BACKGROUND Non-invasive assessment of non-alcoholic steatohepatitis(NASH)is increasing in desirability due to the invasive nature and costs associated with the current form of assessment;liver biopsy.Quantitative mult...BACKGROUND Non-invasive assessment of non-alcoholic steatohepatitis(NASH)is increasing in desirability due to the invasive nature and costs associated with the current form of assessment;liver biopsy.Quantitative multiparametric magnetic resonance imaging(mpMRI)to measure liver fat(proton density fat fraction)and fibroinflammatory disease[iron-corrected T1(cT1)],as well as elastography techniques[vibration-controlled transient elastography(VCTE)liver stiffness measure],magnetic resonance elastography(MRE)and 2D Shear-Wave elastography(SWE)to measure stiffness and fat(controlled attenuated parameter,CAP)are emerging alternatives which could be utilised as safe surrogates to liver biopsy.AIM To evaluate the agreement of non-invasive imaging modalities with liver biopsy,and their subsequent diagnostic accuracy for identifying NASH patients.METHODS From January 2019 to February 2020,Japanese patients suspected of NASH were recruited onto a prospective,observational study and were screened using noninvasive imaging techniques;mpMRI with LiverMultiScan®,VCTE,MRE and 2DSWE.Patients were subsequently biopsied,and samples were scored by three independent pathologists.The diagnostic performances of the non-invasive imaging modalities were assessed using area under receiver operating characteristic curve(AUC)with the median of the histology scores as the gold standard diagnoses.Concordance between all three independent pathologists was further explored using Krippendorff’s alpha(a)from weighted kappa statistics.RESULTS N=145 patients with mean age of 60(SD:13 years.),39%females,and 40%with body mass index≥30 kg/m2 were included in the analysis.For identifying patients with NASH,MR liver fat and cT1 were the strongest performing individual measures(AUC:0.80 and 0.75 respectively),and the mpMRI metrics combined(cT1 and MR liver fat)were the overall best non-invasive test(AUC:0.83).For identifying fibrosis≥1,MRE performed best(AUC:0.97),compared to VCTE-liver stiffness measure(AUC:0.94)and 2D-SWE(AUC:0.94).For assessment of steatosis≥1,MR liver fat was the best performing non-invasive test(AUC:0.92),compared to controlled attenuated parameter(AUC:0.75).Assessment of the agreement between pathologists showed that concordance was best for steatosis(a=0.58),moderate for ballooning(a=0.40)and fibrosis(a=0.40),and worst for lobular inflammation(a=0.11).CONCLUSION Quantitative mpMRI is an effective alternative to liver biopsy for diagnosing NASH and non-alcoholic fatty liver,and thus may offer clinical utility in patient management.展开更多
Studies have investigated the effects of heat and temperature variability(TV)on mortality.However,few assessed whether TV modifies the heat-mortality association.Data on daily temperature and mortality in the warm sea...Studies have investigated the effects of heat and temperature variability(TV)on mortality.However,few assessed whether TV modifies the heat-mortality association.Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries.TV was calculated as the standard deviation of the average of the same and previous days’minimum and maximum temperatures.展开更多
文摘BACKGROUND Non-invasive assessment of non-alcoholic steatohepatitis(NASH)is increasing in desirability due to the invasive nature and costs associated with the current form of assessment;liver biopsy.Quantitative multiparametric magnetic resonance imaging(mpMRI)to measure liver fat(proton density fat fraction)and fibroinflammatory disease[iron-corrected T1(cT1)],as well as elastography techniques[vibration-controlled transient elastography(VCTE)liver stiffness measure],magnetic resonance elastography(MRE)and 2D Shear-Wave elastography(SWE)to measure stiffness and fat(controlled attenuated parameter,CAP)are emerging alternatives which could be utilised as safe surrogates to liver biopsy.AIM To evaluate the agreement of non-invasive imaging modalities with liver biopsy,and their subsequent diagnostic accuracy for identifying NASH patients.METHODS From January 2019 to February 2020,Japanese patients suspected of NASH were recruited onto a prospective,observational study and were screened using noninvasive imaging techniques;mpMRI with LiverMultiScan®,VCTE,MRE and 2DSWE.Patients were subsequently biopsied,and samples were scored by three independent pathologists.The diagnostic performances of the non-invasive imaging modalities were assessed using area under receiver operating characteristic curve(AUC)with the median of the histology scores as the gold standard diagnoses.Concordance between all three independent pathologists was further explored using Krippendorff’s alpha(a)from weighted kappa statistics.RESULTS N=145 patients with mean age of 60(SD:13 years.),39%females,and 40%with body mass index≥30 kg/m2 were included in the analysis.For identifying patients with NASH,MR liver fat and cT1 were the strongest performing individual measures(AUC:0.80 and 0.75 respectively),and the mpMRI metrics combined(cT1 and MR liver fat)were the overall best non-invasive test(AUC:0.83).For identifying fibrosis≥1,MRE performed best(AUC:0.97),compared to VCTE-liver stiffness measure(AUC:0.94)and 2D-SWE(AUC:0.94).For assessment of steatosis≥1,MR liver fat was the best performing non-invasive test(AUC:0.92),compared to controlled attenuated parameter(AUC:0.75).Assessment of the agreement between pathologists showed that concordance was best for steatosis(a=0.58),moderate for ballooning(a=0.40)and fibrosis(a=0.40),and worst for lobular inflammation(a=0.11).CONCLUSION Quantitative mpMRI is an effective alternative to liver biopsy for diagnosing NASH and non-alcoholic fatty liver,and thus may offer clinical utility in patient management.
基金HaK was supported by the National Natural Science Foundation of China(92043301,82030103,and 91843302)and China Medical Board Collaborating Program(16-250)AG and FS were supported by the Medical Research Council,UK(MK/M022625/1)+10 种基金the Natural Environment Research Council,UK(NE/R009384/1)and the European Union's Horizon 2020 Project Exhaustion(820655)VH was supported by the Spanish Ministry of Science and Innovation(PCIN-2017-046)and the German Federal Ministry of Education and Research(01 LSI201A2)YH and MH were supported by the Environment Research and Technology Development Fund(JPMEERF15S11412)the Environmental Restoration and Conservation Agency,Japan.JK and AU were supported by the Czech Science Foundation(18-22125S)ST was supported by the Shanghai Municipal Science and Technology Commission(18411951600)Y-LLG was supported by a Career Development Fellowship of the Australian National Health and Medical Research Council(APP1163693)SL was supported by an Early Career Fellowship of the Australian National Health and Medical Research Council(APP1109193)JJKJJ and NR were supported by the Academy of Finland(310372)The funders had no role in considering the study design or in the collection,analysis,interpretation of data,writing of the report,or decision to submit the article for publication.
基金This study was supported by the Australian Research Council(DP210102076)the Australian National Health and Medical Research Council(APP2000581)+12 种基金Y.W and B.W.were supported by the China Scholarship Council(nos.202006010044 and 202006010043)S.L.was supported by an Emerging Leader Fellowship of the Australian National Health and Medical Research Council(no.APP2009866)Y.G.was supported by Career Development Fellowship(no.APP1163693)and Leader Fellowship(no.APP2008813)of the Australian National Health and Medical Research CouncilJ.K.and A.U.were supported by the Czech Science Foundation(project no.20-28560S)N.S.was supported by the National Institute of Environmental Health Sciences-funded HERCULES Center(no.P30ES019776)Y.H.was supported by the Environment Research and Technology Development Fund(JPMEERF15S11412)of the Environmental Restoration and Conservation AgencyM.d.S.Z.S.C.and P.H.N.S.were supported by the São Paulo Research Foundation(FAPESP)H.O.and E.I.were supported by the Estonian Ministry of Education and Research(IUT34-17)J.M.was supported by a fellowship of Fundação para a Ciência e a Tecnlogia(SFRH/BPD/115112/2016)A.G.and F.S.were supported by the Medical Research Council UK(grant ID MR/R013349/1),the Natural Environment Research Council UK(grant ID NE/R009384/1),and the EU’s Horizon 2020 project,Exhaustion(grant ID 820655)A.S.and F.d.D.were supported by the EU’s Horizon 2020 project,Exhaustion(grant ID 820655)V.H.was supported by the Spanish Ministry of Economy,Industry and Competitiveness(grant ID PCIN-2017-046)A.T.byMCIN/AEI/10.13039/501100011033(grant CEX2018-000794-S).Statistics South Africa kindly provided the mortality data,but had no other role in the study.
文摘Studies have investigated the effects of heat and temperature variability(TV)on mortality.However,few assessed whether TV modifies the heat-mortality association.Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries.TV was calculated as the standard deviation of the average of the same and previous days’minimum and maximum temperatures.
