Análise do valor diagnóstico da ressonância magnética multiparamétrica do fígado para a avaliação não-invasiva da hepatite autoimune
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Data
2023-11-23
Autores
Gomes, Natália Borges Nunes [UNIFESP]
Orientadores
D'Ippolito, Giuseppe [UNIFESP]
Tipo
Tese de doutorado
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Objetivo: Avaliar o desempenho diagnóstico da RM multiparamétrica hepática (RMmp) no estadiamento da fibrose e da inflamação hepáticas em pacientes com hepatite autoimune (HAI), utilizando a histopatologia como padrão de referência. Métodos: Ao longo de 3 anos, foram estudados prospectivamente 33 doentes com HAI submetidos a biópsia hepática e a um protocolo de RMmp, incluindo mapa T1 e elastografia por RM (ERM). A fibrose e a inflamação hepáticas foram graduados por histopatologia de acordo com uma pontuação padronizada para fibrose (F0-F4) e atividade inflamatória (APP0-4). A análise estatística incluiu o teste t independente, o teste U de Mann-Whitney e a análise ROC, esta última para determinar o desempenho da RM no estadiamento da fibrose e na classificação da inflamação. Resultados: O mapa T1 sem contraste mostrou valores significativamente mais elevados em pacientes com fibrose avançada (F 0-2 vs. F 3-4; P < 0,015) e fibrose significativa (F0-1 vs. F2-4; P < 0,005) e em doentes com mais atividade inflamatória (APP 0-1 vs. APP 2-4; P = 0,048). O desempenho diagnóstico foi bom para os grupos de fibrose avançada (AUC 0,835) e significativa (AUC 0,857) e para o grupo de atividade inflamatória (AUC 0,763). O mapa T1 pós-contraste foi capaz de identificar fibrose avançada (F3-4) (P < 0,024), mas não fibrose significativa (F2-4) (P > 0,148) ou atividade inflamatória (P > 0,072). Identificámos pontos de corte para o mapa T1 pré e ERM para obter a maior sensibilidade (MxSE) e especificidade (MxSp) de acordo com o objetivo clínico desejado: Fibrose avançada 618,00 ms e 2,9 kPa (MxSE) e 806,00 ms e 7,0 kPa (MxSp); Fibrose significativa: 592,00 ms e 2,1 kPa (MxSE) e 689,00 ms e 4,6 kPa (MxSp) e Atividade inflamatória 578,00 ms e 2,2kPa (MxSE) e 654,00 ms e 3,0 kPa (MxSp). A AUC do mapa T1 após 20 minutos para fibrose avançada foi 0,822. Semelhante ao mapa T1, a ERM apresentou valores significativamente maiores em pacientes com fibrose avançada (F0-2 vs. F3-4; P < 0,001) e fibrose significativa (F0-1 vs. F2-4; ERM P < 0,004), bem como em pacientes com atividade inflamatória (AAP 0-1 vs. AAP 2-4; P = 0,015). O desempenho diagnóstico da ERM foi melhor para fibrose avançada (F3-4), AUC=0,914, com bons resultados para fibrose significativa (F2-4) (AUC 0,822) e atividade inflamatória (AAP 2-4) (AUC 0,824). Conclusão: O mapa T1 e a ERM demonstraram bom desempenho diagnóstico para detectar inflamação e fibrose em pacientes com HAI.
Objective: To evaluate the diagnostic accuracy of multiparametric liver MRI for staging fibrosis and inflammation in patients with autoimmune hepatitis using histopathology as a reference. Methods: Over 3 years, 33 patients with AIH undergoing liver biopsy and multiparameter liver MRI protocol including T1-mapping with and without liver-specific contrast and MR elastography (MRE) were prospectively studied. Liver fibrosis and inflammation were staged by histopathology according to a standardized score for fibrosis (F0-F4) and inflammatory activity (PPA 0-4). Statistical analysis included independent t-test, Mann-Whitney U-test, and ROC analysis, the latter to determine MRI performance for fibrosis staging and inflammation grading. Results: Unenhanced T1 mapping showed significantly higher values in patients with advanced fibrosis (F 0-2 vs. F 3-4; P < 0.015) and significant fibrosis (F0-1 vs. F2-4; P < 0.005) and in patients with tissue inflammatory activity (PPA 0-1 vs. PPA 2-4; P = 0.048). The diagnostic performance was good for the advanced (AUC 0.835) and significant fibrosis (AUC 0.857) groups and for the inflammatory activity group (AUC 0.763). Post-contrast T1 mapping was able to identify advanced fibrosis (F3-4) (P < 0.024), but not significant fibrosis (F2-4) (P > 0.148) nor inflammatory activity (P > 0.072). We identified cut-off points for T1 map pre and MRE to obtain both the highest sensitivity (MxSE) and specificity (MxSp) according to the clinical objective desidered: Advanced fibrosis 618.00 ms and 2.9 kPa (MxSE) and 806.00 ms and 7.0 kPa (MxSp); Significant fibrosis: 592.00 ms and 2.1 kPa (MxSE) and 689.00 ms and 4.6 kPa (MxSp) and Inflammatory activity 578.00 ms and 2.2kPa (MxSE) and 654.00 ms and 3.0 kPa (MxSp). The AUC of T1 map post 20 min for advanced fibrosis was 0.822. Similar to T1 mapping, MRE showed significantly higher values in patients with advanced fibrosis (F0-2 vs. F3-4; P < 0.001) and significant fibrosis (F0-1 vs. F2-4; MRE P < 0.004) as well as in patients with tissue inflammatory activity (PPA 0-1 vs. PPA 2-4; P = 0.015). The diagnostic performance of MRE was better for advanced fibrosis (F3-4), AUC=0.914. It was good for significant fibrosis (F2-4) (AUC 0.822) and inflammatory activity (PPA 2-4) (AUC 0.824). Conclusion: T1-mapping and MRE sequences showed good diagnostic performance compared to histopathology for detecting significant tissue inflammation and fibrosis in AIH patients. They represent potential noninvasive imaging biomarkers for monitoring disease activity.
Objective: To evaluate the diagnostic accuracy of multiparametric liver MRI for staging fibrosis and inflammation in patients with autoimmune hepatitis using histopathology as a reference. Methods: Over 3 years, 33 patients with AIH undergoing liver biopsy and multiparameter liver MRI protocol including T1-mapping with and without liver-specific contrast and MR elastography (MRE) were prospectively studied. Liver fibrosis and inflammation were staged by histopathology according to a standardized score for fibrosis (F0-F4) and inflammatory activity (PPA 0-4). Statistical analysis included independent t-test, Mann-Whitney U-test, and ROC analysis, the latter to determine MRI performance for fibrosis staging and inflammation grading. Results: Unenhanced T1 mapping showed significantly higher values in patients with advanced fibrosis (F 0-2 vs. F 3-4; P < 0.015) and significant fibrosis (F0-1 vs. F2-4; P < 0.005) and in patients with tissue inflammatory activity (PPA 0-1 vs. PPA 2-4; P = 0.048). The diagnostic performance was good for the advanced (AUC 0.835) and significant fibrosis (AUC 0.857) groups and for the inflammatory activity group (AUC 0.763). Post-contrast T1 mapping was able to identify advanced fibrosis (F3-4) (P < 0.024), but not significant fibrosis (F2-4) (P > 0.148) nor inflammatory activity (P > 0.072). We identified cut-off points for T1 map pre and MRE to obtain both the highest sensitivity (MxSE) and specificity (MxSp) according to the clinical objective desidered: Advanced fibrosis 618.00 ms and 2.9 kPa (MxSE) and 806.00 ms and 7.0 kPa (MxSp); Significant fibrosis: 592.00 ms and 2.1 kPa (MxSE) and 689.00 ms and 4.6 kPa (MxSp) and Inflammatory activity 578.00 ms and 2.2kPa (MxSE) and 654.00 ms and 3.0 kPa (MxSp). The AUC of T1 map post 20 min for advanced fibrosis was 0.822. Similar to T1 mapping, MRE showed significantly higher values in patients with advanced fibrosis (F0-2 vs. F3-4; P < 0.001) and significant fibrosis (F0-1 vs. F2-4; MRE P < 0.004) as well as in patients with tissue inflammatory activity (PPA 0-1 vs. PPA 2-4; P = 0.015). The diagnostic performance of MRE was better for advanced fibrosis (F3-4), AUC=0.914. It was good for significant fibrosis (F2-4) (AUC 0.822) and inflammatory activity (PPA 2-4) (AUC 0.824). Conclusion: T1-mapping and MRE sequences showed good diagnostic performance compared to histopathology for detecting significant tissue inflammation and fibrosis in AIH patients. They represent potential noninvasive imaging biomarkers for monitoring disease activity.
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Citação
GOMES, Natália Borges Nunes. Análise do valor diagnóstico da ressonância magnética multiparamétrica do fígado para a avaliação não-invasiva da hepatite autoimune. 2023. 190 f. Tese (Doutorado em Radiologia Clínica) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2023.