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At this stage, drug-induced liver injury (DILI) caused by nonsteroidal anti-inflammatory drugs, antibiotics, immunomodulators (such as immune checkpoint inhibitors), and herbal or dietary supplements is a growing health problem and one of the most common causes of
acute liver failure.
Without liver transplantation (LT), more than 50% of patients die
.
Therefore, early stratification, identification of these high-risk DILI patients, and acceptance of LT are prerequisites for
improved prognosis.
Traditionally, predictive models consisting of different serum biomarkers have been used clinically to predict the prognosis
of DILI.
With the development of MRI technology, multiple MRI sequences have shown potential advantages
in non-invasive assessment of the severity and prognosis of liver disease.
Some studies have found that the apparent diffusion coefficient (ADC), heterogeneous signal intensity of the liver, gallbladder wall edema, or perihepatic edema have great potential
in assessing necrotizing inflammatory activity in viral hepatitis.
Recently, a study published in the journal European Radiology established an MRI-based predictive model by evaluating the MRI of DILI patients and identifying specific MRI features that may be associated with the type, severity, and prognosis of liver injury, providing imaging support
for more accurate and efficient clinical identification of high-risk DILI patients.
This study conducted a retrospective analysis of eligible DILI patients (2016 to 2020) at Beijing Friendship Hospital affiliated to Capital Medical University, and each patient underwent abdominal contrast MRI within 3 months of onset
。 MRI features independently correlated with severity and prognosis were determined by reverse logistic regression, and unadjusted odds (ORs) and 95% confidence intervals (CIs)
were given.
The median age of 180 patients was 55.
5 years, of whom 126 (70.
0%) were female
.
Types of injury included hepatocellular (135 cases, 75.
0%), mixed (23 cases, 12.
8%), and cholestatic (22 cases, 12.
2%)
.
Patients with hepatocellular and mixed injuries had significantly higher rates of perihepatic edema than cholestatic injuries (62.
2%, 47.
8% vs.
18.
2%, p < 0.
001).
In terms of severity, 157 (87.
2%) patients had mild to moderate impairment and 23 (12.
8%) had severe to fatal impairment/LT.
Hepatic surface irregularity (6.
56 (95% CI, 1.
27 to 22.
84)), transient poor hepatic attenuation (THAD) (3.
27 (95% CI, 1.
14 to 9.
36)), and splenomegaly (5.
86 (95% CI, 1.
96 to 17.
53)) were independently associated with
severity.
Eight (4.
4%) patients died/received LT.
THAD (8.
89 (95% CI, 1.
35-58.
43)) and ascites (64.
63 (95% CI, 6.
93-602.
40)) were independently associated
with LT/LRD.
The prediction of LT/LRD at 1 year using the new model using THAD and ascites was 0.
959 (95% CI, 0.
917-1.
000).
Figure A-F MRI results correlate
with histopathological features.
The data is expressed
as a number (percentage).
THAD, transient hepatic attenuation difference; * = P < 0.
05 and ** = P < 0.
01
This study showed that perihepatic edema is associated with different types of liver injury, liver surface irregularity, THAD and splenomegaly are associated with severity, and THAD and ascites have potential clinical value
in predicting the prognosis of LT/LRD within 1 year.
Original source:
Ting Wu,Dawei Yang,Aileen Wee,et al.
Identification of MRI features associated with injury type, severity, and prognosis in drug-induced liver injury.
DOI:10.
1007/s00330-022-09041-6