European Radiology:利用BOLD磁共振成像检测肝移植后急性细胞排斥反应

2022-06-12 shaosai MedSci原创

在MRI中,基于血氧水平的(BOLD)R2*值(由于组织特征和场不均匀性而产生的横向弛豫率)显示了组织中脱氧血红蛋白浓度或铁沉积的可检测变化。

众所周知肝移植是治疗终末期肝病最有效方法之一。对肝移植后的患者来说,最影响生存质量的并发症之一是急性细胞排斥反应(ACR)。肝脏ACR的发生率约为10-40%,5年生存率为70%以上。ACR被定义为在正常细胞水平上对外来组织或器官的免疫反应,通常发生在移植后5至30天之间。ACR表现为异体移植功能的突然下降和肝门、胆管和静脉部分炎症的典型三联症。虽然免疫抑制药物在临床上被广泛使用,但移植后仍会发生各种类型的排斥反应,导致功能下降,甚至需要再次移植。对于ACR患者,通常给予免疫抑制治疗以减少炎症,从而改善肝功能和生存率。

基于排斥活动指数(RAI)组织病理学是诊断肝脏排斥反应的金标准。然而,这是一个侵入性的过程,可能导致出血且不适合监测免疫抑制药物调节后的治疗反应。在MRI中,基于血氧水平的(BOLD)R2*值(由于组织特征和场不均匀性而产生的横向弛豫率)显示了组织中脱氧血红蛋白浓度或铁沉积的可检测变化。虽然R2*值以前曾被用于评估和监测肾移植后的急性排斥反应,但目前仍不清楚BOLD MRI是否可用于检测肝脏ACR和监测免疫抑制治疗后的治疗反应。据我们所知,没有研究使用BOLD MRI进行肝脏ACR的检测

近日,发表在European Radiology杂志的一项研究评估了R2*值对肝脏ACR受体的检测及其在检测免疫抑制治疗后反应的诊断性能,为临床提供了一个无创的、可反复使用的评估肝脏ACR的影像学手段。

55名高度疑似ACR的受者被纳入本研究。每位患者在治疗前都接受了肝脏BOLD MRI、血液生化检查和活检。在55名患者中,19名患有ACR的受体在治疗后接受了随访MRI检查。获得R2*maps后,在肝脏实质上放置五个兴趣区以估计R2*的平均值,进行统计分析。进行ROC分析以评估R2*值在检测ACR患者方面的诊断性能。 

组织病理学结果显示,27名受者患有ACR(14名轻度,11名中度,2名重度),肝脏R2*值明显低于无ACR的患者。ROC分析显示,R2*值对检测ACR的敏感性和特异性分别为82.1%和89.9%。此外,ACR患者的R2*值和肝功能在免疫抑制治疗后明显增加。 

 
 一位52岁的男性LDLT患者(右侧移植)的R2*值的测量。在第5节的3层R2*图上共画了5个ROI(A、B和C)。有运动伪影的图像被排除在外(D)。测量的R2*值为34.7(ROI1)、39.9(ROI2)和36.5(ROI3)、39.9(ROI4)和36.6(ROI5)s-1,因此平均R2*值为37.5s-1

本研究进行了肝脏BOLD MRI、生化和组织学分析,定量评估了R2*值在检测ACR患者方面的表现,并监测了服用免疫抑制药物后的治疗效果。结果表明,R2*值是一个对检测ACR患者具有很高的敏感性和特异性的影像学生物标志物。此外,免疫抑制治疗明显增加了ACR患者的R2*值并提升了肝功能。因此,本研究得出结论,无创的BOLD MRI技术有助于评估肝脏ACR和监测免疫抑制治疗后的治疗反应。

原文出处:

Hsien-Jen Chiang,Ming-Chung Chou,Yi-Hsuan Chuang,et al.Use of blood oxygen level-dependent magnetic resonance imaging to detect acute cellular rejection post-liver transplantation.DOI:10.1007/s00330-022-08574-0

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