Multiparametrische quantitative Magnetresonanztomografie bei Lebererkrankungen

Zusammenfassung

Die MRT wird routinemäßig bei Patienten mit einer Erkrankung der Leber zum Ausschluss oder zur Verlaufskontrolle einer strukturellen Parenchymveränderung eingesetzt. Durch spezielle MRT-Sequenzen und -Techniken lassen sich Eigenschaften der Leber bezüglich Funktion, Fibrosestadium, Fett- und Eisengehalt quantifizieren. Die MRT hilft sowohl bei der ersten Diagnostik eines Krankheitsbildes als auch bei der Überprüfung des Therapieansprechens.

Abstract

In clinical routine, invasive liver biopsy is considered to be the reference standard for clarifying the aetiology of an unclear liver disease, quantifying hepatic inflammation, steatosis hepatis or liver iron content and for graduation of liver fibrosis stage. However, this invasive procedure has a number of disadvantages and limitations. Liver fibrosis is the common final stage of many chronic liver diseases and may lead to liver cirrhosis. In principle, fibrotic changes of liver parenchyma are reversible, thus non-invasive early detection and characterization methods are of high clinical relevance.

Non-invasive diagnostic imaging methods – in particular multiparametric quantitative magnetic resonance imaging (MRI) – will be established in clinical practice for determining fat and iron content and estimation of liver function. The liver iron concentration can be determined quantitatively using signal intensity ratio (SIR)- method and the relaxometry method by determining R2 and R2* values. Using proton density fat fraction (PDFF) and magnetic resonance spectroscopy the fat content of the liver can be determined non-invasively. Gd-EOB-DTPA-enhanced MRI offers the possibility to estimate global as well as segmental liver function using T1 relaxometry. The possibility to make statements about composition of the liver, liver anatomy, lesion characteristics and the function of entire liver or various liver segments in the sense of a “one-stop-shop” with a single MRI examination gains in importance in terms of health economics.

Kernaussagen

• Die Leberfibrose ist die gemeinsame Endstrecke vieler chronischer Lebererkrankungen und führt unbehandelt zur Leberzirrhose. Da die Leberfibrose prinzipiell reversibel ist, sind nicht invasive Früherkennungsmethoden von großer klinischer Relevanz.

• In der klinischen Routine gilt die invasive Leberbiopsie als Referenzstandard zur Klärung der Ätiologie einer unklaren Lebererkrankung, zur Quantifizierung der hepatischen Inflammation, der Steatosis hepatis oder des Lebereisengehalts sowie zur Graduierung des Leberfibrosestadiums. Dieses invasive Verfahren hat jedoch einige Nachteile und etliche Einschränkungen.

• Zur Bestimmung des Fett- und Eisengehalts etablieren sich im klinischen Alltag nicht invasive bildgebende Diagnosemethoden – insbesondere die multiparametrische quantitative MRT.

• Die Gd-EOB-DTPA-gestützte MRT bietet die Möglichkeit der globalen sowie segmentalen Leberfunktionsdiagnostik.

• Die Lebereisenkonzentration kann quantitativ in der MRT mittels der Signal-Intensity-Ratio-Methode sowie der Relaxometriemethode unter Bestimmung von R2- und R2*-Werten bestimmt werden.

• Mittels Protonendichte-Fettfraktion (PDFF) sowie Magnetresonanzspektroskopie (MRS) kann der Fettgehalt der Leber nicht invasiv quantitativ bestimmt werden.

• Die Möglichkeit, mit einer einzigen MRT-Untersuchung Aussagen sowohl über die Leberanatomie, Läsionseigenschaften sowie die Funktion der gesamten Leber oder der verschiedenen einzelnen Lebersegmente im Sinne eines „one-stop-shop“ zu treffen, gewinnt auf sozialmedizinischer und gesundheitsökonomischer Ebene immer mehr an Bedeutung.

• Allerdings ist zu berücksichtigen, dass manche MR-basierende Methoden noch keinen flächendeckenden Einzug in die klinische Routine erlangt haben, da Validierungen durch Studien noch ausstehen. Zusätzlich sind die Anschaffungskosten für die nötigen Zusatzapplikationen hoch und die genutzten Algorithmen für die Nachbearbeitung noch in der Entwicklungsphase.

Schlüsselwörter

multiparametrische quantitative MRT - Lebererkrankung

Key words

multiparametric quantitative MRI - liver disease

Publication History

Article published online:
27 November 2020

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