소간병변이 의심되는 103명 환자들이 간 자기공명영상과 Fibroscan을 시행하였다. Fibroscan은 간섬유화의 정도를 분류하는 참조표준검사로 사용되었다. T1 이완시간은 조영제 주입 전(preT1)과 주입 20분 후(postT1), 그리고 이들 간의 T1 이완시간 감소율(rrT1)을 3 테슬라 자기공명영상의 횡단 3D VIBE 시퀀스 하에 측정하였다. Receiver operating characteristic (이하 ROC) 분석을 통해 간섬유화 병기설정을 위한 최적의 cut-off 값이 결정되었다. 결과 METAVIR score (F0-F4)에 따른 간섬유화 병기가 증가함에 따라, preT1과 postT1은 증가하였고, rrT1은 감소하였다. PreT1의 F2와 F3 사이(F2, 836.0 ± 74.7 ms; F3, 888.6 ± 77.5 ms, p < 0.05), postT1의 F3와 F4 사이(F3, 309.0 ± 80.2 ms; F4, 406.6 ± 147.7 ms, p < 0.05), 그리고 rrT1의 F3와 F4사이(F3, 65.4 ± 7.7%; F4 57.3 ± 11.4%, p < 0.05)에서 통계적 유의미한 차이를 보였다. ROC 분석은 preT1과 postT1의 병용검사가 간섬유화 병기설정에 있어 가장 유용한 검사라는 것을 보여준다. 결론 preT1과 postT1은 간섬유화 병기가 증가함에 따라 증가하며, T1 mapping이 gadoxetic acid 조영증강 간 자기공명영상에서 간섬유화 병기설정에 있어 유용한 보조적 시퀀스로 사용될 수 있다.

Purpose This study was performed to determine whether the T1 relaxation time of gadoxetic acid-enhanced liver MR imaging is useful for detecting and staging liver fibrosis in patients with chronic liver disease. Materials and Methods One hundred and three patients with suspected focal liver lesion underwent MR imaging and Fibroscan. Fibroscan was chosen as the reference standard for classifying liver fibrosis. T1 relaxation times were acquired before (preT1), 20 minutes after (postT1) contrast administration, and reduction rate of T1 relaxation time (rrT1) on transverse 3D VIBE (volumetric interpolated breath-hold examination) sequence using 3T MR imaging. The optimal cut-off values for the fibrosis staging were determined with ROC analysis. Results PreT1 and postT1 increased and rrT1 decreased constantly with increasing severity of liver fibrosis according to the METAVIR score (F0-F4). There were statistically significant differences between F2 and F3 in preT1 (F2, 836.0 ± 74.7 ms; F3, 888.6 ± 77.5 ms, p < 0.05) and between F3 and F4 in postT1 (F3, 309.0 ± 80.2 ms; F4, 406.6 ± 147.7 ms, p < 0.05) and rrT1 (F3, 65.4 ± 7.7%; F4, 57.3 ± 11.4%, p < 0.05). ROC analysis revealed that combination test (preT1 + postT1) was the best test for predicting liver fibrosis. Conclusion PreT1 and postT1 increased constantly with increasing severity of liver fibrosis. T1 mapping in gadoxetic acid-enhanced liver MR imaging could be a helpful complementary sequence to determine the liver fibrosis stage.

키워드

참고문헌

  1. Byass P. The global burden of liver disease: a challenge for methods and for public health. BMC Med 2014;12:159 
  2. Sohrabpour AA, Mohamadnejad M, Malekzadeh R. Review article: the reversibility of cirrhosis. Aliment Pharmacol Ther 2012;36:824-832 
  3. Bruix J, Sherman M; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011;53:1020-1022 
  4. Schuppan D, Kim YO. Evolving therapies for liver fibrosis. J Clin Invest 2013;123:1887-1901 
  5. Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002;97:2614-2618 
  6. Bedossa P, Dargere D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 2003;38:1449-1457 
  7. Lucero C, Brown RS Jr. Noninvasive measures of liver fibrosis and severity of liver disease. Gastroenterol Hepatol (N Y) 2016;12:33-40 
  8. Pang JX, Zimmer S, Niu S, Crotty P, Tracey J, Pradhan F, et al. Liver stiffness by transient elastography predicts liver-related complications and mortality in patients with chronic liver disease. PLoS One 2014;9:e95776 
  9. Degos F, Perez P, Roche B, Mahmoudi A, Asselineau J, Voitot H, et al. Diagnostic accuracy of FibroScan and comparison to liver fibrosis biomarkers in chronic viral hepatitis: a multicenter prospective study (the FIBROSTIC study). J Hepatol 2010;53:1013-1021 
  10. Mueller S, Sandrin L. Liver stiffness: a novel parameter for the diagnosis of liver disease. Hepat Med 2010;2:49-67 
  11. Nguyen D, Talwalkar JA. Noninvasive assessment of liver fibrosis. Hepatology 2011;53:2107-2110 
  12. Pang JX, Pradhan F, Zimmer S, Niu S, Crotty P, Tracey J, et al. The feasibility and reliability of transient elastography using FibroscanⓇ: a practice audit of 2335 examinations. Can J Gastroenterol Hepatol 2014;28:143-149 
  13. Tsuda N, Harada K, Matsui O. Effect of change in transporter expression on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging during hepatocarcinogenesis in rats. J Gastroenterol Hepatol 2011;26:568-576 
  14. Kim T, Murakami T, Hasuike Y, Gotoh M, Kato N, Takahashi M, et al. Experimental hepatic dysfunction: evaluation by MRI with Gd-EOB-DTPA. J Magn Reson Imaging 1997;7:683-688 
  15. Tsuda N, Matsui O. Cirrhotic rat liver: reference to transporter activity and morphologic changes in bile canaliculi--gadoxetic acid-enhanced MR imaging. Radiology 2010;256:767-773 
  16. Yoon JH, Lee JM, Kim E, Okuaki T, Han JK. Quantitative liver function analysis: volumetric T1 mapping with fast multisection B1 inhomogeneity correction in hepatocyte-specific contrast-enhanced liver MR imaging. Radiology 2016;282:408-417 
  17. Haimerl M, Verloh N, Zeman F, Fellner C, Muller-Wille R, Schreyer AG, et al. Assessment of clinical signs of liver cirrhosis using T1 mapping on Gd-EOB-DTPA-enhanced 3T MRI. PLoS One 2013;8:e85658 
  18. Haimerl M, Utpatel K, Verloh N, Zeman F, Fellner C, Nickel D, et al. Gd-EOB-DTPA-enhanced MR relaxometry for the detection and staging of liver fibrosis. Sci Rep 2017;7:41429 
  19. Haimerl M, Schlabeck M, Verloh N, Zeman F, Fellner C, Nickel D, et al. Volume-assisted estimation of liver function based on Gd-EOB-DTPA-enhanced MR relaxometry. Eur Radiol 2016;26:1125-1133 
  20. Heye T, Yang SR, Bock M, Brost S, Weigand K, Longerich T, et al. MR relaxometry of the liver: significant elevation of T1 relaxation time in patients with liver cirrhosis. Eur Radiol 2012;22:1224-1232 
  21. Haimerl M, Verloh N, Fellner C, Zeman F, Teufel A, Fichtner-Feigl S, et al. MRI-based estimation of liver function: Gd-EOB-DTPA-enhanced T1 relaxometry of 3T vs. the MELD score. Sci Rep 2014;4:5621 
  22. Yamada A, Hara T, Li F, Fujinaga Y, Ueda K, Kadoya M, et al. Quantitative evaluation of liver function with use of gadoxetate disodium-enhanced MR imaging. Radiology 2011;260:727-733 
  23. Bensamoun SF, Leclerc GE, Debernard L, Cheng X, Robert L, Charleux F, et al. Cutoff values for alcoholic liver fibrosis using magnetic resonance elastography technique. Alcohol Clin Exp Res 2013;37:811-817 
  24. Foucher J, Chanteloup E, Vergniol J, Castera L, Le Bail B, Adhoute X, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut 2006;55:403-408 
  25. Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. Hepatology 1996;24:289-293 
  26. Thomsen C, Christoffersen P, Henriksen O, Juhl E. Prolonged T1 in patients with liver cirrhosis: an in vivo MRI study. Magn Reson Imaging 1990;8:599-604 
  27. Bataller R, Brenner DA. Liver fibrosis. J Clin Invest 2005;115:209-218 
  28. Rodriguez-Moreno F, Gonzalez-Reimers E, Santolaria-Fernandez F, Galindo-Martin L, Hernandez-Torres O, Batista-Lopez N, et al. Zinc, copper, manganese, and iron in chronic alcoholic liver disease. Alcohol 1997;14:39-44 
  29. Kim KA, Park MS, Kim IS, Kiefer B, Chung WS, Kim MJ, et al. Quantitative evaluation of liver cirrhosis using T1 relaxation time with 3 tesla MRI before and after oxygen inhalation. J Magn Reson Imaging 2012;36:405-410 
  30. Seale MK, Catalano OA, Saini S, Hahn PF, Sahani DV. Hepatobiliary-specific MR contrast agents: role in imaging the liver and biliary tree. Radiographics 2009;29:1725-1748 
  31. Verloh N, Haimerl M, Zeman F, Schlabeck M, Barreiros A, Loss M, et al. Assessing liver function by liver enhancement during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MRI at 3 Tesla. Eur Radiol 2014;24:1013-1019 
  32. Tamada T, Ito K, Higaki A, Yoshida K, Kanki A, Sato T, et al. Gd-EOB-DTPA-enhanced MR imaging: evaluation of hepatic enhancement effects in normal and cirrhotic livers. Eur J Radiol 2011;80:e311-316 
  33. Pan S, Wang XQ, Guo QY. Quantitative assessment of hepatic fibrosis in chronic hepatitis B and C: T1 mapping on Gd-EOB-DTPA-enhanced liver magnetic resonance imaging. World J Gastroenterol 2018;24:2024-2035 
  34. Sandrasegaran K, Akisik FM, Lin C, Tahir B, Rajan J, Saxena R, et al. Value of diffusion-weighted MRI for assessing liver fibrosis and cirrhosis. AJR Am J Roentgenol 2009;193:1556-1560 
  35. Bakan AA, Inci E, Bakan S, Gokturk S, Cimilli T. Utility of diffusion-weighted imaging in the evaluation of liver fibrosis. Eur Radiol 2012;22:682-687 
  36. Hagiwara M, Rusinek H, Lee VS, Losada M, Bannan MA, Krinsky GA, et al. Advanced liver fibrosis: diagnosis with 3D whole-liver perfusion MR imaging--initial experience. Radiology 2008;246:926-934 
  37. Chen BB, Hsu CY, Yu CW, Wei SY, Kao JH, Lee HS, et al. Dynamic contrast-enhanced magnetic resonance imaging with Gd-EOB-DTPA for the evaluation of liver fibrosis in chronic hepatitis patients. Eur Radiol 2012;22:171-180 
  38. Tapper EB, Loomba R. Noninvasive imaging biomarker assessment of liver fibrosis by elastography in NAFLD. Nat Rev Gastroenterol Hepatol 2018;15:274-282 
  39. Venkatesh SK, Yin M, Ehman RL. Magnetic resonance elastography of liver: technique, analysis, and clinical applications. J Magn Reson Imaging 2013;37:544-555