Predicting gastroesophageal varices through spleen magnetic resonance elastography in pediatric liver fibrosis

查看全文 作　　者：Haesung [1]Yoon;Hyun Joo [1]Shin;Myung-Joon [1]Kim;Seok Joo [2]Han;Hong [3]Koh;Seung [3]Kim;Mi-Jung [1]Lee

机构地区：[1]Department of Radiology,Severance Hospital, Severance Pediatric Liver Disease Research Group, Research Institute of Radiological Science, Yonsei University College of Medicine;[2]Department of Surgery, Severance Hospital, Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine;[3]Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Children's Hospital, Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine

出　　处：《World Journal of Gastroenterology》索引2019年第25卷第3期,共11页

摘　　要：BACKGROUND A recent retrospective study confirmed that hepatic stiffness and splenic stiffness measured with magnetic resonance elastography(MRE) are strongly associated with the presence of esophageal varices. In addition, strong correlations have been reported between splenic stiffness values measured with MRE and hepatic venous pressure gradients in animal models. However, most studies have been conducted on adult populations, and previous pediatric MRE studies have only demonstrated the feasibility of MRE in pediatric populations, while the actual clinical application of spleen MRE has been limited.AIM To assess the utility of splenic stiffness measurements by MRE to predict gastroesophageal varices in children.METHODS We retrospectively reviewed abdominal MRE images taken on a 3 T system in pediatric patients. Patients who had undergone Kasai operations for biliary atresia were selected for the Kasai group, and patients with normal livers and spleens were selected for the control group. Two-dimensional spin-echo echoplanar MRE acquisition centered on the liver, with a pneumatic driver at 60 Hz and a low amplitude, was performed to obtain hepatic and splenic stiffness values. Laboratory results for aspartate aminotransferase to platelet ratio index(APRI) were evaluated within six months of MRE, and the normalized spleen size ratio was determined with the upper normal size limit. All Kasai group patients underwent gastroesophageal endoscopy during routine follow-up. The MannWhitney U test, Kendall's tau b correlation and diagnostic performance analysis using the area under the curve(AUC) were performed for statistical analysis.RESULTS The median spleen MRE value was 5.5 kPa in the control group(n = 9, age 9-18 years, range 4.7-6.4 kPa) and 8.6 kPa in the Kasai group(n = 22, age 4-18 years,range 5.0-17.8 kPa). In the Kasai group, the APRI, spleen size ratio and spleen MRE values were higher in patients with portal hypertension(n = 11) than in patients without(n = 11)(all P < 0.001) and in patients with gastroesophageal varices(n = 6) than in patients without(n = 16)(all P < 0.05), even though their liver MRE values were not different. The APRI(τ = 0.477, P = 0.007), spleen size ratio(τ = 0.401, P = 0.024) and spleen MRE values(τ = 0.426, P = 0.016) also correlated with varices grades. The AUC in predicting gastroesophageal varices was 0.844 at a cut-off of 0.65(100% sensitivity and 75% specificity) for the APRI,and 0.844 at a cut-off of 9.9 kPa(83.3% sensitivity and 81.3% specificity) for spleen MRE values.CONCLUSION At a cut-off of 9.9 kPa, spleen MRE values predicted gastroesophageal varices as well as the APRI and spleen size ratio in biliary atresia patients after the Kasai operation. However, liver MRE values were not useful for this purpose. 关键词：BILIARY ATRESIA Magnetic resonance ELASTOGRAPHY Kasai operation SPLENIC stiffness Portal hypertension

相关文献

参考文献（38）
引证文献（6）
耦合文献（0）

参考文献(38)

引证文献(6)

互联网出版许可证新出网证(渝)字10号全国400电话 - 免长途话费

Predicting gastroesophageal varices through spleen magnetic resonance elastography in pediatric liver fibrosis

参考文献(38)

引证文献(6)

用户提示