同步辐射微束X射线荧光技术及磁共振磁敏感成像技术定量测定肝纤维化铁沉积的实验和临床研究
摘要
第一部分3.0T磁共振磁敏感成像技术定量测定大鼠肝纤维化铁沉积的实验研究
目的：评价腹部磁共振磁敏感成像(susceptibility-weighted MR imaging, SWI)技术定量测定一次大剂量注射二甲基亚硝胺(dimethylnitrosamine, DMN)诱导的大鼠肝纤维化模型肝脏铁沉积的应用价值。
材料与方法：单次腹腔内大剂量注射DMN(50mg/kg体重)诱导的SD大鼠肝纤维化铁沉积模型作为实验组(n=50),10只注射相同剂量生理盐水的SD大鼠作为正常对照组。所有实验组和对照组大鼠均接受磁共振腹部SWI扫描、相位值的测量以及组织病理学检查,以确定肝脏铁沉积的存在和程度。其中,实验组大鼠于5个不同时间点(DMN注射后5天、7天、10天、14天和28天)每次随机抽取10只完成上述检查。
结果：47只实验组和10只对照组大鼠纳入最后的数据分析,3只实验组大鼠在DMN注射后3天由于肝脏急性出血坏死死亡。根据组织病理学结果将肝脏铁沉积分成三组(0级(n=10)、Ⅰ级(n=42)和Ⅱ级(n=5)),三组所测得的平均相位值分别为0.0183±0.0697、-0.0302±0.0158和-0.0656±0.0062,三组相位值之间存在统计学差异(F=70.057,p<0.001)。肝脏相位值与组织病理学铁沉积分级之间存在高度负相关(r=-0.843,p<0.01)。另外,DMN注射后5个不同时间点实验组大鼠肝脏的平均相位值分别为-0.0059±0.008、-0.0234±0.0068、-0.0424±0.0061、-0.0589±0.0082和-0.030718±0.0078,而对照组大鼠的平均相位值为0.0183±0.0697,上述六组大鼠肝脏的相位值存在显著性差异(F=132.743,p<0.001)。
结论：腹部磁共振SWI序列是一种敏感的定量测定大鼠肝纤维化铁沉积的新方法,与病理组织学结果呈高度相关性。
第二部分同步辐射微束X射线荧光技术定量测定大鼠肝纤维化铁沉积的实验研究
目的：探讨同步辐射微束X射线荧光(synchrotron radiation X-ray fluorescence, SRXRF)技术定量测定一次大剂量腹腔注射二甲基亚硝胺(dimethylnitrosamine, DMN)诱导的大鼠肝纤维化模型中肝脏铁沉积的应用价值。
材料与方法：应用单次腹腔内大剂量注射DMN(50mg/kg体重)诱导的50只SD大鼠肝纤维化铁沉积模型作为实验组,10只注射相同剂量生理盐水的SD大鼠作为正常对照组。所有的实验组和对照组大鼠肝脏组织均接受SRXRF扫描和组织病理学铁沉积测定。所有样本扫描前均充分干燥。SRXRF扫描时单色光能量为12.5Kev,光斑大小2mm x2mm。铁元素的特异性荧光峰值位于6.40KeV处。实验组大鼠于5个不同时间点(DMN注射后5天、7天、10天、14天和28天)每次随机抽取10只完成SRXRF和组织病理学检查。测量和分析SRXRF检查的铁元素特异性荧光光子数,并和病理铁染色结果进行相关性检验。
结果：47组实验组和10只对照组大鼠纳入最后的数据分析,3只实验组大鼠在DMN注射后3天由于肝脏急性出血坏死死亡。对照组与实验组大鼠SRXRF检查测得的铁元素特异性荧光光子数分别为(4.10±0.91)、(10.01±4.03)x104光子数/g干燥肝组织。两组之间存在显著性差异(Z=-4.574,p<0.01)。根据肝脏组织病理学铁染色结果将铁沉积分为0级(n=10)、Ⅰ级(n=42)和Ⅱ级(n=5),相应三组SRXRF测得的铁元素特异性荧光光子数分别为(4.10±0.91)、(9.16±3.15)、(17.16±3.63)x104光子数/g干燥肝组织,三组之间存在显著性统计学差异(F=33.174,p<0.01)。SRXRF检查所得肝脏铁元素特异性荧光光子数与组织病理学测定的铁沉积之间存在中度正相关(r=0.722,p<0.01)。测定实验组5个不同时间点SRXRF检查所得的肝脏铁元素特异性荧光光子数,其平均值分别为(5.03±1.23)、(8.85±2.66)、(10.39±1.73)、(15.10±4.25)和(9.17±1.77)x104光子数/g干燥肝组织,将对照组和上述五组实验组大鼠SRXRF测得的肝脏铁元素特异性光子数进行比较,结果发现六组之间存在统计学差异(F=25.412,p<0.01)。
结论：SRXRF技术可作为一种无损的定量测定大鼠肝纤维化铁沉积的新技术,不同程度铁沉积的肝脏组织铁元素特异性荧光光子数有显著性差异,和病理铁染色结果之间有中度相关性。
第三部分一、3.0T磁共振磁敏感成像技术定量测定慢性乙型病毒性肝炎患者肝脏铁沉积的临床研究
目的：比较不同TE时间(10ms、5ms和2.5mS)时,磁敏感成像(susceptibility-weighted imaging, SWI)序列用于定量测定慢性乙型病毒性肝炎患者肝脏铁沉积的价值,探讨铁沉积与肝纤维化分期和炎症活动度之间的相关性。
材料和方法：前瞻性入组57个慢性乙型病毒性肝炎患者。所有病人接受腹部磁共振SWI扫描和病理组织学检查。分别测量三个不同的TE值时SWI序列的相位值。选择整个肝右叶进行相位值的测量,避开大血管和伪影。肝脏病理学检查包括半定量的普鲁士兰染色铁沉积分级、肝纤维化分期和炎症活动度分级。ROC曲线用来分析肝脏铁沉积的存在。
结果：共51例患者纳入最终的数据分析,将病理普鲁士兰染色显示的肝脏铁沉积的情况分成五级,0级到4级铁沉积的病例数分别为15、12、12、8、4。选择3个不同TE值(10ms、5ms和2.5ms)时,SWI检出肝脏铁沉积的敏感性和特异性分别为88.89%/66.67%、86.11%/60%和75%/80%。三组TE值时,肝脏组织病理学五组铁沉积分级之间的相位值均存在显著性差异(F=115.01、41.86和31.167；p<0.001)。并且,组织病理学铁沉积分级与相位值之间均呈高度负相关(r=-0.904、-0.856和-0.799；p<0.001)。ROC曲线分析结果显示,三组不同TE值时,当相位值分别大于-0.0453、-0.0127和0.0125时,SWI诊断肝脏铁沉积的敏感性均为100%,特异性分别为86.1%,、80.6%和83.3%。当TE值为10ms和5ms时,SWI的相位值与肝脏炎症活动度呈低度负相关(r=-0.394,-0.368；p=0.004,0.008)。三组SWI的相位值和肝纤维化分期之间均无相关性(p>0.05)。
结论：腹部SWI序列可用于检测慢性乙型病毒性肝炎患者是否存在铁沉积,不同程度铁沉积患者的相位值之间有统计学差异,特别是应用较长的TE值(TE=10ms)时。铁沉积与肝脏炎症活动度相关而与肝纤维化之间无相关性。
第三部分二、3.0T腹部磁共振磁敏感成像技术与T2*加权成像技术定量测定慢性乙型病毒性肝炎患者肝脏铁沉积的比较研究
目的：比较3.0T磁共振腹部磁敏感成像(susceptibility-weighted imaging,SWI)序列与多回波的T2*加权成像(T2*一weighted gradient-echo imaging,T2*WI)序列定量测定慢性乙型病毒性肝炎患者肝脏铁沉积的能力。
材料和方法：前瞻性入组43例慢性乙型病毒性肝炎患者,所有病例同时接受3.0T磁共振腹部SWI、T2*WI序列扫描和肝活检组织病理学检查。SWI序列相位图用于相位值的测量,T2*WI序列T2*map用于T2*值的测量。测量整个肝右叶的相位值和T2*值,避开大血管和伪影。2名病理学家(观察者1和观察者2)共同商讨决定普鲁士兰染色肝脏铁沉积的分级。
结果：39例患者(男/女,29/10),平均年龄27-72(51.69±11.57)岁纳入最后的数据统计,其中0级到4级组织病理学诊断的铁沉积病例数分别为11、8、9、7、4,平均相位值分别为-0.0213±0.0094、-0.05063±0.0010、-0.0589±0.01]7、-0.0940±0.0110、-0.1568±0.0119；T2*值分别为19.65±1.31、15.53±1.96、15.34±1.91、8.36±1.07、4.60±1.50。不同程度铁沉积分级组的相位值和T2*值之间均存在显著性差异(F=139.60、93.91;p<0.001)。肝脏相位值和T2*值均与病理组织学铁沉积分级均呈高度负相关(r=-0.937、-0.898；p<0.001)。然而,肝脏相位值与病理组织学结果的相关性高于T2*值。
结论：腹部SMI与T2*WI均可以用于肝脏铁沉积的定量检测,而前者较后者的检测敏感性更高。
第四部分同步辐射微束X射线荧光技术定量测定肝脏铁沉积的临床研究
目的：应用同步辐射微束X射线荧光(synchrotron radiation X-ray fluorescence, SRXRF)技术定量测定肝脏铁沉积,并探讨铁沉积与肝纤维化分期和炎症活动度的相关性。
材料与方法：前瞻性入组64例拟行肝脏部分切除术(n=58)和肝移植术(n=6)的病例。所取肝脏标本均选用远离肿瘤组织的肝实质区域。所有标本行SRXRF和肝脏组织病理学检查。ROC曲线用于分析肝脏铁沉积和明显铁沉积的存在(组织病理学铁沉积3级和4级)。
结果：64例肝脏标本中,普鲁士兰染色结果显示35例伴有铁沉积,其中,1级到4级的病例数分别为15、9、7、4,无铁沉积(0级)的29例。SRXRF所测得的0级到4级五组肝脏标本铁元素特异性荧光光子数分别为(1.30±0.48)、(2.12±0.55)、(3.23±1.44)、(4.08±0.88)、(6.06±1.51)x105/g干燥肝组织,上述5组的结果存在显著性差异(F=44.166,p<0.001)。铁元素特异性荧光光子数与组织病理学铁分级之间呈高度正相关(r=0.855,p<0.001)。当肝脏铁元素特异性荧光光子数大于1.95x105光子数/g干燥肝组织时.SRXRF诊断肝脏铁沉积的敏感性和特异性为82.9%和89.7%。当肝脏铁元素荧光特异性光子数大于3.43x105光子数/g干燥肝组织时,该技术诊断肝脏明显铁沉积的敏感性和特异性为90.9%和91.7%。另外,铁元素特异性荧光光子数与肝脏炎症活动度呈低度正相关(r=0.252,p=0.045),而与肝纤维化分期之间无相关性(p=0.706)。
结论：SRXRF可用于定量评估肝脏的铁沉积,是一种无损性定量诊断的新技术。临床病例研究结果表明,铁沉积与肝脏的炎症活动度相关而与肝纤维化分期无关。
第五部分3.0T腹部磁敏感成像技术定量测定慢性乙型病毒性肝炎患者的肝脏铁沉积及其与血清铁标记物的相关性研究
目的：分析腹部磁敏感成像(susceptibility-weighted imaging, SWI)序列定量测定慢性乙型病毒性肝炎患者的肝脏铁沉积情况,并探讨该技术与血清铁标记物(血清铁、铁蛋白、转铁蛋白和转铁蛋白饱和度)的相关性。
材料与方法：前瞻性入组327例慢性乙型病毒性肝炎患者,同时纳入50例健康志愿者作为正常对照组。所有病人接受腹部磁共振SWI序列扫描以及血清铁标记物测定,所有正常志愿者仅接受磁共振SWI序列扫描。对所有患者和正常志愿者进行相位值的测量,并依据SWI图像对铁沉积进行分级。
结果：303个慢性乙型病毒性肝炎和47个正常志愿者符合本研究要求,纳入最后的数据分析。77例(25.4%)患者的肝脏存在铁沉积。患者肝脏铁沉积组、无铁沉积组以及正常志愿者组肝脏的平均相位值分别为-0.0710±0.047、-0.0152±0.0103、-0.0141±0.0147。肝脏铁沉积组与无铁沉积组和正常志愿者组之间均存在统计学差异(p<0.001)。患者肝脏无铁沉积组与正常志愿者组的肝脏相位值之间未见统计学差异(p=0.254)。另外,肝脏铁沉积不同等级之间的相位值存在显著性差异(F=84.044,p<0.000)。肝脏铁沉积组血清铁、铁蛋白、转铁蛋白和转铁蛋白饱和度均高于无铁沉积组(p<0.000)。仅血清铁蛋白在肝脏不同程度铁沉积间存在显著性差异(χ2=8.519,p=0.036),并且肝脏相位值与铁蛋白仅呈低度负相关(r=-0.365,p=0.007)。
结论：腹部SWI序列可用于定量测定慢性乙型病毒性肝炎患者肝脏的铁沉积。血清铁标记物中,仅血清铁蛋白在肝脏不同程度铁沉积间存在显著性差异,并与肝脏相位值呈低度负相关。SWI序列是更有效的定量检测肝脏铁沉积的方法。
PartⅠ The experimental study of using3.0T susceptibility-weighted MR imaging to quantitatively assess the hepatic iron deposition in rat liver fibrosis model
Objectives:To assess the value of abdominal susceptibility-weighted MR imaging (SWI) to quantitatively assess the hepatic iron deposition (HID) in a high-dose injection of dimethylnitrosamine (DMN) induced rat liver fibrosis model.
Materials and Methods:Experimental group consisted with SD rats (n=50) with liver fibrosis accompanied by iron deposition induced by a single intraperitoneal injection of a high dose DMN (50mg/kg of body weight).10saline-injected SD rats (using the same dose of DMN) were used as control group. All rats in both experimental and control groups were underwent MR abdominal SWI examinations, liver phase values measurement and histopathological assessment for detecting HID and evaluating its grade. At five timepoints (day5,7,10,14and28after DMN injections),10rats were randomized taken to examinations in experimental group.
Results:A total of47rats in experimental group and10rats in control group were included in the final data analysis and the other3rats in experimental group died on day3after DMN injection for acute submassive hemorrhagic necrosis. The mean liver phase values in histopathological iron deposition grade0(n=10), Ⅰ (n=42) and Ⅱ(n=5) were respectively0.0183±0.0697,-0.0302±0.0158and-0.0656±0.0062. Significant differences were found among these groups and any two of them (F=70.057,p<0.001). A high negative correlation was detected between phase values and histopatho logical iron deposition grades (r=-0.843, p<0.01). Furthermore, the mean phase values in experimental group at the five timepoints (day5,7,10,14, and28after DMN injections) were respectively-0.0059±0.0087,-0.0234±0.0068,-0.0424±0.0061,-0.0589±0.0082,-0.030718±0.0078and in control group were0.0183±0.0697. There were significant differences among these six groups (F=132.743,p<0.001).
Conclusion:Abdominal SWI was a new sensitive method for quantitatively assessing HID in DMN induced rat liver fibrosis, which was highly correlated with the histopathological results.
Part Ⅱ The experimental study of using synchrotron radiation X-ray fluorescence facilities to quantitatively assess the hepatic iron deposition in rat liver fibres is model
Objectives:To discuss the value of synchrotron radiation X-ray fluorescence (SRXRF) facilities to quantitatively assess hepatic iron deposition (HID) in rat liver fibrosis model induced by single high-dose injection of dimethylnitrosamine (DMN).
Materials and Methods:Experimental group consisted with SD rats (n=50) with liver fibrosis accompanied by iron deposition induced by a single intraperitoneal injection of a high dose DMN (50mg/kg ofbody weight).10saline-injected SD rats (using the same dose of DMN) were used as control group. All rats in experimental and control groups were received both SRXRF and histopathological examinations for assessing HID. All samples are fully dried before SRXRF scanning. The energy of monochromatic light in SRXRF examination was12.5KeV and the spot size was2mm x2mm. The peak of iron-specific fluorescence located at6.40keV. Every time10rats at day5,7,10,14and28after DMN injections in experimental groups were received SRXRF and histopathological examinations. The photons of iron in SRXRF were measured and analyzed. Correlation was detected between the photons of iron and histopathological iron deposition grades.
Results:A total of47rats in experimental group and all rats in control group were included in the final data analysis. The other3rats in experimental group died on day3after DMN injection for acute submassive hemorrhagic necrosis. The mean photons of iron in control and experimental groups were (4.10±0.91) and (10.01±4.03) x104Fe photons/g dry liver tissue respectively and significant statistically differences were found between them. Additionally, according to the results of pathological Prussian blue stain, HID divided into three groups (grade0(n=10), Ⅰ (n=42) and Ⅱ (n=5)) and the mean photons in the three groups were (4.10±0.91),(9.16±3.15) and (17.16±3.63) x104Fe photons/g dry liver tissue respectively. Significant statistically differences were also observed among them (F=33.174, p<0.01). A moderate positive correlation was found between the photons of iron and histopathological iron deposition grades (r=0.722， p<0.01). Furthermore, the mean photons of iron at the five timepoints (day5,7,10,14and28after DMN injections) were (5.03±1.23),(8.85±2.66),(10.39±1.73),(15.10±4.25) and (9.17±1.77) x104Fe photons/g dry liver tissue respectively. When compared the photons of iron in these five groups and the controls, significant differences were observed among them (F=25.412,p<0.01).
Conclusion:SRXRF was a new nondestructive analytical technique that could be used to quantitatively assess liver iron concentration in rat liver fibrosis. The mean photons of iron had significant differences in different grade of HID and a moderate positive correlation was detected between iron photons and histopathological iron deposition grades.
PartⅢ-1The clinical study of3.0T abdominal susceptibility-weighted MR imaging to quantitatively assess hepatic iron deposition in chronic hepatitis B patients
Objectives:To assess the value of abdominal susceptibility-weighted MR imaging (SWI) with three TE values (10,5and2.5ms) to quantitatively assess hepatic iron deposition (HID) in patients with chronic hepatitis B (CHB) and to investigate the correlations between HID and the grade of liver fibrosis and inflammatory activity.
Materials and Methods:A total of57CHB patients were prospectively included in this study. All patients were underwent both abdominal SWI and histopatho logical examinations. Liver phase values were measured on the images with three different TE values, which were measured containing the entire right liver avoiding large vessels or artifacts. Histopatho logical evaluations were included semi-quantitative Pearls'Prussian blue stains for iron deposition grade, liver fibrosis scores and inflammatory activity. ROC curves were used to predict HID.
Results:Final data analysis included51patients.36patients were determined with HID based on the results of Pearls'Prussian blue stains. There were15,12,12,8and4patients respectively according the histopatho logical iron deposition grade0to4. The sensitivities and specificities of SWI for the different three TE values (10,5and2.5ms) were88.89%/66.67%,86.11%/60%and75%/80%, respectively. There were statistically significant differences of the liver mean phase values among the histopathological iron deposition grades (F=115.01,41.86and31.167respectively;p<0.001of all) and high negative correlations were observed between them (r=-0.904,-0.856,-0.799; p<0.001). When the phase values were respectively greater than-0.0453,-0.0127and0.0125for the three different TE values, the sensitivities were all100%and the specificities were86.1%,80.6%and83.3%, respectively. Furthermore, low negative correlations were found between the inflammatory activity and phase values in both10and5ms TE values (r=-0.394,-0.368; p=0.004,0.008). However, there were no correlations between phase values and liver fibrosis in all the three different TE values (p>0.05).
Conclusion:Abdominal SWI was able to be used to quantitatively detect HID in CHB patients and the liver phase values had significant differences in different histopathological iron deposition grade particularly when using a longer TE value (TE=10ms). HID was associated with inflammatory activity rather than liver fibrosis.
PartⅢ-2Comparative study of3.0T abdominal susceptibility-weighted imaging and T2*-weighted gradient-echo imaging in quantitatively assessing hepatic iron deposition in patients with chronic hepatitis B
Objectives:To compare the ability of3.0T abdominal susceptibility-weighted imaging (SWI) and multi-echo T2*-weighted gradient-echo imaging (T2*WI) sequences in quantitatively assessing hepatic iron deposition (HID) in patients with chronic hepatitis B (CHB).
Materials and methods:A total of43patients were prospectively included in this study. All of them were consecutive underwent SWI, T2*WI examinations and liver histopathological examination. Phase values were measured in phase images of SWI sequence and T2*values in T2*map. The phase and T2*values were measured contained the entire right liver avoiding large vessels or artifacts. Two pathologists (R1and R2) consulted together in determining the iron deposition grade by Pearls'Prussian blue staining.
Results:39patients (male/female,29/10) aged27-72(51.69±11.57) years were included in the final data analysis. The case numbers were11,8,9,7,4patients respectively according to histopatho logical iron deposition grade0to4and the liver mean phase values were sequentially-0.0213±0.0094,-0.05063±0.0010,-0.0589±0.0117,-0.0940±0.0110,-0.1568±0.0119. The mean T2*values were19.65±1.31,15.53±1.96,15.34±1.91,8.36±1.07,4.60±1.50, respectively. Significant statistically differences were observed in both phase and T2*values among these five different histopatho logical iron grades (F=139.60,93.91;p<0.001). Both phase values and T2*values were found having negative correlations with the histopathological iron deposition grades (r=-0.937,-0.898; p<0.001) and the correlations of histopathological iron grades with phase values were higher than that with T2*values.
Conclusion:Both abdominal SWI and T2*WI could be used to quantitatively assess HID in CHB patients and SWI appeared to have higher sensitivity.
Part IV The clinical study of synchrotron radiation X-ray fluorescence in quantitatively assessing hepatic iron deposition
Objectives:To use synchrotron radiation X-ray fluorescence (SRXRF) facilities to quantitatively assess hepatic iron deposition (HID) and to investigate the relationship between HID and the grade of liver fibrosis and inflammatory activity.
Materials and Methods:A total of64patients were prospectively included in this study (partial liver excision (n=58), liver transplantation (n=6)). All the specimens were selected in the liver parenchyma away from tumor masses and all the required specimens received both SRXRF and histopathological examinations. The receiver operating characteristics (ROC) curves were determined to predict patients with HID and significant iron deposition (histopathological iron grade3and4).
Results:35patients were determined with HID based on the results of Pearls'Prussian blue stains in all the included64patients and there were respectively15,9,7and4patients according to the histopathological iron deposition grade1to4.29patients were not found iron deposition (histopathological iron deposition grade0). The photons of iron assessed by SRXRF in five histopathological iron deposition grades were respectively (1.30±0.48),(2.12±0.55),(3.23±1.44),(4.08±0.88) and (6.06±1.51) x105photons/g dry liver tissue and significantly statistically differences were observed among them (F=44.166, p<0.001). High positive correlation was obtained between histopathological iron grades and the amounts of iron photons (r=0.855,p<0.001). When the photons of iron were more than1.95x105photons/g dry liver tissue, the sensitivity and specificity to predict HID were82.9%and89.7%. Meanwhile, when the photons of iron were more than3.43x105photons/g dry liver, the sensitivity and specificity to predict patients with significant HID were90.9%and91.7%. Furthermore, weak positive correlation was observed between the amounts of photons of iron and inflammatory activity (r=0.252, p=0.045). However, no correlation was found between it with liver fibrosis (p-0.706).
Conclusion:SRXRF was a powerful nondestructive analytical technique that could be used to quantitatively assess HID. In our clinical study, HID was found to associate with inflammatory activity rather than liver fibrosis.
PartV Value of3.0T abdominal susceptibility-weighted MR imaging on quantitatively assessing hepatic iron deposition and to determine its correlations with serum iron markers in chronic hepatitis B patients
Objectives:Using abdominal susceptibility-weighted MR Imaging (SWI) technique to quantitatively assess hepatic iron deposition (HID) in chronic hepatitis B (CHB) patients and to determine its correlations with serum iron markers (serum iron, ferritin, transferrin and transferrin saturation).
Materials and Methods:Patients (n=327) with HBV infection and healthy controls (n=50) were prospectively enrolled. All patients underwent abdominal SWI and were assessed for serum iron markers. Phase values were measured and five grades of hepatic iron deposition were described by SWI.
Results:303patients and47controls were included in the final data analysis. In total,77(25.4%) of patients with HBV infection had HID as determined by SWI. The mean phase values in patients with HID, without HID and normal controls were respectively-0.0710±0.047,-0.0152±0.0103and-0.0141±0.0147. There were significant differences between patients with HID and patients without (p<0.001). However, no significant statistically differences were observed between patients without HID and the normal controls (p=0.254). Phase values were also significantly different across different grades of HID (F=84.044, p<0.001). Levels of serum iron, ferritin, transferrin and transferrin saturation were significantly higher in patients with compared with those without HID (p<0.001). Only serum ferritin levels were significantly different across different grades of HID (x2=8.519,p=0.036) and there was a low negative correlation between serum ferritin levels and phase values (r=-0.365, p=0.007).
Conclusion:Abdominal SWI could be used to quantitatively assess HID in CHB patients. Only serum ferritin levels in serum iron markers were significantly different across different grades of HID and low negative correlation was found between serum ferritin levels and phase values. SWI may represent a more powerful tool to assess HID.
目的：评价腹部磁共振磁敏感成像(susceptibility-weighted MR imaging, SWI)技术定量测定一次大剂量注射二甲基亚硝胺(dimethylnitrosamine, DMN)诱导的大鼠肝纤维化模型肝脏铁沉积的应用价值。
材料与方法：单次腹腔内大剂量注射DMN(50mg/kg体重)诱导的SD大鼠肝纤维化铁沉积模型作为实验组(n=50),10只注射相同剂量生理盐水的SD大鼠作为正常对照组。所有实验组和对照组大鼠均接受磁共振腹部SWI扫描、相位值的测量以及组织病理学检查,以确定肝脏铁沉积的存在和程度。其中,实验组大鼠于5个不同时间点(DMN注射后5天、7天、10天、14天和28天)每次随机抽取10只完成上述检查。
结果：47只实验组和10只对照组大鼠纳入最后的数据分析,3只实验组大鼠在DMN注射后3天由于肝脏急性出血坏死死亡。根据组织病理学结果将肝脏铁沉积分成三组(0级(n=10)、Ⅰ级(n=42)和Ⅱ级(n=5)),三组所测得的平均相位值分别为0.0183±0.0697、-0.0302±0.0158和-0.0656±0.0062,三组相位值之间存在统计学差异(F=70.057,p<0.001)。肝脏相位值与组织病理学铁沉积分级之间存在高度负相关(r=-0.843,p<0.01)。另外,DMN注射后5个不同时间点实验组大鼠肝脏的平均相位值分别为-0.0059±0.008、-0.0234±0.0068、-0.0424±0.0061、-0.0589±0.0082和-0.030718±0.0078,而对照组大鼠的平均相位值为0.0183±0.0697,上述六组大鼠肝脏的相位值存在显著性差异(F=132.743,p<0.001)。
结论：腹部磁共振SWI序列是一种敏感的定量测定大鼠肝纤维化铁沉积的新方法,与病理组织学结果呈高度相关性。
第二部分同步辐射微束X射线荧光技术定量测定大鼠肝纤维化铁沉积的实验研究
目的：探讨同步辐射微束X射线荧光(synchrotron radiation X-ray fluorescence, SRXRF)技术定量测定一次大剂量腹腔注射二甲基亚硝胺(dimethylnitrosamine, DMN)诱导的大鼠肝纤维化模型中肝脏铁沉积的应用价值。
材料与方法：应用单次腹腔内大剂量注射DMN(50mg/kg体重)诱导的50只SD大鼠肝纤维化铁沉积模型作为实验组,10只注射相同剂量生理盐水的SD大鼠作为正常对照组。所有的实验组和对照组大鼠肝脏组织均接受SRXRF扫描和组织病理学铁沉积测定。所有样本扫描前均充分干燥。SRXRF扫描时单色光能量为12.5Kev,光斑大小2mm x2mm。铁元素的特异性荧光峰值位于6.40KeV处。实验组大鼠于5个不同时间点(DMN注射后5天、7天、10天、14天和28天)每次随机抽取10只完成SRXRF和组织病理学检查。测量和分析SRXRF检查的铁元素特异性荧光光子数,并和病理铁染色结果进行相关性检验。
结果：47组实验组和10只对照组大鼠纳入最后的数据分析,3只实验组大鼠在DMN注射后3天由于肝脏急性出血坏死死亡。对照组与实验组大鼠SRXRF检查测得的铁元素特异性荧光光子数分别为(4.10±0.91)、(10.01±4.03)x104光子数/g干燥肝组织。两组之间存在显著性差异(Z=-4.574,p<0.01)。根据肝脏组织病理学铁染色结果将铁沉积分为0级(n=10)、Ⅰ级(n=42)和Ⅱ级(n=5),相应三组SRXRF测得的铁元素特异性荧光光子数分别为(4.10±0.91)、(9.16±3.15)、(17.16±3.63)x104光子数/g干燥肝组织,三组之间存在显著性统计学差异(F=33.174,p<0.01)。SRXRF检查所得肝脏铁元素特异性荧光光子数与组织病理学测定的铁沉积之间存在中度正相关(r=0.722,p<0.01)。测定实验组5个不同时间点SRXRF检查所得的肝脏铁元素特异性荧光光子数,其平均值分别为(5.03±1.23)、(8.85±2.66)、(10.39±1.73)、(15.10±4.25)和(9.17±1.77)x104光子数/g干燥肝组织,将对照组和上述五组实验组大鼠SRXRF测得的肝脏铁元素特异性光子数进行比较,结果发现六组之间存在统计学差异(F=25.412,p<0.01)。
结论：SRXRF技术可作为一种无损的定量测定大鼠肝纤维化铁沉积的新技术,不同程度铁沉积的肝脏组织铁元素特异性荧光光子数有显著性差异,和病理铁染色结果之间有中度相关性。
第三部分一、3.0T磁共振磁敏感成像技术定量测定慢性乙型病毒性肝炎患者肝脏铁沉积的临床研究
目的：比较不同TE时间(10ms、5ms和2.5mS)时,磁敏感成像(susceptibility-weighted imaging, SWI)序列用于定量测定慢性乙型病毒性肝炎患者肝脏铁沉积的价值,探讨铁沉积与肝纤维化分期和炎症活动度之间的相关性。
材料和方法：前瞻性入组57个慢性乙型病毒性肝炎患者。所有病人接受腹部磁共振SWI扫描和病理组织学检查。分别测量三个不同的TE值时SWI序列的相位值。选择整个肝右叶进行相位值的测量,避开大血管和伪影。肝脏病理学检查包括半定量的普鲁士兰染色铁沉积分级、肝纤维化分期和炎症活动度分级。ROC曲线用来分析肝脏铁沉积的存在。
结果：共51例患者纳入最终的数据分析,将病理普鲁士兰染色显示的肝脏铁沉积的情况分成五级,0级到4级铁沉积的病例数分别为15、12、12、8、4。选择3个不同TE值(10ms、5ms和2.5ms)时,SWI检出肝脏铁沉积的敏感性和特异性分别为88.89%/66.67%、86.11%/60%和75%/80%。三组TE值时,肝脏组织病理学五组铁沉积分级之间的相位值均存在显著性差异(F=115.01、41.86和31.167；p<0.001)。并且,组织病理学铁沉积分级与相位值之间均呈高度负相关(r=-0.904、-0.856和-0.799；p<0.001)。ROC曲线分析结果显示,三组不同TE值时,当相位值分别大于-0.0453、-0.0127和0.0125时,SWI诊断肝脏铁沉积的敏感性均为100%,特异性分别为86.1%,、80.6%和83.3%。当TE值为10ms和5ms时,SWI的相位值与肝脏炎症活动度呈低度负相关(r=-0.394,-0.368；p=0.004,0.008)。三组SWI的相位值和肝纤维化分期之间均无相关性(p>0.05)。
结论：腹部SWI序列可用于检测慢性乙型病毒性肝炎患者是否存在铁沉积,不同程度铁沉积患者的相位值之间有统计学差异,特别是应用较长的TE值(TE=10ms)时。铁沉积与肝脏炎症活动度相关而与肝纤维化之间无相关性。
第三部分二、3.0T腹部磁共振磁敏感成像技术与T2*加权成像技术定量测定慢性乙型病毒性肝炎患者肝脏铁沉积的比较研究
目的：比较3.0T磁共振腹部磁敏感成像(susceptibility-weighted imaging,SWI)序列与多回波的T2*加权成像(T2*一weighted gradient-echo imaging,T2*WI)序列定量测定慢性乙型病毒性肝炎患者肝脏铁沉积的能力。
材料和方法：前瞻性入组43例慢性乙型病毒性肝炎患者,所有病例同时接受3.0T磁共振腹部SWI、T2*WI序列扫描和肝活检组织病理学检查。SWI序列相位图用于相位值的测量,T2*WI序列T2*map用于T2*值的测量。测量整个肝右叶的相位值和T2*值,避开大血管和伪影。2名病理学家(观察者1和观察者2)共同商讨决定普鲁士兰染色肝脏铁沉积的分级。
结果：39例患者(男/女,29/10),平均年龄27-72(51.69±11.57)岁纳入最后的数据统计,其中0级到4级组织病理学诊断的铁沉积病例数分别为11、8、9、7、4,平均相位值分别为-0.0213±0.0094、-0.05063±0.0010、-0.0589±0.01]7、-0.0940±0.0110、-0.1568±0.0119；T2*值分别为19.65±1.31、15.53±1.96、15.34±1.91、8.36±1.07、4.60±1.50。不同程度铁沉积分级组的相位值和T2*值之间均存在显著性差异(F=139.60、93.91;p<0.001)。肝脏相位值和T2*值均与病理组织学铁沉积分级均呈高度负相关(r=-0.937、-0.898；p<0.001)。然而,肝脏相位值与病理组织学结果的相关性高于T2*值。
结论：腹部SMI与T2*WI均可以用于肝脏铁沉积的定量检测,而前者较后者的检测敏感性更高。
第四部分同步辐射微束X射线荧光技术定量测定肝脏铁沉积的临床研究
目的：应用同步辐射微束X射线荧光(synchrotron radiation X-ray fluorescence, SRXRF)技术定量测定肝脏铁沉积,并探讨铁沉积与肝纤维化分期和炎症活动度的相关性。
材料与方法：前瞻性入组64例拟行肝脏部分切除术(n=58)和肝移植术(n=6)的病例。所取肝脏标本均选用远离肿瘤组织的肝实质区域。所有标本行SRXRF和肝脏组织病理学检查。ROC曲线用于分析肝脏铁沉积和明显铁沉积的存在(组织病理学铁沉积3级和4级)。
结果：64例肝脏标本中,普鲁士兰染色结果显示35例伴有铁沉积,其中,1级到4级的病例数分别为15、9、7、4,无铁沉积(0级)的29例。SRXRF所测得的0级到4级五组肝脏标本铁元素特异性荧光光子数分别为(1.30±0.48)、(2.12±0.55)、(3.23±1.44)、(4.08±0.88)、(6.06±1.51)x105/g干燥肝组织,上述5组的结果存在显著性差异(F=44.166,p<0.001)。铁元素特异性荧光光子数与组织病理学铁分级之间呈高度正相关(r=0.855,p<0.001)。当肝脏铁元素特异性荧光光子数大于1.95x105光子数/g干燥肝组织时.SRXRF诊断肝脏铁沉积的敏感性和特异性为82.9%和89.7%。当肝脏铁元素荧光特异性光子数大于3.43x105光子数/g干燥肝组织时,该技术诊断肝脏明显铁沉积的敏感性和特异性为90.9%和91.7%。另外,铁元素特异性荧光光子数与肝脏炎症活动度呈低度正相关(r=0.252,p=0.045),而与肝纤维化分期之间无相关性(p=0.706)。
结论：SRXRF可用于定量评估肝脏的铁沉积,是一种无损性定量诊断的新技术。临床病例研究结果表明,铁沉积与肝脏的炎症活动度相关而与肝纤维化分期无关。
第五部分3.0T腹部磁敏感成像技术定量测定慢性乙型病毒性肝炎患者的肝脏铁沉积及其与血清铁标记物的相关性研究
目的：分析腹部磁敏感成像(susceptibility-weighted imaging, SWI)序列定量测定慢性乙型病毒性肝炎患者的肝脏铁沉积情况,并探讨该技术与血清铁标记物(血清铁、铁蛋白、转铁蛋白和转铁蛋白饱和度)的相关性。
材料与方法：前瞻性入组327例慢性乙型病毒性肝炎患者,同时纳入50例健康志愿者作为正常对照组。所有病人接受腹部磁共振SWI序列扫描以及血清铁标记物测定,所有正常志愿者仅接受磁共振SWI序列扫描。对所有患者和正常志愿者进行相位值的测量,并依据SWI图像对铁沉积进行分级。
结果：303个慢性乙型病毒性肝炎和47个正常志愿者符合本研究要求,纳入最后的数据分析。77例(25.4%)患者的肝脏存在铁沉积。患者肝脏铁沉积组、无铁沉积组以及正常志愿者组肝脏的平均相位值分别为-0.0710±0.047、-0.0152±0.0103、-0.0141±0.0147。肝脏铁沉积组与无铁沉积组和正常志愿者组之间均存在统计学差异(p<0.001)。患者肝脏无铁沉积组与正常志愿者组的肝脏相位值之间未见统计学差异(p=0.254)。另外,肝脏铁沉积不同等级之间的相位值存在显著性差异(F=84.044,p<0.000)。肝脏铁沉积组血清铁、铁蛋白、转铁蛋白和转铁蛋白饱和度均高于无铁沉积组(p<0.000)。仅血清铁蛋白在肝脏不同程度铁沉积间存在显著性差异(χ2=8.519,p=0.036),并且肝脏相位值与铁蛋白仅呈低度负相关(r=-0.365,p=0.007)。
结论：腹部SWI序列可用于定量测定慢性乙型病毒性肝炎患者肝脏的铁沉积。血清铁标记物中,仅血清铁蛋白在肝脏不同程度铁沉积间存在显著性差异,并与肝脏相位值呈低度负相关。SWI序列是更有效的定量检测肝脏铁沉积的方法。
PartⅠ The experimental study of using3.0T susceptibility-weighted MR imaging to quantitatively assess the hepatic iron deposition in rat liver fibrosis model
Objectives:To assess the value of abdominal susceptibility-weighted MR imaging (SWI) to quantitatively assess the hepatic iron deposition (HID) in a high-dose injection of dimethylnitrosamine (DMN) induced rat liver fibrosis model.
Materials and Methods:Experimental group consisted with SD rats (n=50) with liver fibrosis accompanied by iron deposition induced by a single intraperitoneal injection of a high dose DMN (50mg/kg of body weight).10saline-injected SD rats (using the same dose of DMN) were used as control group. All rats in both experimental and control groups were underwent MR abdominal SWI examinations, liver phase values measurement and histopathological assessment for detecting HID and evaluating its grade. At five timepoints (day5,7,10,14and28after DMN injections),10rats were randomized taken to examinations in experimental group.
Results:A total of47rats in experimental group and10rats in control group were included in the final data analysis and the other3rats in experimental group died on day3after DMN injection for acute submassive hemorrhagic necrosis. The mean liver phase values in histopathological iron deposition grade0(n=10), Ⅰ (n=42) and Ⅱ(n=5) were respectively0.0183±0.0697,-0.0302±0.0158and-0.0656±0.0062. Significant differences were found among these groups and any two of them (F=70.057,p<0.001). A high negative correlation was detected between phase values and histopatho logical iron deposition grades (r=-0.843, p<0.01). Furthermore, the mean phase values in experimental group at the five timepoints (day5,7,10,14, and28after DMN injections) were respectively-0.0059±0.0087,-0.0234±0.0068,-0.0424±0.0061,-0.0589±0.0082,-0.030718±0.0078and in control group were0.0183±0.0697. There were significant differences among these six groups (F=132.743,p<0.001).
Conclusion:Abdominal SWI was a new sensitive method for quantitatively assessing HID in DMN induced rat liver fibrosis, which was highly correlated with the histopathological results.
Part Ⅱ The experimental study of using synchrotron radiation X-ray fluorescence facilities to quantitatively assess the hepatic iron deposition in rat liver fibres is model
Objectives:To discuss the value of synchrotron radiation X-ray fluorescence (SRXRF) facilities to quantitatively assess hepatic iron deposition (HID) in rat liver fibrosis model induced by single high-dose injection of dimethylnitrosamine (DMN).
Materials and Methods:Experimental group consisted with SD rats (n=50) with liver fibrosis accompanied by iron deposition induced by a single intraperitoneal injection of a high dose DMN (50mg/kg ofbody weight).10saline-injected SD rats (using the same dose of DMN) were used as control group. All rats in experimental and control groups were received both SRXRF and histopathological examinations for assessing HID. All samples are fully dried before SRXRF scanning. The energy of monochromatic light in SRXRF examination was12.5KeV and the spot size was2mm x2mm. The peak of iron-specific fluorescence located at6.40keV. Every time10rats at day5,7,10,14and28after DMN injections in experimental groups were received SRXRF and histopathological examinations. The photons of iron in SRXRF were measured and analyzed. Correlation was detected between the photons of iron and histopathological iron deposition grades.
Results:A total of47rats in experimental group and all rats in control group were included in the final data analysis. The other3rats in experimental group died on day3after DMN injection for acute submassive hemorrhagic necrosis. The mean photons of iron in control and experimental groups were (4.10±0.91) and (10.01±4.03) x104Fe photons/g dry liver tissue respectively and significant statistically differences were found between them. Additionally, according to the results of pathological Prussian blue stain, HID divided into three groups (grade0(n=10), Ⅰ (n=42) and Ⅱ (n=5)) and the mean photons in the three groups were (4.10±0.91),(9.16±3.15) and (17.16±3.63) x104Fe photons/g dry liver tissue respectively. Significant statistically differences were also observed among them (F=33.174, p<0.01). A moderate positive correlation was found between the photons of iron and histopathological iron deposition grades (r=0.722， p<0.01). Furthermore, the mean photons of iron at the five timepoints (day5,7,10,14and28after DMN injections) were (5.03±1.23),(8.85±2.66),(10.39±1.73),(15.10±4.25) and (9.17±1.77) x104Fe photons/g dry liver tissue respectively. When compared the photons of iron in these five groups and the controls, significant differences were observed among them (F=25.412,p<0.01).
Conclusion:SRXRF was a new nondestructive analytical technique that could be used to quantitatively assess liver iron concentration in rat liver fibrosis. The mean photons of iron had significant differences in different grade of HID and a moderate positive correlation was detected between iron photons and histopathological iron deposition grades.
PartⅢ-1The clinical study of3.0T abdominal susceptibility-weighted MR imaging to quantitatively assess hepatic iron deposition in chronic hepatitis B patients
Objectives:To assess the value of abdominal susceptibility-weighted MR imaging (SWI) with three TE values (10,5and2.5ms) to quantitatively assess hepatic iron deposition (HID) in patients with chronic hepatitis B (CHB) and to investigate the correlations between HID and the grade of liver fibrosis and inflammatory activity.
Materials and Methods:A total of57CHB patients were prospectively included in this study. All patients were underwent both abdominal SWI and histopatho logical examinations. Liver phase values were measured on the images with three different TE values, which were measured containing the entire right liver avoiding large vessels or artifacts. Histopatho logical evaluations were included semi-quantitative Pearls'Prussian blue stains for iron deposition grade, liver fibrosis scores and inflammatory activity. ROC curves were used to predict HID.
Results:Final data analysis included51patients.36patients were determined with HID based on the results of Pearls'Prussian blue stains. There were15,12,12,8and4patients respectively according the histopatho logical iron deposition grade0to4. The sensitivities and specificities of SWI for the different three TE values (10,5and2.5ms) were88.89%/66.67%,86.11%/60%and75%/80%, respectively. There were statistically significant differences of the liver mean phase values among the histopathological iron deposition grades (F=115.01,41.86and31.167respectively;p<0.001of all) and high negative correlations were observed between them (r=-0.904,-0.856,-0.799; p<0.001). When the phase values were respectively greater than-0.0453,-0.0127and0.0125for the three different TE values, the sensitivities were all100%and the specificities were86.1%,80.6%and83.3%, respectively. Furthermore, low negative correlations were found between the inflammatory activity and phase values in both10and5ms TE values (r=-0.394,-0.368; p=0.004,0.008). However, there were no correlations between phase values and liver fibrosis in all the three different TE values (p>0.05).
Conclusion:Abdominal SWI was able to be used to quantitatively detect HID in CHB patients and the liver phase values had significant differences in different histopathological iron deposition grade particularly when using a longer TE value (TE=10ms). HID was associated with inflammatory activity rather than liver fibrosis.
PartⅢ-2Comparative study of3.0T abdominal susceptibility-weighted imaging and T2*-weighted gradient-echo imaging in quantitatively assessing hepatic iron deposition in patients with chronic hepatitis B
Objectives:To compare the ability of3.0T abdominal susceptibility-weighted imaging (SWI) and multi-echo T2*-weighted gradient-echo imaging (T2*WI) sequences in quantitatively assessing hepatic iron deposition (HID) in patients with chronic hepatitis B (CHB).
Materials and methods:A total of43patients were prospectively included in this study. All of them were consecutive underwent SWI, T2*WI examinations and liver histopathological examination. Phase values were measured in phase images of SWI sequence and T2*values in T2*map. The phase and T2*values were measured contained the entire right liver avoiding large vessels or artifacts. Two pathologists (R1and R2) consulted together in determining the iron deposition grade by Pearls'Prussian blue staining.
Results:39patients (male/female,29/10) aged27-72(51.69±11.57) years were included in the final data analysis. The case numbers were11,8,9,7,4patients respectively according to histopatho logical iron deposition grade0to4and the liver mean phase values were sequentially-0.0213±0.0094,-0.05063±0.0010,-0.0589±0.0117,-0.0940±0.0110,-0.1568±0.0119. The mean T2*values were19.65±1.31,15.53±1.96,15.34±1.91,8.36±1.07,4.60±1.50, respectively. Significant statistically differences were observed in both phase and T2*values among these five different histopatho logical iron grades (F=139.60,93.91;p<0.001). Both phase values and T2*values were found having negative correlations with the histopathological iron deposition grades (r=-0.937,-0.898; p<0.001) and the correlations of histopathological iron grades with phase values were higher than that with T2*values.
Conclusion:Both abdominal SWI and T2*WI could be used to quantitatively assess HID in CHB patients and SWI appeared to have higher sensitivity.
Part IV The clinical study of synchrotron radiation X-ray fluorescence in quantitatively assessing hepatic iron deposition
Objectives:To use synchrotron radiation X-ray fluorescence (SRXRF) facilities to quantitatively assess hepatic iron deposition (HID) and to investigate the relationship between HID and the grade of liver fibrosis and inflammatory activity.
Materials and Methods:A total of64patients were prospectively included in this study (partial liver excision (n=58), liver transplantation (n=6)). All the specimens were selected in the liver parenchyma away from tumor masses and all the required specimens received both SRXRF and histopathological examinations. The receiver operating characteristics (ROC) curves were determined to predict patients with HID and significant iron deposition (histopathological iron grade3and4).
Results:35patients were determined with HID based on the results of Pearls'Prussian blue stains in all the included64patients and there were respectively15,9,7and4patients according to the histopathological iron deposition grade1to4.29patients were not found iron deposition (histopathological iron deposition grade0). The photons of iron assessed by SRXRF in five histopathological iron deposition grades were respectively (1.30±0.48),(2.12±0.55),(3.23±1.44),(4.08±0.88) and (6.06±1.51) x105photons/g dry liver tissue and significantly statistically differences were observed among them (F=44.166, p<0.001). High positive correlation was obtained between histopathological iron grades and the amounts of iron photons (r=0.855,p<0.001). When the photons of iron were more than1.95x105photons/g dry liver tissue, the sensitivity and specificity to predict HID were82.9%and89.7%. Meanwhile, when the photons of iron were more than3.43x105photons/g dry liver, the sensitivity and specificity to predict patients with significant HID were90.9%and91.7%. Furthermore, weak positive correlation was observed between the amounts of photons of iron and inflammatory activity (r=0.252, p=0.045). However, no correlation was found between it with liver fibrosis (p-0.706).
Conclusion:SRXRF was a powerful nondestructive analytical technique that could be used to quantitatively assess HID. In our clinical study, HID was found to associate with inflammatory activity rather than liver fibrosis.
PartV Value of3.0T abdominal susceptibility-weighted MR imaging on quantitatively assessing hepatic iron deposition and to determine its correlations with serum iron markers in chronic hepatitis B patients
Objectives:Using abdominal susceptibility-weighted MR Imaging (SWI) technique to quantitatively assess hepatic iron deposition (HID) in chronic hepatitis B (CHB) patients and to determine its correlations with serum iron markers (serum iron, ferritin, transferrin and transferrin saturation).
Materials and Methods:Patients (n=327) with HBV infection and healthy controls (n=50) were prospectively enrolled. All patients underwent abdominal SWI and were assessed for serum iron markers. Phase values were measured and five grades of hepatic iron deposition were described by SWI.
Results:303patients and47controls were included in the final data analysis. In total,77(25.4%) of patients with HBV infection had HID as determined by SWI. The mean phase values in patients with HID, without HID and normal controls were respectively-0.0710±0.047,-0.0152±0.0103and-0.0141±0.0147. There were significant differences between patients with HID and patients without (p<0.001). However, no significant statistically differences were observed between patients without HID and the normal controls (p=0.254). Phase values were also significantly different across different grades of HID (F=84.044, p<0.001). Levels of serum iron, ferritin, transferrin and transferrin saturation were significantly higher in patients with compared with those without HID (p<0.001). Only serum ferritin levels were significantly different across different grades of HID (x2=8.519,p=0.036) and there was a low negative correlation between serum ferritin levels and phase values (r=-0.365, p=0.007).
Conclusion:Abdominal SWI could be used to quantitatively assess HID in CHB patients. Only serum ferritin levels in serum iron markers were significantly different across different grades of HID and low negative correlation was found between serum ferritin levels and phase values. SWI may represent a more powerful tool to assess HID.
引文
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