多回声T_2~*加权序列和核磁共振扩散加权成像对肝纤维化和肝硬化的量化对比初步实验
|
摘要
目的:比较多回声T_2~*加权序列与扩散加权成像(DWI)鉴别慢性肝病病患纤维化阶段的效力。方法:选取慢性肝病肝纤维化患者42例为试验组,24名健康成人志愿者为对照组。均进行MRI检查,比较肝纤维化各阶段的肝T_2~*值与ADC值,分析T_2~*值和ADC值对S1～4期纤维化分期的诊断效果,以及T_2~*值和ADC值在预测纤维化0期患者出现纤维化1期或更高阶段(≥S1),纤维化1期和以下患者出现2期或更高阶段(≥S2),纤维化2期或以下患者出现3期或更高阶段(≥S3)的效力。结果:每个纤维化阶段的T_2~*值和ADC值在2～4期均有明显的重叠,纤维化期和T_2~*及ADC值均呈显著正相关(r=0.389、0.665,P<0.001),T_2~*值和ADC值在不同纤维化阶段比较差异均有统计学意义(H=19.904、28.954,P<0.001);ROC分析显示,T_2~*值和ADC值的AUC分别为0.814和0.762,比较差异有统计学意义(P<0.001),且与ADC值比较,T_2~*值在区分≥S1、≥S2、≥S3时的AUC值均有更好的表现(P<0.05),另外在识别≥S1期时,T_2~*值和ADC值的AUC、敏感性和特异性为0.988、100%和89.7%。结论:多回声呼吸控制T_2~*加权梯度回波序列对肝纤维化期的快速、无创和准确评估有重要意义,可以作为一种技术用于判定抗病毒治疗和监测慢性肝炎患者的治疗反应,并替代部分患者的肝活检。
Objective:To compare the effectiveness of multiple echo T_2~* weighted sequence and diffusion weighted imaging(DWI)in differentiating fibrosis stage in chronic liver disease.Method:A total of 42 patients with chronic liver disease and liver fibrosis were selected as experimental group and 24 healthy adult volunteers as control group.They all underwent MRI examinations.The value of hepatic T_2~* and ADC in different stages of hepatic fibrosis were compared,the diagnostic effect of T_2~* and ADC values on stage S1-4 fibrosis were analyzed,and the effectiveness of T_2~* and ADC values in predicting patients with fibrosis stage 0 had stage 1 or higher(≥S1),patients with fibrosis stage 1 and below had stage 2 or higher(≥S2),patients with fibrosis stage 2 or below have stage 3 or higher(≥S3).Result:The value of T_2~* and ADC in each stage of fibrosis overlapped significantly in 2-4 stages,and there was a significant positive correlation between the value of T_2~* and ADC in fibrosis stage(r=0.389,0.665,P<0.001),the T_2~* and ADC values at different stages of fibrosis were compared,the differences were statistically significant(H=19.904,28.954,P<0.001).ROC analysis showed that the AUC values of T_2~* and ADC were 0.814 and 0.762 respectively,the difference was statistically significant(P<0.001),compared with ADC value,T_2~* value has better performance in AUC value when distinguishing between ≥S1,≥S2,≥S3(P<0.05),in addition,the AUC,sensitivity and specificity of T_2~* and ADC values were 0.988,100% and 89.7% for stage ≥S1.Conclusion:Multi-echo breath-controlled T_2~* weighted gradient echo sequence is important for rapid,non-invasive and accurate assessment of hepatic fibrosis.It can be used as a technique to determine antiviral therapy and monitor the response of patients with chronic hepatitis,and to replace liver biopsy in some patients.
Objective:To compare the effectiveness of multiple echo T_2~* weighted sequence and diffusion weighted imaging(DWI)in differentiating fibrosis stage in chronic liver disease.Method:A total of 42 patients with chronic liver disease and liver fibrosis were selected as experimental group and 24 healthy adult volunteers as control group.They all underwent MRI examinations.The value of hepatic T_2~* and ADC in different stages of hepatic fibrosis were compared,the diagnostic effect of T_2~* and ADC values on stage S1-4 fibrosis were analyzed,and the effectiveness of T_2~* and ADC values in predicting patients with fibrosis stage 0 had stage 1 or higher(≥S1),patients with fibrosis stage 1 and below had stage 2 or higher(≥S2),patients with fibrosis stage 2 or below have stage 3 or higher(≥S3).Result:The value of T_2~* and ADC in each stage of fibrosis overlapped significantly in 2-4 stages,and there was a significant positive correlation between the value of T_2~* and ADC in fibrosis stage(r=0.389,0.665,P<0.001),the T_2~* and ADC values at different stages of fibrosis were compared,the differences were statistically significant(H=19.904,28.954,P<0.001).ROC analysis showed that the AUC values of T_2~* and ADC were 0.814 and 0.762 respectively,the difference was statistically significant(P<0.001),compared with ADC value,T_2~* value has better performance in AUC value when distinguishing between ≥S1,≥S2,≥S3(P<0.05),in addition,the AUC,sensitivity and specificity of T_2~* and ADC values were 0.988,100% and 89.7% for stage ≥S1.Conclusion:Multi-echo breath-controlled T_2~* weighted gradient echo sequence is important for rapid,non-invasive and accurate assessment of hepatic fibrosis.It can be used as a technique to determine antiviral therapy and monitor the response of patients with chronic hepatitis,and to replace liver biopsy in some patients.
引文
[1]曹卫星.DWI肝脏ADC值和MRI测量肝脾大小比对肝纤维化及肝硬化早期诊断及分级的评估价值[J].肝脏,2016,21(11):949-951.
[2]崔恩铭,龙晚生,李卓永,等.磁共振扩散加权成像联合Gd-EOB-DTPA定量分析肝纤维化[J].实用放射学杂志,2016,32(11):1072-1075.
[3]石俊英,张斯佳,史景璐,等.经量化扩散加权成像与超声剪切波弹性成像对乙型肝炎相关性肝纤维化比较分析[J].中国临床医学影像杂志,2017,28(6):447-449.
[4]许尚文,陈自谦,夏加林,等.MR扩散加权成像与超声弹性成像诊断乙型病毒性肝炎肝纤维化分级的对比研究[J].中华放射学杂志,2016,50(7):518-521.
[5]陈繁,陈天武.体素内不相干运动扩散加权成像在肝纤维化定量诊断与分期中的研究进展[J].国际医学放射学杂志,2017,40(1):46-50.
[6]彭令荣,孟占鳌,王劲,等.磁共振弹力成像与扩散加权成像诊断慢性乙型病毒性肝炎纤维化程度分级的对比[J].实用医学杂志,2017,33(17):2930-2933.
[7]张晶,赵虹,杨柳青,等.T2*值在慢性肝病肝纤维化定量评价中的作用初探[J].国际医学放射学杂志,2017,40(2):129-132.
[8]李锦伟,王剑,谢渭芬.磁共振成像技术在肝纤维化诊断中的应用进展[J].中华消化杂志,2016,36(6):430-432.
[9]王小凤,舒健,唐光才,等.磁共振T2值评估大鼠肝纤维化的应用价值[J].中国医学影像学杂志,2017,25(6):401-404.
[10]李超,朱绍成,张单霞,等.MR体素内不相干运动扩散加权成像评估慢性乙型病毒性肝炎肝纤维化程度的价值研究[J].磁共振成像,2017,8(9):662-667.
[11]张蕊,彭晓刚,卢敬红,等.磁共振弥散加权成像在肝炎纤维化评估中的价值[J].北京生物医学工程,2016,35(1):68-71.
[12]黄岩花,胡祥华,周宁,等.磁共振DWI在慢性病毒性肝炎患者肝纤维化和炎症程度评价中的价值[J].中华全科医学,2016,14(11):1918-1920.
[13]石俊英,史景璐,张斯佳.肝纤维化分级的MRI扩散加权成像与超声剪切波弹性成像对比分析[J].临床研究,2017,25(5):174-175.
[14]张展庆,王开福,徐谢生,等.分析比较MR扩散加权成像和CT灌注成像对肝纤维化诊断价值[J].现代医用影像学,2017,26(3):735-737.
[15]张莉,马雪英,梁丰丽,等.ADC值联合肝纤四项对肝纤维化分期的评估[J].实用放射学杂志,2016,32(1):52-55.
[16]毛元德,彭泽学.CT灌注成像和MR扩散加权成像对肝纤维化诊断价值的比较[J].医学信息,2016,29(13):287.
[17]张亚超.MR扩散加权成像和CT灌注成像在肝纤维化中的诊断价值[J].医疗装备,2017,30(17):13-14.
[18]杨卫,金红花.磁共振弥散加权成像在乙型肝炎肝纤维化程度评估中的价值[J].西南军医,2016,18(2):139-141.
[2]崔恩铭,龙晚生,李卓永,等.磁共振扩散加权成像联合Gd-EOB-DTPA定量分析肝纤维化[J].实用放射学杂志,2016,32(11):1072-1075.
[3]石俊英,张斯佳,史景璐,等.经量化扩散加权成像与超声剪切波弹性成像对乙型肝炎相关性肝纤维化比较分析[J].中国临床医学影像杂志,2017,28(6):447-449.
[4]许尚文,陈自谦,夏加林,等.MR扩散加权成像与超声弹性成像诊断乙型病毒性肝炎肝纤维化分级的对比研究[J].中华放射学杂志,2016,50(7):518-521.
[5]陈繁,陈天武.体素内不相干运动扩散加权成像在肝纤维化定量诊断与分期中的研究进展[J].国际医学放射学杂志,2017,40(1):46-50.
[6]彭令荣,孟占鳌,王劲,等.磁共振弹力成像与扩散加权成像诊断慢性乙型病毒性肝炎纤维化程度分级的对比[J].实用医学杂志,2017,33(17):2930-2933.
[7]张晶,赵虹,杨柳青,等.T2*值在慢性肝病肝纤维化定量评价中的作用初探[J].国际医学放射学杂志,2017,40(2):129-132.
[8]李锦伟,王剑,谢渭芬.磁共振成像技术在肝纤维化诊断中的应用进展[J].中华消化杂志,2016,36(6):430-432.
[9]王小凤,舒健,唐光才,等.磁共振T2值评估大鼠肝纤维化的应用价值[J].中国医学影像学杂志,2017,25(6):401-404.
[10]李超,朱绍成,张单霞,等.MR体素内不相干运动扩散加权成像评估慢性乙型病毒性肝炎肝纤维化程度的价值研究[J].磁共振成像,2017,8(9):662-667.
[11]张蕊,彭晓刚,卢敬红,等.磁共振弥散加权成像在肝炎纤维化评估中的价值[J].北京生物医学工程,2016,35(1):68-71.
[12]黄岩花,胡祥华,周宁,等.磁共振DWI在慢性病毒性肝炎患者肝纤维化和炎症程度评价中的价值[J].中华全科医学,2016,14(11):1918-1920.
[13]石俊英,史景璐,张斯佳.肝纤维化分级的MRI扩散加权成像与超声剪切波弹性成像对比分析[J].临床研究,2017,25(5):174-175.
[14]张展庆,王开福,徐谢生,等.分析比较MR扩散加权成像和CT灌注成像对肝纤维化诊断价值[J].现代医用影像学,2017,26(3):735-737.
[15]张莉,马雪英,梁丰丽,等.ADC值联合肝纤四项对肝纤维化分期的评估[J].实用放射学杂志,2016,32(1):52-55.
[16]毛元德,彭泽学.CT灌注成像和MR扩散加权成像对肝纤维化诊断价值的比较[J].医学信息,2016,29(13):287.
[17]张亚超.MR扩散加权成像和CT灌注成像在肝纤维化中的诊断价值[J].医疗装备,2017,30(17):13-14.
[18]杨卫,金红花.磁共振弥散加权成像在乙型肝炎肝纤维化程度评估中的价值[J].西南军医,2016,18(2):139-141.