BMI依赖性瞬时与MR弹性成像不一致：重度肥胖中纤维化高估风险
该回顾性研究纳入268例MASLD患者，30天内行VCTE和MRE检查，发现高级别跨阈值不一致总体为19.0%，且随BMI升高急剧增加（BMI≥35达64.7%），以TE高估/MRE低为主。BMI每增加5 kg/m2，高级别不一致的比值比近三倍（OR 2.70），提示重度肥胖中VCTE易高估纤维化，需BMI感知的分诊与模态协调。
要点
- BMI≥35的MASLD患者中VCTE与MRE高级别不一致率高达64.7%，报告时需警惕VCTE高估纤维化。
- BMI每增加5 kg/m2，高级别不一致风险近三倍（OR 2.70），重度肥胖者VCTE结果应谨慎解读。
- VCTE与MRE相关性中等（ρ=0.54），分期一致性中等（κ=0.50），两者不可随意互换。
核心结论
- 在MASLD中，VCTE与MRE不一致强烈依赖BMI，在重度肥胖中具有临床后果，支持BMI感知的纤维化分诊和模态协调。
研究设计与样本
- 回顾性研究，纳入268例MASLD成人，均在30天内接受VCTE和MRE检查，以MRE为参考标准评估纤维化分期。
- 采用logistic回归（校正年龄、性别和糖尿病）评估高级别不一致的预测因素，并建立BMI分层校准模型将TE值转为MRE等效评分。
诊断标准与关键数值
- 高级别跨阈值不一致定义为VCTE≥F3且MRE<F2，或MRE≥F3且VCTE<F2。
- VCTE与MRE相关系数Spearman ρ=0.54、log-Pearson r=0.70，分期一致性κ=0.50。
- 高级别不一致总体19.0%，按BMI分层：<25为7.7%、25-29.9为10.3%、30-34.9为21.4%、≥35为64.7%。
- BMI每增加5 kg/m2，高级别不一致的OR=2.70（95%CI 1.93-3.93）。
临床应用与阅片要点
- 对BMI≥35的MASLD患者，VCTE提示进展期纤维化时应警惕高估，建议结合MRE或BMI分层校准模型进行复核。
- 日常报告中可注明VCTE结果受BMI影响，尤其TE高/MRE低的不一致模式在重度肥胖中常见。
局限性
- 回顾性研究设计，可能存在选择偏倚。
- 单中心真实世界队列，结果外推需谨慎。
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
PURPOSE: Elastography is central to fibrosis risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD). While vibration-controlled transient elastography (VCTE) is most widely used, magnetic resonance elastography (MRE) is more accurate. A discordance between them has been reported, and body mass index (BMI) has been proposed as a determinant. We investigated the impact of BMI on VCTE-MRE discordance in a real-world cohort.
METHODS: This retrospective study included 268 adults with MASLD who underwent VCTE and MRE within 30 days. The primary endpoint was high-grade cross-threshold discordance, defined as VCTE ≥ F3 with MRE < F2 or MRE ≥ F3 with VCTE < F2. Secondary endpoints included discordance at ≥F2,≥F3, and ≥ 2-stage disagreement. Predictors of high-grade discordance were evaluated using logistic regression adjusted for age, sex, and diabetes. BMI-stratified calibration models were developed to harmonize TE values into MRE-equivalent scores.
RESULTS: VCTE and MRE showed moderate correlation (Spearman ρ = 0.54; log-Pearson r = 0.70) and moderate staged agreement (κ = 0.50). High-grade discordance occurred in 19.0% overall and increased sharply with BMI: 7.7% (< 25), 10.3% (25-29.9), 21.4% (30-34.9), and 64.7% (≥ 35). Discordance was predominantly TE-high/MRE-low. Multivariable analysis showed that every 5 kg/m2 increase in BMI nearly tripled the odds of high-grade discordance (OR 2.70; 95% CI 1.93-3.93). Calibration modelling revealed that advanced VCTE values in patients with BMI ≥ 35 corresponded to MRE values well below the threshold for advanced fibrosis.
CONCLUSION: In MASLD, VCTE-MRE discordance is strongly BMI-dependent and clinically consequential in severe obesity, supporting BMI-aware fibrosis triage and modality harmonization.
引用
- Roy A, Jajodia S, Chakraborty S, et al. BMI-dependent discordance between transient and MR elastography: risk of fibrosis overestimation in severe obesity. Abdom Radiol (NY). 2026. PMID: 42138746. doi:10.1007/s00261-026-05565-3
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。