|
磁共振弹性成像在肝纤维化中的应用进展:技术创新与临床实践
|
Abstract:
磁共振弹性成像(magnetic resonance elastography, MRE)作为一种非侵入性的医学影像技术,近年来在肝纤维化的检测中展现了重要的应用价值。与传统活检方法相比,MRE不仅避免了取样误差和潜在并发症的风险,而且能够提供整个肝脏的全面信息,实现了从局部到整体的诊断转变。在临床实践中,MRE已被广泛应用于监测肝纤维化患者的病情进展、指导个性化治疗方案的选择,并在预测肝硬化及其并发症方面显示出巨大潜力。本文综述了MRE在肝纤维化中的应用进展,包括其技术原理、临床应用、局限及未来发展方向,特别关注其在肝纤维化监测中的创新应用。通过结合最新的研究成果和临床实践,本文旨在为临床医生和研究人员提供一个全面的视角,以更好地理解和应用这一技术。
Magnetic resonance elastography (MRE), as a non-invasive medical imaging technique, has demonstrated profound application value in the detection of liver fibrosis in recent years. Compared to traditional biopsy methods, MRE not only avoids the risks of sampling errors and potential complications but also provides comprehensive information about the entire liver, achieving a diagnostic shift from local to global assessment. In clinical practice, MRE has been widely used to monitor the progression of liver fibrosis patients, guide the selection of personalized treatment plans, and has shown great potential in predicting liver cirrhosis and its complications. This article reviews the progress of MRE application in liver fibrosis, including its technical principles, clinical applications, limitations, and future development directions, with particular focus on its innovative application in liver fibrosis monitoring. By combining the latest research findings and clinical practices, this article aims to provide clinicians and researchers with a comprehensive perspective to better understand and apply this technology.
[1] | Rojo, D.A., Taouli, B., Leung, H.D., et al. (2024) Imaging-Based Non-Invasive Liver Disease Assessment for Staging Liver Fibrosis in Chronic Liver Disease: A Systematic Review Supporting the AASLD Practice Guideline. Hepatology, 81, 725-748. |
[2] | Ananchuensook, P., Moonlisarn, K., Boonkaew, B., Bunchorntavakul, C. and Tangkijvanich, P. (2025) Diagnostic Performance of Serum Mac-2-Binding Protein Glycosylation Isomer as a Fibrosis Biomarker in Non-Obese and Obese Patients with MASLD. Biomedicines, 13, Article 415. https://doi.org/10.3390/biomedicines13020415 |
[3] | Ali, R., Li, H., Zhang, H., Pan, W., Reeder, S.B., Harris, D., et al. (2025) Multi-Site, Multi-Vendor Development and Validation of a Deep Learning Model for Liver Stiffness Prediction Using Abdominal Biparametric MRI. European Radiology. https://doi.org/10.1007/s00330-024-11312-3 |
[4] | Hennedige, T.P., Wang, G., Leung, F.P., Alsaif, H.S., Teo, L.L., Lim, S.G., et al. (2017) Magnetic Resonance Elastography and Diffusion Weighted Imaging in the Evaluation of Hepatic Fibrosis in Chronic Hepatitis B. Gut and Liver, 11, 401-408. https://doi.org/10.5009/gnl16079 |
[5] | 彭令荣, 孟占鳌, 王劲, 等. 磁共振弹力成像与扩散加权成像诊断慢性乙型病毒性肝炎纤维化程度分级的对比[J]. 实用医学杂志, 2017, 33(17): 2930-2933. |
[6] | Ehman, R.L. (2022) Magnetic Resonance Elastography: From Invention to Standard of Care. Abdominal Radiology, 47, 3028-3036. https://doi.org/10.1007/s00261-022-03597-z |
[7] | Feuille, C., Kari, S., Patel, R., Oberoi, R., Liu, J., Ohliger, M., et al. (2024) Utility and Impact of Magnetic Resonance Elastography in the Clinical Course and Management of Chronic Liver Disease. Scientific Reports, 14, Article No. 1765. https://doi.org/10.1038/s41598-024-51295-1 |
[8] | Choi, S.L., Lee, E.S., Ko, A., Park, H.J., Park, S.B., Choi, B.I., et al. (2019) Technical Success Rates and Reliability of Spin-Echo Echo-Planar Imaging (SE-EPI) MR Elastography in Patients with Chronic Liver Disease or Liver Cirrhosis. European Radiology, 30, 1730-1737. https://doi.org/10.1007/s00330-019-06496-y |
[9] | Serai, S.D. and Trout, A.T. (2018) Can MR Elastography Be Used to Measure Liver Stiffness in Patients with Iron Overload? Abdominal Radiology, 44, 104-109. https://doi.org/10.1007/s00261-018-1723-9 |
[10] | 李哲成, 黄云, 张泽宇, 等. 肝纤维化严重程度预测指标分析与预测模型构建[J]. 中国普通外科杂志, 2020, 29(11): 1364-1369. |
[11] | Priego-Parra, B.A., Triana-Romero, A., Bernal-Reyes, R., Icaza-Chávez, M.E., Martínez-Vázquez, S.E., Amieva-Balmori, M., et al. (2024) Comparative Evaluation of APRI, FIB-4, HFS, and NFS: Scoring Tools for Liver Fibrosis in a Mexican Population with MASLD. Revista de Gastroenterología de México (English Edition), 89, 498-505. https://doi.org/10.1016/j.rgmxen.2024.09.002 |
[12] | Hoffman, D.H., Ayoola, A., Nickel, D., Han, F., Chandarana, H. and Shanbhogue, K.P. (2019) T1 Mapping, T2 Mapping and MR Elastography of the Liver for Detection and Staging of Liver Fibrosis. Abdominal Radiology, 45, 692-700. https://doi.org/10.1007/s00261-019-02382-9 |
[13] | Idilman, I.S., Li, J., Yin, M. and Venkatesh, S.K. (2020) MR Elastography of Liver: Current Status and Future Perspectives. Abdominal Radiology, 45, 3444-3462. https://doi.org/10.1007/s00261-020-02656-7 |
[14] | 古晓利, 潘秋合, 陈建波, 等. 双能量CT增强与磁共振弹性成像联合诊断慢性乙型肝炎肝纤维化的临床价值[J]. 新发传染病电子杂志, 2024, 9(3): 56-60. |
[15] | Alsaqal, S., Hockings, P., Ahlström, H., Gummesson, A., Hedström, A., Hulthe, J., et al. (2021) The Combination of MR Elastography and Proton Density Fat Fraction Improves Diagnosis of Nonalcoholic Steatohepatitis. Journal of Magnetic Resonance Imaging, 56, 368-379. https://doi.org/10.1002/jmri.28040 |
[16] | Liang, Y. and Li, D. (2020) Magnetic Resonance Elastography in Staging Liver Fibrosis in Non-Alcoholic Fatty Liver Disease: A Pooled Analysis of the Diagnostic Accuracy. BMC Gastroenterology, 20, Article No. 89. https://doi.org/10.1186/s12876-020-01234-x |
[17] | Lefebvre, T., Wartelle-Bladou, C., Wong, P., Sebastiani, G., Giard, J., Castel, H., et al. (2019) Prospective Comparison of Transient, Point Shear Wave, and Magnetic Resonance Elastography for Staging Liver Fibrosis. European Radiology, 29, 6477-6488. https://doi.org/10.1007/s00330-019-06331-4 |
[18] | Roy, A., Verma, N., Jajodia, S., Goenka, U., Tiwari, A., Sonthalia, N., et al. (2024) Magnetic Resonance Elastography (MRE) Outperforms Acoustic Force Radiation Impulse (ARFI) in Predicting Oesophageal Varices in Obese NAFLD Cirrhosis. Abdominal Radiology, 49, 3088-3095. https://doi.org/10.1007/s00261-024-04309-5 |
[19] | 王晓培, 韩昕君, 王宇, 等. 磁共振弹性成像测得肝弹力值、脾弹力值对门静脉高压的诊断效能[J]. 中国医学影像学杂志, 2022, 30(12): 1252-1257, 1262. |
[20] | Alsaied, T., Possner, M., Lubert, A.M., Trout, A.T., Szugye, C., Palermo, J.J., et al. (2019) Relation of Magnetic Resonance Elastography to Fontan Failure and Portal Hypertension. The American Journal of Cardiology, 124, 1454-1459. https://doi.org/10.1016/j.amjcard.2019.07.052 |
[21] | 刘盼盼, 胡春峰, 严金明, 等. 磁共振弹性成像在布加综合征患者介入治疗效果评估中的应用价值[J]. 临床放射学杂志, 2019, 38(2): 342-345. |
[22] | Melekoglu Ellik, Z., Idilman, I.S., Kartal, A., Balaban, Y., Elhan, A.H., Karcaaltincaba, M., et al. (2022) Evaluation of Magnetic Resonance Elastography and Transient Elastography for Liver Fibrosis and Steatosis Assessments in the Liver Transplant Setting. The Turkish Journal of Gastroenterology, 33, 153-160. https://doi.org/10.5152/tjg.2022.21705 |
[23] | Gidener, T., Yin, M., Dierkhising, R., Allen, A.M., Ehman, R.L. and Venkatesh, S.K. (2021) 582 Magnetic Resonance Elastography for Prediction of Long-Term Progression and Outcome in Chronic Liver Disease. Gastroenterology, 160, S-787. https://doi.org/10.1016/s0016-5085(21)02596-8 |
[24] | 顾天翊, 陆伦根. 非酒精性脂肪性肝炎患者肝纤维化预后的决定性因素[J]. 肝脏, 2018, 23(5): 375-377. |
[25] | 赵媛, 曹耀章, 李小鹏. 富马酸丙酚替诺福韦联合肝爽颗粒治疗慢性乙肝肝纤维化的疗效及对患者免疫功能和炎症状态的影响[J]. 海南医学, 2023, 34(10): 1383-1387. |
[26] | 周家豪, 李若坤, 严福华. 磁共振弹性成像在慢性肝病中的应用[J]. 肝脏, 2021, 26(2): 112-114. |
[27] | Allen, A.M., Shah, V.H., Therneau, T.M., Venkatesh, S.K., Mounajjed, T., Larson, J.J., et al. (2019) The Role of Three‐dimensional Magnetic Resonance Elastography in the Diagnosis of Nonalcoholic Steatohepatitis in Obese Patients Undergoing Bariatric Surgery. Hepatology, 71, 510-521. https://doi.org/10.1002/hep.30483 |
[28] | Koch, V., Gotta, J., Chernyak, V., Cengiz, D., Torgashov, K., Eichler, K., et al. (2024) Biomechanical Assessment of Liver Integrity: Prospective Evaluation of Mechanical versus Acoustic MR Elastography. Journal of Magnetic Resonance Imaging, 61, 1890-1904. https://doi.org/10.1002/jmri.29560 |
[29] | Yin, M., Glaser, K.J., Talwalkar, J.A., Chen, J., Manduca, A. and Ehman, R.L. (2016) Hepatic MR Elastography: Clinical Performance in a Series of 1377 Consecutive Examinations. Radiology, 278, 114-124. https://doi.org/10.1148/radiol.2015142141 |
[30] | Zeng, Q., Mohammed, S.K., Aleef, T.A., Honarvar, M., Schneider, C., Pang, E.H.T., et al. (2025) Validation of Volumetric Multifrequency Shear Wave Vibro-Elastography with Matrix Array Transducer for the in Vivo Liver. IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control, 72, 178-190. https://doi.org/10.1109/tuffc.2024.3519192 |