MRI改良法测量门静脉右支前间隙改变与肝纤维化、肝硬化病理学分期的相关性研究
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摘要
目的探讨MRI改良测量门静脉右支前间隙与肝纤维化及肝硬化病理学分期的相关性。方法搜集96例(男55例,女41例,平均年龄39岁)经过病理穿刺证实正常肝S0(23例)、肝纤维化S1期(30例)、S2期(13例)、S3期(11例)、S4期或早期肝硬化(10例)和肝硬化患者(9例)的MRI资料,其中,肝穿与MRI检查时间间隔为(10.6±29.2)天。所有患者均行MRI增强后三期横断薄层扫描,对MRI增强门静脉期图像进行垂直于门静脉右支斜矢状重建,在此重建图像测量门静脉右支前壁与左内叶之间距离。将S0期患者做为对照组,分析所测结果与肝纤维化病理学分期的相关性。结果正常S0期门静脉右支前间隙为(6.2±1.7)mm,S1、S2、S3、S4期及肝硬化期分别为(8.2±2.1)mm、(7.6±3.1)mm、(10.8±5.0)mm、(11.0±4.5)mm和(13.3±4.8)mm,经统计学分析S0、S1、S2期与S3、S4及肝硬化各期比较差异具有统计学意义(P<0.05或P<0.01);S0、S1、S2期差异无统计学意义(P>0.05);S3、S4及肝硬化期比较差异无统计学意义(P>0.05)。门静脉右支前间隙与肝纤维化病理分期相关性采用Spearman等级分析,其相关系数r=0.537,P<0.001。ROC曲线显示采用斜矢状位重建法测量出门静脉右支前间隙来判断S≥3期、S≥4期及肝硬化期的曲线下面积分别为0.804、0.819、0.866,其中诊断S≥3期的最适诊断宽度为0.8 cm,敏感性为75.9%,特异性为66.7%;诊断S≥4期最适宽度为0.9 cm,敏感性为78.9%,特异性为76.7%;诊断肝硬化期的最适宽度为1.0 cm,敏感性为88.9%,特异性为79.5%。结论通过改良MRI斜矢状位重建方法测量门静脉右支与肝左内叶前间隙,发现该间隙与肝纤维化病理学分期存在明显的相关性,且该间隙对肝纤维化S≥3期、S≥4期及肝硬化期具有一定的诊断价值。
Objective To investigate the correlation between the space of hilar portal space with different stages of fibrosis of liver in pathology with modified hilar portal space measurement on MRI.Methods MRI images of 96 cases pathologically confirmed liver fibrosis and cirrhosis were retrospectively studied,including fibrosis S1 in 30 patients,S2 in 13 patients,S3 in 11 patients,S4 in 10 patients and cirrhosis in 9 patients.Twenty-three patients proven to be S0 were included in the control group.The oblique sagittal images which were vertical to the right branch of portal vein were reconstructed in MR enhanced portal phase images.The width between anterior wall of the right branch of portal vein and the left medial lobe was measured on the reconstruction images.The correlation between the measured results and pathological stages of liver fibrosis was analyzed.The receiver operating characteristic curve was created for fibrosis/cirrhosis diagnosis.Results The width of anterior space of right portal vein enlarged with the stage of fibrosis.It was significantly greater in group 3 compared to group S0 ~ S1(P < 0.05 or P < 0.01).Spearman rank correlation analysis 1 showed significant positive correlation between the width of anterior space and liver fibrosis staging(r = 0.537,P < 0.001).ROC curve analysis showed the area under curve(AUC) of S≥3、S≥4 and cirrhosis group are 0.804、0.819、0.866.Conclusion The change in the hilar portal space with modified measurement is more positively correlated with liver fibrosis staging,which is of great value to diagnosis and assessment of liver fibrosis in S3,S4 and cirrhosis.
Objective To investigate the correlation between the space of hilar portal space with different stages of fibrosis of liver in pathology with modified hilar portal space measurement on MRI.Methods MRI images of 96 cases pathologically confirmed liver fibrosis and cirrhosis were retrospectively studied,including fibrosis S1 in 30 patients,S2 in 13 patients,S3 in 11 patients,S4 in 10 patients and cirrhosis in 9 patients.Twenty-three patients proven to be S0 were included in the control group.The oblique sagittal images which were vertical to the right branch of portal vein were reconstructed in MR enhanced portal phase images.The width between anterior wall of the right branch of portal vein and the left medial lobe was measured on the reconstruction images.The correlation between the measured results and pathological stages of liver fibrosis was analyzed.The receiver operating characteristic curve was created for fibrosis/cirrhosis diagnosis.Results The width of anterior space of right portal vein enlarged with the stage of fibrosis.It was significantly greater in group 3 compared to group S0 ~ S1(P < 0.05 or P < 0.01).Spearman rank correlation analysis 1 showed significant positive correlation between the width of anterior space and liver fibrosis staging(r = 0.537,P < 0.001).ROC curve analysis showed the area under curve(AUC) of S≥3、S≥4 and cirrhosis group are 0.804、0.819、0.866.Conclusion The change in the hilar portal space with modified measurement is more positively correlated with liver fibrosis staging,which is of great value to diagnosis and assessment of liver fibrosis in S3,S4 and cirrhosis.
引文
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3 蒋宝国,王洪新,李林.门静脉右支前间隙增宽对早期肝硬化诊断价值的多排螺旋CT研究[J].实用放射学杂志,2010,26:500-503.
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8 Rosenthal SJ,Harrison LA,Baxter KG,et al.Doppler US of helical flow in the portal vein[J].Radiographics,1995,15:1103-1111.
2 胡菊林,戴小平,周建波,等.CT评价门静脉右支前间隙改变及与肝纤维化和肝硬化病理学分期的关系[J].中国医学影像学杂志,2014,674-677.
3 蒋宝国,王洪新,李林.门静脉右支前间隙增宽对早期肝硬化诊断价值的多排螺旋CT研究[J].实用放射学杂志,2010,26:500-503.
4 张慧,周庭永,钱学华,等.肝门静脉右支的临床解剖.解剖学报,2011,42:264-268.
5 病毒性肝炎防治方案[J].中华传染病杂志,2001,19:56-62.
6 Lafortune M,Matricardi L,Denys A,et al.Segment 4(the quadrate lobe):a barometer of cirrhotic liver disease at US[J].Radiology,1998,206:157-160.
7 丁可,黄仲奎,龙莉玲,等.慢肝纤维化、肝硬化CT肝脏容积变化与病理学分期的相关性[J].实用放射学杂志,2008,24:35-39.
8 Rosenthal SJ,Harrison LA,Baxter KG,et al.Doppler US of helical flow in the portal vein[J].Radiographics,1995,15:1103-1111.