Ressonância magnética por elastografia no diagnóstico de fibrose hepática

Abstract

Background: Liver fibrosis can be reversible with specific treatments and its early detection causes treatment to begin before reaching an irreversible degree. Liver biopsy, despite being considered the gold standard for detecting fibrosis, is an invasive method, subject to possible complications such as bleeding, pneumothorax, puncture of biliary trees and death. On the other hand, magnetic resonance elastography (MRE) has been shown to be effective non-invasive method for detecting liver fibrosis. Objective: to evaluate the relationship between demographic and clinical data, liver stiffness and morphological alteration of the hepatic parenchyma. Secondly, to evaluate the predictive factors associated with the morphological alteration of the hepatic parenchyma. Methods: This is a cross-sectional and double blind study. Data from the electronic medical records of these patients were evaluated. MRE was performed at 1.5 T by using a gradient-recalled-echo pulse sequence, and analyzed by two independent readers, blinded to clinical information and morphological scoring. Results: One-hundred twenty three subjects were retrospectively evaluated, with mean age of 52.8±12.7 years, and there was a predominance of males, 73 (59.3%). The mean liver stiffness value was 2.9 kPa (95% CI 2.7 – 3.1). The Cohen's kappa coefficient showed an excellent agreement of 0.931 (95% CI 0.95–0.97) for measured liver stiffness values between readers R1 and R2. Subjects “abnormal” showed a mean liver stiffness significantly higher (4.10 ± 1.45 kPa) compared to those without morphological alteration of the hepatic parenchyma (2.48 ± 0.53 kPa, p < 0.001). In addition, we identified alcoholism (p = 0.044), hepatitis C (p = 0.008) and cirrhosis (p = 0.016) as independent factors associated with morphological alterations of the hepatic parenchyma. Conclusions: Our results found a significant relationship between architecture of the hepatic parenchyma and alcoholism, hepatic comorbidities and liver stiffness. In addition, we observed the alcoholism, hepatitis C, and cirrhosis as independent factors associated with morphological alterations of the hepatic parenchyma.