磁共振弹性成像在代谢相关脂肪性肝病肝纤维化评价中的应用

张子毅; 尤红; 佟小非

doi:10.12449/JCH260325

磁共振弹性成像在代谢相关脂肪性肝病肝纤维化评价中的应用

DOI: 10.12449/JCH260325

张子毅^{1, 2},
尤红^{1, 2},
佟小非^3, , ,

1.
首都医科大学附属北京友谊医院肝病中心，北京 100050
2.
消化健康全国重点实验室，国家消化系统疾病临床医学研究中心，北京 100050
3.
首都医科大学附属北京友谊医院研究型病房，北京 100050

基金项目:

国家自然科学基金 (82400719);

北京市医院管理中心临床医学发展专项 (ZLRK202501);

北京市医院管理中心临床医学发展专项 (ZLRK202301)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：张子毅负责文章撰写；尤红、佟小非负责研究指导和论文审阅。

详细信息

通信作者:
佟小非， tongxf@163.com （ORCID： 0000-0001-9437-2937）

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出版历程
- 收稿日期: 2025-07-25
- 录用日期: 2025-09-03
- 出版日期: 2026-03-25

Application of magnetic resonance elastography in assessment of liver fibrosis in metabolic dysfunction-associated fatty liver disease

Ziyi ZHANG^{1, 2},
Hong YOU^{1, 2},
Xiaofei TONG^{3
, ,
,}

1.
Liver Research Center，Beijing Friendship Hospital，Capital Medical University，Beijing 100050，China
2.
State Key Laboratory of Digestive Health，National Clinical Research Center for Digestive Diseases，Beijing 100050，China
3.
Research Ward，Beijing Friendship Hospital，Capital Medical University，Beijing 100050，China

Research funding:

National Natural Science Foundation of China (82400719);

Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (ZLRK202501);

Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (ZLRK202301)

More Information

Corresponding author: TONG Xiaofei， tongxf@163.com （ORCID： 0000-0001-9437-2937）

摘要

摘要: 磁共振弹性成像（MRE）已成为代谢相关脂肪性肝病（MAFLD）中诊断和分期纤维化的重要工具，其具有较高的诊断准确性，能够有效评估MAFLD患者肝纤维化的动态变化及其长期预后。此外，MRE在代谢相关脂肪性肝炎新药研发的患者筛选与疗效评估中也显示出广泛潜力。本文综合分析了MRE在评估MAFLD患者肝纤维化方面的潜在价值，并探讨了其在临床实践中的优势和未来的发展方向。
- 代谢相关脂肪性肝病 /
- 肝纤维化 /
- 磁共振弹性成像
Abstract: Magnetic resonance elastography （MRE） has become an important tool for the diagnosis and staging of fibrosis in metabolic dysfunction-associated fatty liver disease （MAFLD）， and its high diagnostic accuracy can help to effectively evaluate the dynamic changes and long-term prognosis of fibrosis in patients with MAFLD. In addition， MRE also shows wide potential in patient screening and outcome assessment in new drug development for metabolic-associated steatohepatitis. This article comprehensively analyzes the potential value of MRE in evaluating liver fibrosis in MAFLD patients， as well as its advantages in clinical practice and future development directions.
- Metabolic Dysfunction-Associated Fatty Liver Disease /
- Liver Fibrosis /
- Magnetic Resonance Elastography

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表 1 以MRE作为入选标准的MASH新药临床试验

Table 1. New drug clinical trials of MASH with MRE as the inclusion criterion

临床试验ID	试验阶段	药物名称	纳入标准
NCT04197479	3期	Resmetirom	MRE≥2.0 kPa且<4.0 kPa
NCT03350165	2期	Pemafibrate	MRE≥2.5 kPa
NCT04710524	2期	FM101	MRE≥2.9 kPa
NCT05084404	2期	Guanabenz	MRE≤3.6 kPa
NCT04550481	2期	Lisinopril	MRE≥5 kPa
NCT02781584	2期	Selonsertib、Firsocostat、Cilofexor、Fenofibrate、Vascepa	MRE≥2.88 kPa
NCT03938246	2期	TVB 2640	MRE≥2.5 kPa
NCT03166735	2期	BI 1467335	MRE≥3.64 kPa
NCT02854605	2期	GS-9674	MRE≥2.5 kPa
NCT04702490	2期	MET409、Empagliflozin	MRE≥2.61 kPa
NCT04773964	2期	MET642	MRE提示的NASH
NCT04342793	2期	ALS-L1023	MRE≥2.5 kPa
NCT02856555	2期	GS-0976	MRE≥2.5 kPa
NCT04669158	1～2期	Idebenone	MRE提示的肝纤维化
NCT06309992	3期	Survodutide	MRE<4.68 kPa
NCT06773221	2期	Chiglitazar	MRE≥4.45 kPa
注：数据来源于https：//clinicaltrials.gov/。MRE，磁共振弹性成像；MASH，代谢相关脂肪性肝炎；NASH，非酒精性脂肪性肝炎。

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表 2 以MRE作为主要终点/次要终点评价指标的MASH新药临床试验

Table 2. New drug clinical trials of MASH with MRE as the primary or secondary endpoint

临床试验ID	试验阶段	药物名称	测量指标	终点类型
NCT04342793	2期	ALS-L1023	基线期与24周治疗后比较MRE-LSM的变化情况	主要终点
NCT06773221	2期	Chiglitazar	相较于基线期治疗72周后MRE-LSM是否下降20%	主要终点
NCT03639623	2期	Saroglitazar	基线到治疗结束期间的MRE-LSM变化	次要终点
NCT02605616	2期	AZ compound	基线期与约12周的治疗后比较MRE-LSM	次要终点
NCT03350165	2期	Pemafibrate	基线期与72周治疗后比较MRE-LSM的变化情况	次要终点
NCT06152991	3期	Godex Carnitine Orotate Complex	第96周治疗后MRE-LSM相较于基线期的变化率，降低> 20%视作肝纤维化改善	次要终点
NCT03459079	2期	Lanifibranor	基线期与24周治疗后MRE-LSM的变化情况	次要终点
NCT04710524	2期	FM101	基线期与91 d治疗后比较MRE-LSM的变化情况	次要终点
NCT05084404	2期	Guanabenz	第24周治疗后MRE-LSM相较于基线期的变化率	次要终点
NCT04235205	2期	Elobixibat、Cholestyramine	第16周治疗后MRE-LSM相较于基线期的绝对变化值	次要终点
NCT04550481	2期	Lisinopril	基线期与24周治疗后比较MRE-LSM的变化情况	次要终点
NCT04378010	2期	EDP-305	基线期与12周治疗后比较MRE-LSM的变化情况	次要终点
NCT03987451	2期	Semaglutide	第48周治疗后MRE-LSM相较于基线期的变化率	次要终点
NCT04669158	1～2期	Idebenone	治疗48周后经MRE评估，肝纤维化等级降低的患者数量	次要终点
NCT03656068	2期	Nitazoxanide	基线期与12、24周治疗后比较MRE-LSM的变化情况及变化率	次要终点
NCT02421094	2期	GR-MD-02	基线期与16周治疗后比较MRE-LSM的变化情况	次要终点
NCT06309992	3期	Survodutide	基线期与48周治疗后比较MRE-LSM的绝对变化值及变化率	次要终点
注：数据来源于https：//clinicaltrials.gov/。MRE，磁共振弹性成像；MASH，代谢相关脂肪性肝炎；LSM，肝硬度值。

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参考文献(44)

[1]	QUEK J, CHAN KE, WONG ZY, et al. Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: A systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2023, 8( 1): 20- 30. DOI: 10.1016/S2468-1253(22)00317-X.
[2]	RINELLA ME, NEUSCHWANDER-TETRI BA, SIDDIQUI MS, et al. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease[J]. Hepatology, 2023, 77( 5): 1797- 1835. DOI: 10.1097/HEP.0000000000000323.
[3]	RIAZI K, AZHARI H, CHARETTE JH, et al. The prevalence and incidence of NAFLD worldwide: A systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2022, 7( 9): 851- 861. DOI: 10.1016/S2468-1253(22)00165-0.
[4]	European Association for the Study of the Liver(EASL), European Association for the Study of Diabetes(EASD), European Association for the Study of Obesity(EASO). EASL-EASD-EASO clinical practice guidelines on the management of metabolic dysfunction-associated steatotic liver disease(MASLD)[J]. J Hepatol, 2024, 81( 3): 492- 542. DOI: 10.1016/j.jhep.2024.04.031.
[5]	Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of metabolic dysfunction-associated(non-alcoholic) fatty liver disease(version 2024)[J]. J Pract Hepatol, 2024, 27( 4): 494- 510. DOI: 10.3760/cma.j.cn501113-20240327-00163. 中华医学会肝病学分会. 代谢相关(非酒精性)脂肪性肝病防治指南(2024年版)[J]. 实用肝脏病杂志, 2024, 27( 4): 494- 510. DOI: 10.3760/cma.j.cn501113-20240327-00163.
[6]	SANYAL AJ, VAN NATTA ML, CLARK J, et al. Prospective study of outcomes in adults with nonalcoholic fatty liver disease[J]. N Engl J Med, 2021, 385( 17): 1559- 1569. DOI: 10.1056/NEJMoa2029349.
[7]	CHHATWAL J, DALGIC OO, CHEN WY, et al. Analysis of a simulation model to estimate long-term outcomes in patients with nonalcoholic fatty liver disease[J]. JAMA Netw Open, 2022, 5( 9): e2230426. DOI: 10.1001/jamanetworkopen.2022.30426.
[8]	PAI RK, JAIRATH V, HOGAN M, et al. Reliability of histologic assessment for NAFLD and development of an expanded NAFLD activity score[J]. Hepatology, 2022, 76( 4): 1150- 1163. DOI: 10.1002/hep.32475.
[9]	LIU ZY, ZHUANG YJ, DONG X, et al. Construction of a non-invasive diagnostic model for liver fibrosis in non-alcoholic fatty liver disease[J]. Clin J Med Offic, 2024, 52( 7): 688- 691. DOI: 10.16680/j.1671-3826.2024.07.07. 刘正一, 庄颖洁, 董旭, 等. 非酒精性脂肪性肝病肝纤维化无创诊断模型构建[J]. 临床军医杂志, 2024, 52( 7): 688- 691. DOI: 10.16680/j.1671-3826.2024.07.07.
[10]	PEPIN KM, WELLE CL, GUGLIELMO FF, et al. Magnetic resonance elastography of the liver: Everything you need to know to get started[J]. Abdom Radiol, 2022, 47( 1): 94- 114. DOI: 10.1007/s00261-021-03324-0.
[11]	QIBA MR Biomarker Committee. Magnetic Resonance Elastography of the Liver, Quantitative Imaging Biomarkers Alliance. P[EB/OL].( 2023-11-07)[ 2024-08-16]. https://qibawiki.rsna.org/images/4/47/MRE-QIBAProfile-2023-11-07-CLINICALLY-FEASIBLE-maintenance.pdf. https://qibawiki.rsna.org/images/4/47/MRE-QIBAProfile-2023-11-07-CLINICALLY-FEASIBLE-maintenance.pdf
[12]	SELVARAJ EA, MÓZES FE, JAYASWAL ANA, et al. Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: A systematic review and meta-analysis[J]. J Hepatol, 2021, 75( 4): 770- 785. DOI: 10.1016/j.jhep.2021.04.044.
[13]	LIANG JX, AMPUERO J, NIU H, et al. An individual patient data meta-analysis to determine cut-offs for and confounders of NAFLD-fibrosis staging with magnetic resonance elastography[J]. J Hepatol, 2023, 79( 3): 592- 604. DOI: 10.1016/j.jhep.2023.04.025.
[14]	FURLAN A, TUBLIN ME, YU L, et al. Comparison of 2D shear wave elastography, transient elastography, and MR elastography for the diagnosis of fibrosis in patients with nonalcoholic fatty liver disease[J]. AJR Am J Roentgenol, 2020, 214( 1): W20- W26. DOI: 10.2214/AJR.19.21267.
[15]	IMAJO K, HONDA Y, KOBAYASHI T, et al. Direct comparison of US and MR elastography for staging liver fibrosis in patients with nonalcoholic fatty liver disease[J]. Clin Gastroenterol Hepatol, 2022, 20( 4): 908- 917. DOI: 10.1016/j.cgh.2020.12.016.
[16]	KIM MN, HAN JW, AN J, et al. KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease[J]. Clin Mol Hepatol, 2024, 30( Suppl): S5- S105. DOI: 10.3350/cmh.2024.0506.
[17]	SIDDIQUI MS, VUPPALANCHI R, VAN NATTA ML, et al. Vibration-controlled transient elastography to assess fibrosis and steatosis in patients with nonalcoholic fatty liver disease[J]. Clin Gastroenterol Hepatol, 2019, 17( 1): 156- 163. DOI: 10.1016/j.cgh.2018.04.043.
[18]	PARK CC, NGUYEN P, HERNANDEZ C, et al. Magnetic resonance elastography vs transient elastography in detection of fibrosis and noninvasive measurement of steatosis in patients with biopsy-proven nonalcoholic fatty liver disease[J]. Gastroenterology, 2017, 152( 3): 598- 607. DOI: 10.1053/j.gastro.2016.10.026.
[19]	CUI J, ANG B, HAUFE W, et al. Comparative diagnostic accuracy of magnetic resonance elastography vs. eight clinical prediction rules for non-invasive diagnosis of advanced fibrosis in biopsy-proven non-alcoholic fatty liver disease: A prospective study[J]. Aliment Pharmacol Ther, 2015, 41( 12): 1271- 1280. DOI: 10.1111/apt.13196.
[20]	XIAO GQ, ZHU SX, XIAO X, et al. Comparison of laboratory tests, ultrasound, or magnetic resonance elastography to detect fibrosis in patients with nonalcoholic fatty liver disease: A meta-analysis[J]. Hepatology, 2017, 66( 5): 1486- 1501. DOI: 10.1002/hep.29302.
[21]	NEWSOME PN, SASSO M, DEEKS JJ, et al. FibroScan-AST(FAST) score for the non-invasive identification of patients with non-alcoholic steatohepatitis with significant activity and fibrosis: A prospective derivation and global validation study[J]. Lancet Gastroenterol Hepatol, 2020, 5( 4): 362- 373. DOI: 10.1016/S2468-1253(19)30383-8.
[22]	NOUREDDIN M, TRUONG E, GORNBEIN JA, et al. MRI-based(MAST) score accurately identifies patients with NASH and significant fibrosis[J]. J Hepatol, 2022, 76( 4): 781- 787. DOI: 10.1016/j.jhep.2021.11.012.
[23]	STERLING RK, LISSEN E, CLUMECK N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection[J]. Hepatology, 2006, 43( 6): 1317- 1325. DOI: 10.1002/hep.21178.
[24]	JUNG J, LOOMBA RR, IMAJO K, et al. MRE combined with FIB-4(MEFIB) index in detection of candidates for pharmacological treatment of NASH-related fibrosis[J]. Gut, 2021, 70( 10): 1946- 1953. DOI: 10.1136/gutjnl-2020-322976.
[25]	KIM BK, TAMAKI N, IMAJO K, et al. Head-to-head comparison between MEFIB, MAST, and FAST for detecting stage 2 fibrosis or higher among patients with NAFLD[J]. J Hepatol, 2022, 77( 6): 1482- 1490. DOI: 10.1016/j.jhep.2022.07.020.
[26]	HAN MAT, VIPANI A, NOUREDDIN N, et al. MR elastography-based liver fibrosis correlates with liver events in nonalcoholic fatty liver patients: A multicenter study[J]. Liver Int, 2020, 40( 9): 2242- 2251. DOI: 10.1111/liv.14593.
[27]	GIDENER T, AHMED OT, LARSON JJ, et al. Liver stiffness by magnetic resonance elastography predicts future cirrhosis, decompensation, and death in NAFLD[J]. Clin Gastroenterol Hepatol, 2021, 19( 9): 1915- 1924. DOI: 10.1016/j.cgh.2020.09.044.
[28]	AJMERA VH, LIU A, SINGH S, et al. Clinical utility of an increase in magnetic resonance elastography in predicting fibrosis progression in nonalcoholic fatty liver disease[J]. Hepatology, 2020, 71( 3): 849- 860. DOI: 10.1002/hep.30974.
[29]	GIDENER T, DIERKHISING RA, MARA KC, et al. Change in serial liver stiffness measurement by magnetic resonance elastography and outcomes in NAFLD[J]. Hepatology, 2023, 77( 1): 268- 274. DOI: 10.1002/hep.32594.
[30]	Food and Drug Administration. Noncirrhotic nonalcoholic steatohepatitis with liver fibrosis: Developing drugs for treatment[EB/OL].( 2018-12-04)[ 2024-08-16]. https://www.federalregister.gov/documents/2018/12/04/2018-26333/noncirrhotic-nonalcoholic-steatohepatitis-with-liver-fibrosis-developing-drugs-for-treatment-draft. https://www.federalregister.gov/documents/2018/12/04/2018-26333/noncirrhotic-nonalcoholic-steatohepatitis-with-liver-fibrosis-developing-drugs-for-treatment-draft
[31]	National Medical Products Administration. Guidelines for clinical trials of drugs for treatment of nonalcoholic steatohepatitis(interim)[EB/OL].( 2019-12-20)[ 2024-08-16]. https://www.nmpa.gov.cn/xxgk/ggtg/ypggtg/ypqtggtg/20191220141201879.html. https://www.nmpa.gov.cn/xxgk/ggtg/ypggtg/ypqtggtg/20191220141201879.html 国家药品监督管理局. 非酒精性脂肪性肝炎治疗药物临床试验指导原则(试行)[EB/OL].( 2019-12-20)[ 2024-08-16]. https://www.nmpa.gov.cn/xxgk/ggtg/ypggtg/ypqtggtg/20191220141201879.html. https://www.nmpa.gov.cn/xxgk/ggtg/ypggtg/ypqtggtg/20191220141201879.html
[32]	CHEUNG A, NEUSCHWANDER-TETRI BA, KLEINER DE, et al. Defining improvement in nonalcoholic steatohepatitis for treatment trial endpoints: Recommendations from the liver forum[J]. Hepatology, 2019, 70( 5): 1841- 1855. DOI: 10.1002/hep.30672.
[33]	WANG J, GLASER KJ, ZHANG TH, et al. Assessment of advanced hepatic MR elastography methods for susceptibility artifact suppression in clinical patients[J]. J Magn Reson Imaging, 2018, 47( 4): 976- 987. DOI: 10.1002/jmri.25818.
[34]	YIN ZY, MURPHY MC, LI JH, et al. Prediction of nonalcoholic fatty liver disease(NAFLD) activity score(NAS) with multiparametric hepatic magnetic resonance imaging and elastography[J]. Eur Radiol, 2019, 29( 11): 5823- 5831. DOI: 10.1007/s00330-019-06076-0.
[35]	ALLEN AM, SHAH VH, THERNEAU TM, et al. The role of three-dimensional magnetic resonance elastography in the diagnosis of nonalcoholic steatohepatitis in obese patients undergoing bariatric surgery[J]. Hepatology, 2020, 71( 2): 510- 521. DOI: 10.1002/hep.30483.
[36]	SHI Y, QI YF, LAN GY, et al. Three-dimensional MR elastography depicts liver inflammation, fibrosis, and portal hypertension in chronic hepatitis B or C[J]. Radiology, 2021, 301( 1): 154- 162. DOI: 10.1148/radiol.2021202804.
[37]	WU H, ZHU Z, LI JH, et al. Three-dimensional vector MR elastography for evaluating tissue mechanical heterogeneity to assess liver disease progression[J]. Radiology, 2025, 315( 1): e242349. DOI: 10.1148/radiol.242349.
[38]	LI MS, YANG H, LIU Y, et al. Comparison of the diagnostic performance of 2D and 3D MR elastography in staging liver fibrosis[J]. Eur Radiol, 2021, 31( 12): 9468- 9478. DOI: 10.1007/s00330-021-08053-y.
[39]	LU M, WANG MJ, CHEN L. Advances in the application of elastography in noninvasive diagnosis of liver fibrosis in nonalcoholic fatty liver disease[J]. J Clin Hepatol, 2023, 39( 2): 408- 412. DOI: 10.3969/j.issn.1001-5256.2023.02.025. 陆梦, 王铭杰, 陈立. 弹性成像技术在非酒精性脂肪性肝病肝纤维化无创诊断中的应用进展[J]. 临床肝胆病杂志, 2023, 39( 2): 408- 412. DOI: 10.3969/j.issn.1001-5256.2023.02.025.
[40]	KIM DW, KIM SY, YOON HM, et al. Comparison of technical failure of MR elastography for measuring liver stiffness between gradient-recalled echo and spin-echo echo-planar imaging: A systematic review and meta-analysis[J]. J Magn Reson Imaging, 2020, 51( 4): 1086- 1102. DOI: 10.1002/jmri.26918.
[41]	GARTEISER P, DOBLAS S, van BEERS BE. Magnetic resonance elastography of liver and spleen: Methods and applications[J]. NMR Biomed, 2018, 31( 10): e3891. DOI: 10.1002/nbm.3891.
[42]	WANG K, MANNING P, SZEVERENYI N, et al. Repeatability and reproducibility of 2D and 3D hepatic MR elastography with rigid and flexible drivers at end-expiration and end-inspiration in healthy volunteers[J]. Abdom Radiol, 2017, 42( 12): 2843- 2854. DOI: 10.1007/s00261-017-1206-4.
[43]	BOYARKO AC, DILLMAN JR, TKACH JA, et al. Comparison of compressed SENSE and SENSE for quantitative liver MRI in children and young adults[J]. Abdom Radiol, 2021, 46( 10): 4567- 4575. DOI: 10.1007/s00261-021-03092-x.
[44]	DZYUBAK B, LI JH, CHEN J, et al. Automated analysis of multiparametric magnetic resonance imaging/magnetic resonance elastography exams for prediction of nonalcoholic steatohepatitis[J]. J Magn Reson Imaging, 2021, 54( 1): 122- 131. DOI: 10.1002/jmri.27549.