MRI风险分层在代谢功能障碍相关脂肪性肝病中的应用：从弥漫性肝病到局灶性病变
本文为叙述性综述，阐述多参数MRI在MASLD评估中的作用，包括MRI-PDFF、MRE、R2*铁定量和钆塞酸增强MRI等定量生物标志物，用于评估脂肪变、纤维化、铁过载、肝细胞功能和局灶性肝病变，并总结机会性检出、临床显著纤维化识别及纵向监测的价值，同时讨论脂肪肝中的关键影像陷阱。
要点
- 多参数MRI可无创全面评估MASLD的脂肪变、纤维化和铁过载。
- MRI-PDFF、MRE、R2*和钆塞酸增强MRI提供互补的定量信息。
- 注意脂肪肝中病灶显影改变、脂肪和硬度分布不均等陷阱。
核心结论
- 多参数MRI支持MASLD的无创全肝评估，有助于影像引导的风险分层和纵向疾病管理。
研究设计与样本
- 叙述性综述，总结多参数MRI在MASLD评估中的临床应用，未报告系统检索范围或纳入文献数量。
关键影像表现/征象
- 脂肪肝可改变局灶性病变的显影性，并出现不均匀脂肪分布和硬度分布。
- 局灶性硬度异常可干扰纤维化评估。
- 非肝硬化MASLD中肝细胞癌的诊断存在挑战。
诊断标准与关键数值
- 定量MRI生物标志物包括MRI-PDFF评估脂肪变、MRE评估纤维化、R2*定量铁过载、钆塞酸增强MRI评估肝细胞功能和局灶病变。
临床应用与阅片要点
- 可将多参数MRI定量指标整合到MASLD风险分层和纵向监测中。
- 阅片时需警惕脂肪肝中病灶显影改变、不均匀脂肪和硬度分布及局灶性硬度异常。
- 非肝硬化MASLD患者发生肝细胞癌时诊断难度增加，需仔细评估。
局限性
- 叙述性综述，未报告系统检索策略、纳入文献数量及证据分级。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide. Hepatic steatosis, its imaging hallmark, is a frequent incidental finding in abdominal imaging, often prompting further clinical evaluation. Despite this, the integration of imaging-derived biomarkers into structured risk stratification pathways and longitudinal disease management remains inconsistent in clinical practice. This narrative review outlines the role of multiparametric magnetic resonance imaging (MRI) in the assessment of MASLD, focusing on clinically actionable applications for abdominal radiology. Quantitative MRI biomarkers - including proton density fat fraction (MRI-PDFF), magnetic resonance elastography (MRE), R2* iron quantification, and gadoxetic acid-enhanced MRI - provide complementary information for evaluation of steatosis, fibrosis, iron overload, hepatocellular function, and focal liver lesions. The contribution of multiparametric MRI to opportunistic disease detection, identification of clinically significant fibrosis, and longitudinal monitoring of disease progression and therapeutic response is summarized. Key imaging pitfalls in steatotic livers are addressed, including altered lesion conspicuity, heterogeneous fat and stiffness distribution, focal stiffness abnormalities, and diagnostic challenges related to hepatocellular carcinoma in non-cirrhotic MASLD. Multiparametric MRI enables comprehensive, noninvasive, whole-liver evaluation of MASLD and supports imaging-informed risk stratification and longitudinal disease management in abdominal radiology practice.
引用
- Carboni G, Concatto NH, Vanceta R, et al. MRI risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD): from diffuse liver disease to focal lesions. Abdom Radiol (NY). 2026. PMID: 41986476. doi:10.1007/s00261-026-05502-4
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。