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Magnetresonanzelastographie der Leber

Magnetic resonance elastography of the liver

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Zusammenfassung

Klinisches/methodisches Problem

Die Leberfibrose lässt sich nichtinvasiv und bildgestützt nur schwer von normal gesundem Gewebe unterscheiden. Morphologische Kenngrößen geben kaum Aufschluss über das Vorliegen einer Leberfibrose, insbesondere der Schweregrad der Erkrankung kann nicht sicher beurteilt werden.

Radiologische Standardverfahren

Diagnose und Graduierung der Leberfibrose sind derzeit keine Aufgabenstellungen der Radiologie, als Goldstandard gilt die Leberpunktion.

Methodische Innovationen

Die Elastographie ist sensitiv auf Veränderungen mechanischer Eigenschaften eines Organs. In der Leber korreliert der Fibrosegrad mit der Steifigkeit. Die Elastographie in der MRT (MRE) nutzt harmonische Schwingungen, welche über bewegungssensitive Phasenkontrastaufnahmetechniken kodiert werden. Aus den aufgenommenen Wellenbildern können Karten viskoelastischer Kenngrößen berechnet werden.

Leistungsfähigkeit

Auf dem derzeitigen Stand der Technik ist die MRE in der Lage, frühe Fibrosegrade (F0–F1) von mittlerer und schwerer Fibrose (F2–F4) mit einer diagnostischen Güte („area under the receiver operating characteristic“, AUROC) von 0,92 abzugrenzen.

Bewertung

Die MRE ist die derzeit genaueste bildgestützte Methode zur Fibrosegraduierung.

Empfehlung für die Praxis

Bei weiterer Verbesserung der diagnostischen Genauigkeit der MRE könnte sich die Methode zu einer Standardmethode in der Leberradiologie entwickeln.

Abstract

Clinical/methodical issue

The early detection of liver fibrosis remains a major challenge in medical imaging.

Standard radiological methods

Nowadays staging of liver fibrosis is not a task for radiological examinations and the gold standard is liver puncture.

Methodical innovations

Elastography is sensitive to the mechanical properties of soft tissues and in the liver stiffness is highly correlated to the degree of fibrosis. In magnetic resonance imaging elastography (MRE) time-harmonic vibrations are induced in the liver and encoded by motion-sensitive phase-contrast sequences. Viscoelastic constants are recovered from the obtained wave images and displayed by so-called elastograms.

Performance

The MRE procedure is able to discriminate low grades of fibrosis (F0-F1) from medium and severe fibrosis (F2-F4) with a diagnostic accuracy (AUROC) of 0.92.

Achievements

Currently, MRE is the most sensitive imaging modality for the noninvasive staging of liver fibrosis.

Practical recommendations

Current technical developments of MRE may further improve the accuracy of the method towards a new gold standard for noninvasive staging of fibrosis by radiologists.

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Authors and Affiliations

  1. Institut für Radiologie, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    I. Sack, T. Fischer & A. Thomas

  2. Institut für Medizinische Informatik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland

    J. Braun

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  1. I. Sack
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  2. T. Fischer
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  3. A. Thomas
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  4. J. Braun
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Correspondence to I. Sack.

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Sack, I., Fischer, T., Thomas, A. et al. Magnetresonanzelastographie der Leber. Radiologe 52, 738–744 (2012). https://doi.org/10.1007/s00117-012-2311-6

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