Kronik hepatit B'de, inflamasyon ve fibrozisin derecelendirilmesinde karaciğer spesifik kontrastlı manyetik rezonans görüntüleme, difüzyon ağırlıklı görüntüleme ve fonksiyonel karaciğer parametrelerinin histopatolojik verilerle birliktekorelasyonunun retrospektif olarakkarşılaştırılması
Küçük Resim Yok
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
KHB'de, tedavi ihtiyacının saptanması ve prognozun belirlenmesinde parankimal inflamasyon ve fibrozisin derecesi önemli bir rol oynamaktadır. Çalışmamızda, KHB hastalarında karaciğerde fibrozis ve inflamasyonu öngörmede invaziv olmayan biyobelirteçlerden ALBI, APRI, FIB-4, GPR skorları, GA kontrastlı MRG'de RE ve ADC ölçümlerinin, referans yöntem olarak kabul edilen histopatolojik ISHAK skorlama sistemi ile kıyaslanarak prediktivitesinin retrospektif olarak değerlendirilmesi amaçlanmıştır. Ocak 2012 ve Ekim 2020 tarihleri arasında Tekirdağ Namık Kemal Üniversitesi Hastanesi Radyoloji Ana Bilim Dalı, Girişimsel Radyoloji Polikliniğinde KHB tanısıyla perkütan karaciğer parankim biyopsisi yapılan ve biyopsi ile yakın zamanlı GA kontrastlı MRG'si bulunan 60 hasta çalışmaya dahil edildi. Biyopsi işlemiyle yakın zamanlı bakılan ALBI, APRI, FIB-4, GPR skorları hesaplandı, GA kontrastlı MRG'de RE= [(HBF sinyal intensitesi-kontrastsız faz sinyal intensitesi)/ kontrastsız faz sinyal intensitesi] ve ADC değerleri hesaplandı. Ölçümlerin, ISHAK sınıflamasına göre inflamasyon ve fibrozis dereceleri ile ilişkileri değerlendirildi. Çalışmamızda yaşları 19-73 arasında değişmekte olan, 31'i kadın, 29 'u erkek toplam 60 KHB hastası değerlendirildi. Gruplar arasında yaş ve cinsiyet bakımından anlamlı fark bulunmadı (p<0.05). Biyobelirteçlerden APRI, FIB-4, GPR skorları hem fibrozis hem de inflamasyon dereceleri ile pozitif yönde korele olarak saptanırken, ALBI skoru inflamasyon derecesi ile korelasyon göstermedi. GA kontrastlı MRG'de, RE değeri artan inflamasyon ve fibrozis ile negatif yönde korele olarak izlendi. ADC ölçümlerinin hem inflamasyon hem de fibrozis evreleri ile ilişkisi saptanmadı. Fibrozis <2 ve ?2 gruplarında ALBI değerinin EAA, duyarlılık, özgüllük değerleri sırasıyla 0,746, %66, %72; APRI değerinin EAA, duyarlılık, özgüllük değerleri sırasıyla 0,764, %79, %66; FIB-4 değerinin EAA, duyarlılık, özgüllük değerleri sırasıyla %100, %44; GPR değerinin EAA, duyarlılık, özgüllük değerleri sırasıyla 0,797, %79, %69; ortalama RE değerinin EAA, duyarlılık, özgüllük değerleri sırasıyla 0,736, %62, %72 olarak bulundu. HAİ <6 ve ?6 gruplarında APRI değerinin EAA, duyarlılık,özgüllük değerleri sırasıyla 0,776, %80, %70; FIB-4 değerinin EAA, duyarlılık, özgüllük değerleri sırasıyla 0,709, %92, %41; GPR değerinin EAA, duyarlılık, özgüllük değerlerisırasıyla 0,757, %69, %64; ortalama RE değerinin EAA, duyarlılık, özgüllük değerlerisırasıyla0,692, %53, %76 olarak bulundu. Hepatik inflamasyon ve fibrozisin belirlenmesinde invaziv olmayan yöntemlerden GA kontrastlı MRG'de RE değeri fibrozisi öngörmede inflamasyona göre daha anlamlı olmakla beraber biyokimyasal belirteçler ile kıyaslandığında belirgin üstünlüğü saptanmamıştır. Sonuç olarak KHB'li hastalarda inflamasyon ve fibrozisi belirlemede, GA kontrastlı MRG'den ölçülen RE değeri etkili bir biyobelirteç olup, non-invaziv bir yöntem olarak hastalığın erken tanı ve takibinde kullanılabilir.
In chronic hepatitis B (CHB), the degree of parenchymal inflammation and fibrosis play an important role in determining the need for treatment and determining the prognosis. In the current study, we aimed to retrospectively evaluate the predictivity of noninvasive biomarkers ALBI, APRI, FIB-4, GPR scores, RE and ADC measurements in GA contrast MRI in predicting liver fibrosis and inflammation in CHB patients, by comparing them with the histopathological ISHAK scoring system, which is accepted as a reference method. Between January 2012 and October 2020, 60 patients who underwent percutaneous liver parenchymal biopsy with the diagnosis of CHB in Interventional Radiology Polyclinic of Tekirdağ Namık Kemal University Hospital, Department of Radiology; and those with recent biopsy and GA contrast MRI were included in the study. ALBI, APRI, FIB-4, GPR scores, which were seen recently with the biopsy procedure, were calculated, RE = [(HBF signal intensity-uncontrast phase signal intensity)/ uncontrast phase signal intensity] and ADC values were calculated in GA contrast MRI. The relations of the measurements with the degrees of inflammation and fibrosis according to the ISHAK classification were evaluated. In our study, a total of 60 patients with CHB (31 female and 29 male), aged between 19- 73 years were evaluated. There was no significant difference between the groups compared in terms of age and gender (p<0.05). Biomarkers APRI, FIB-4, and GPR scores were positively correlated with both fibrosis and inflammation degrees, while ALBI score did not correlate with the degree of inflammation. In GA contrast MRI, the RE value was negatively correlated with increased inflammation and fibrosis. ADC measurements were not associated with both inflammation and fibrosis stages. In the fibrosis <2 and ?2 groups, the AUC, sensitivity and specificity values of the ALBI value were 0.746, 66%, 72%, respectively; AUC, sensitivity and specificity values of APRI value were 0.764, 79%, 66%, respectively; AUC, sensitivity and specificity values of the FIB-4 value were 100%, 44%, respectively; AUC, sensitivity, specificity values of GPR value were 0.797, 79%, 69%, respectively; The AUC, sensitivity and specificity values of the mean relative enhancement value were 0.736, 62%, and 72%, respectively. In HAI <6 and ?6 groups, the AUC, sensitivity and specificity values of APRI 49 values were 0.776, 80%, 70%, respectively; AUC, sensitivity and specificity values of FIB-4 value were 0.709, 92%, 41%, respectively; AUC, sensitivity and specificity values of GPR value were 0.757, 69%, 64%, respectively; AUC, sensitivity and specificity of the mean relative enhancement value were 0.692, 53% and 76%, respectively. Although the RE value in GA contrast MRI, which is one of the non-invasive methods in the determination of hepatic inflammation and fibrosis, is more significant than inflammation in predicting fibrosis, it has not been found to be significantly superior when compared to biochemical markers. In light of these findings, RE value is an effective biomarker in determining inflammation and fibrosis in GA contrast MRI, and it is thought that it can be used as a noninvasive method for early diagnosis and follow-up of the disease
In chronic hepatitis B (CHB), the degree of parenchymal inflammation and fibrosis play an important role in determining the need for treatment and determining the prognosis. In the current study, we aimed to retrospectively evaluate the predictivity of noninvasive biomarkers ALBI, APRI, FIB-4, GPR scores, RE and ADC measurements in GA contrast MRI in predicting liver fibrosis and inflammation in CHB patients, by comparing them with the histopathological ISHAK scoring system, which is accepted as a reference method. Between January 2012 and October 2020, 60 patients who underwent percutaneous liver parenchymal biopsy with the diagnosis of CHB in Interventional Radiology Polyclinic of Tekirdağ Namık Kemal University Hospital, Department of Radiology; and those with recent biopsy and GA contrast MRI were included in the study. ALBI, APRI, FIB-4, GPR scores, which were seen recently with the biopsy procedure, were calculated, RE = [(HBF signal intensity-uncontrast phase signal intensity)/ uncontrast phase signal intensity] and ADC values were calculated in GA contrast MRI. The relations of the measurements with the degrees of inflammation and fibrosis according to the ISHAK classification were evaluated. In our study, a total of 60 patients with CHB (31 female and 29 male), aged between 19- 73 years were evaluated. There was no significant difference between the groups compared in terms of age and gender (p<0.05). Biomarkers APRI, FIB-4, and GPR scores were positively correlated with both fibrosis and inflammation degrees, while ALBI score did not correlate with the degree of inflammation. In GA contrast MRI, the RE value was negatively correlated with increased inflammation and fibrosis. ADC measurements were not associated with both inflammation and fibrosis stages. In the fibrosis <2 and ?2 groups, the AUC, sensitivity and specificity values of the ALBI value were 0.746, 66%, 72%, respectively; AUC, sensitivity and specificity values of APRI value were 0.764, 79%, 66%, respectively; AUC, sensitivity and specificity values of the FIB-4 value were 100%, 44%, respectively; AUC, sensitivity, specificity values of GPR value were 0.797, 79%, 69%, respectively; The AUC, sensitivity and specificity values of the mean relative enhancement value were 0.736, 62%, and 72%, respectively. In HAI <6 and ?6 groups, the AUC, sensitivity and specificity values of APRI 49 values were 0.776, 80%, 70%, respectively; AUC, sensitivity and specificity values of FIB-4 value were 0.709, 92%, 41%, respectively; AUC, sensitivity and specificity values of GPR value were 0.757, 69%, 64%, respectively; AUC, sensitivity and specificity of the mean relative enhancement value were 0.692, 53% and 76%, respectively. Although the RE value in GA contrast MRI, which is one of the non-invasive methods in the determination of hepatic inflammation and fibrosis, is more significant than inflammation in predicting fibrosis, it has not been found to be significantly superior when compared to biochemical markers. In light of these findings, RE value is an effective biomarker in determining inflammation and fibrosis in GA contrast MRI, and it is thought that it can be used as a noninvasive method for early diagnosis and follow-up of the disease
Açıklama
Tıp Fakültesi, Radyoloji Ana Bilim Dalı
Anahtar Kelimeler
Radyoloji ve Nükleer Tıp, Radiology and Nuclear Medicine
