摘要
目的探讨磁共振弥散加权成像（DWI）评价慢性病毒性肝炎患者纤维化和炎症程度的临床应用价值。方法对85例慢性肝炎患者和22名健康志愿者进行前瞻性的DWI检查，选用5个不同b值（100、300、500、800、1000s／mm^2），测量不同b值条件下的肝脏表观弥散系数（ADC）值。对慢性肝炎患者肝穿刺病理改变进行纤维化分期和炎症分级。运用单因素方差分析比较不同纤维化分期之间和不同炎症分级之间ADC值的差异，运用Spearman相关分析探讨ADC值变化和纤维化分期、炎症分级之间的相关性。运用受试者工作曲线评估ADC值预测2期及以上肝纤维化、3期及以上肝纤维化、Ⅰ级及以上炎症活动度的诊断效能。结果ADC值与纤维化分期之间有中度负相关性，b值取800s／mm^2时相关性最佳（r=-0．697，P=0．000）。在不同b值条件下，肝纤维化≤1期与1〉2期之间、纤维化≤2期与≥3期之间肝脏ADC值进行比较，差异均有统计学意义（均P〈0．05）；在b值取800s／mm^2时，DWI诊断／〉2期肝纤维化的曲线下面积为0．909，以ADC值≤1．26×10。mm。／s为标准，敏感性和特异性分别为76．6％和88．3％；DWI诊断≥3期肝纤维化的曲线下面积为0．917，以ADC值≤1．19×10^-3mm^2／s为标准，敏感性为80．0％，特异性为91．5％。ADC值与炎症分级之间有轻中度负相关性。当b值取500s／mm^2时，诊断≥1级肝脏炎症活动度的曲线下面积为0．781，以ADC值≤1．54×10^-3mm^2／s为标准，敏感性为60．0％，特异性为86．4％。结论磁共振弥散加权成像可以初步用于肝纤维化的分期和炎症的分级，为临床肝纤维化的早期诊断和治疗后的随访提供了新的手段。
Objective To evaluate the clinical practical value of apparent diffusion coefficient （ ADC ） measurements based on diffusion-weighted MR imaging （DWI） for quantification of liver fibrosis and inflammation for hepatitis viral infection. Methods Diffusion-weighted MRI with parallel imaging was prospectively performed on 85 patients with chronic hepatitis and on 22 healthy volunteers within a single breath-hold using a single-shot spin-echo echo-planar sequence at b values of 100, 300, 500, 800 and 1000 s/mm^2 respectively. ADC values of liver were measured with five different b values. The inflammation grades and fibrosis stages were evaluated histologically by biopsy. One-way analysis of variance and Spearman＇ s rank correlation test were used for statistical analysis. Receiver operating characteristics analysis was used to assess the performance of ADC in predicting the presence of stage ≥2 and stage ≥3 hepatic fibrosis, and grade ≥1 hepatic inflammation. Results There was moderate negative correlation between hepatic ADC values and fibrosis stage. And the best correlation was obtained for a b value of 800 s/mm^2 （r = - 0. 697, P =0. 000）. At all b values there was a significant decrease in hepatic ADC in patients with stage ≤ 1 versus stage ≥2 fibrosis and stage ≤2 versus stage ≥ 3 fibrosis （P 〈 0. 05 ）. Hepatic ADC was a significant predictor of stage ≥2 and ≥3 fibrosis. The areas under the curve were 0. 909 vs 0. 917, sensitivity 76. 6% vs 80. 0% and specificity 88.3% vs 91.5% （ADC with a b value of 800 s/mm^2, 1.26×10^-3 mm^2/s or less and 1.19×10^-3 mm^2/s or less）. There was weak to moderate negative correlation between ADCs and inflammation grade. Hepatic ADC was a significant predictor of grade ≥1 inflammation with an area under the curve of 0. 781, sensitivity of 60. 0% and specificity of 86. 4% （ADC with a b value of 500 s/mm^2, 1.54×10^-3 mm^2/s or less）. Conclusion The DWI measurement of hepatic ADC can be used to quantify liver fibrosis and inflammation. It will be a new approach for early diagnosis and therapeutic follow-up of hepatic fibrosis.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2009年第25期1757-1761,共5页
National Medical Journal of China
基金
国家自然科学基金（30570532）
关键词
磁共振成像
肝硬化
炎症
Magnetic resonance imaging
Liver cirrhosis
Inflammation
