Kim SH, Lee JM, Han JK, Lee JY, Lee KH, Han CJ, Jo JY, Yi NJ, Suh KS, Shin KS, Jo SY, Choi BI.
放射科，首尔大学医学院，首尔，韩国

目标：回顾性评价核磁共振（MR）显像在预测候选人是否适合做活体肝脏捐赠者的诊断结果，并将组织病理学结果作为参考标准。

材料和方法：本研究已经过机构审查委员会的同意；所有候选人均知情同意了使用其MR数据进行进一步研究。57名潜在的肝脏捐赠者进行了双回声1.5T的MR显像（40名男性，17名女性；年龄在17至57岁；平均年龄32岁）。两名放射学家对MR显像进行了分级，求同存异。在反相位图像肝性信号强度（SI）变化的基础上，肝脏的三分之一出现了肝性脂肪变性。在定量分析中，放射科研究人员通过对２５个感兴趣的肝区和３个感兴趣的脾脏区域求平均值的方法，计算出了平均肝性SI和平均脾脏SI。研究人员还计算并比较了反相位图像和相位图像中的ＳＩ相对减少（ＲＳＩＤ）。应用线性回归分析法来分析与RSID有关的总脂肪变性程度、大泡性脂肪变程度、小泡性脂肪变程度等，同时还分析了运用诊断结果来预测候选人是否适合做活体肝脏捐赠者。

结果：大泡性脂肪变的组织病理学结果显示，52名候选人适合肝脏捐赠，而剩下的5名则不适宜做器官捐赠者。RSID与总脂肪变性有一定的关联（r=0.850）。如果不适合肝脏捐赠的RSID标准为20%，那么敏感性、特异性和准确性则分别为100%、92.3%和93%。应用RSID时，研究人员发现，4例被认为不适合捐赠的肝脏有不同程度的小泡性脂肪变，组织病理学结果显示大泡性脂肪变也低于中等程度。定性分析和定量分析相对来说比较精确。

结论：当RSID标准小于20%时，双回声MR显像能促使研究人员正确的预测57名候选人中的53名适合做活体肝移植的捐赠者。

Hepatic macrosteatosis: predicting appropriateness of liver donation by using MR imaging--correlation with histopathologic findings
Kim SH, Lee JM, Han JK, Lee JY, Lee KH, Han CJ, Jo JY, Yi NJ, Suh KS, Shin KS, Jo SY, Choi BI.
Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.

PURPOSE: To retrospectively evaluate the diagnostic performance of magnetic resonance (MR) imaging in predicting the appropriateness of liver donation in potential living liver donors by using histopathologic results as the reference standard.

MATERIALS AND METHODS: This study was approved by institutional review board; all patients gave informed consent for the use of MR data for future research. Fifty-seven potential liver donors (40 male, 17 female; age range, 17-57 years; mean age, 32 years) underwent dual-echo 1.5-T MR imaging. Two radiologists qualitatively graded each MR image, with consensus for disagreements. Livers were assigned one of three degrees of hepatic steatosis on the basis of changes in hepatic signal intensity (SI) between in-phase and opposed-phase images.

For quantitative analysis, a third radiologist calculated mean hepatic and mean splenic SI by averaging 25 hepatic regions of interest and three splenic regions of interest. Relative SI decrease (RSID) in the liver on opposed-phase images compared with in-phase images was calculated. Linear regression analysis was used to correlate RSID with the degree of total steatosis, macrosteatosis, and microsteatosis. Diagnostic performance for predicting the appropriateness of liver donation was analyzed.

RESULTS: Histologic findings of macrosteatosis resulted in 52 patients being categorized as appropriate donors, with the remaining five being categorized as inappropriate donors. RSID was correlated with total steatosis (r = 0.850). When the RSID criterion for inappropriateness of liver donation was set at 20%, the sensitivity, specificity, and accuracy were 100%, 92.3%, and 93%, respectively. When RSID was used, four livers that had been misclassified as inappropriate for transplantation were found to have microsteatosis of various degrees and a less than moderate degree of macrosteatosis at histologic analysis. Qualitative and quantitative analyses were comparably accurate.

CONCLUSION: When an RSID criterion of less than 20% was used, dual-echo MR imaging facilitated the correct prediction of appropriateness of liver donation in 53 of 57 patients.

PMID: 16684918 [PubMed - indexed for MEDLINE

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