磁共振扩散成像和门脉血流量测量在乙肝慢性肝病中的应用评估  

The Application of Diffusion and Portal flow Parameters with MRI in Chronic Liver Disease of Hepatitis B Patients

作　　者：王康[1] 王之[1] 王培军[2] 赵泽华[1] 徐嵩森[1] 芮元鹏[1] 王伟忠[1] 薛雪英[3] 

机构地区：[1]上海中医药大学附属普陀医院放射科,200061 [2]上海同济大学同济医院放射科,200071 [3]上海中医药大学附属普陀医院传染科,200061

出　　处：《临床放射学杂志》2007年第7期702-707,共6页Journal of Clinical Radiology

基　　金：国家自然科学基金项目(编号:30470517);上海市医学发展基础研究重点项目(编号:04JC14074)

摘　　要：目的探讨扩散加权成像(DWI)和门脉血流量指标与乙肝慢性肝炎、肝硬化程度的动态变化关系。资料与方法对47例乙肝患者[6例慢性肝炎、41例肝硬化(14例ChildA级,12例ChildB级,15例ChildC级)]及10名正常对照者进行DWI测量肝脏表观扩散系数(ADC),采用相位对比法(PC)测门静脉主干流速、每分钟流量。所有入选者同时检测血清肝纤维化标志物:透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、层粘连蛋白(LN)、Ⅳ型胶原(CIV)。结果(1)ADC3正常对照组和ChildA、B、C级肝硬化差异均有统计学意义(P=0.024,0.031,0.016)。ADC3慢性肝炎组和ChildC级肝硬化差异也有统计学意义(P=0.044)。(2)ChildA、B、C级肝硬化门脉流速较慢性肝炎组和正常组均显著下降(P=0.000,0.000,0.000;P=0.000,0.000,0.000)。(3)门脉流速与HA、PCⅢ、CIV、LN均呈明显负相关(r=-0.545,P=0.000;r=-0.420,P=0.001;r=-0.336,P=0.011;r=-0.458,P=0.000)。ADC3值与HA、PCⅢ、CIV、LN呈明显负相关(r=-0.326,P=0.013;r=-0.287,P=0.031;r=-0.271,P=0.042;r=-0.334,P=0.011)。ADC1值与HA、LN呈明显负相关(r=-0.362,P=0.006;r=-0.406,P=0.002)。结论DWI和门脉血流量指标能反映出慢性肝炎、肝硬化的动态变化,对肝硬化的诊断及临床治疗有重要的参考价值。Objective To estimate the relationship between diffusion and portal flow parameters and the severity of chronic liver disease of hepatitis B patients. Materials and Methods 47 hepatitis B patients [ 6 with chronic hepatitis,41 with cirrhosis （14 with Child- Pugh class A cirrhosis; 12 with class B cirrhosis; and 15 with class C cirrhosis）] and 10 normal volunteers were selected for measurements of apparent diffusion coefficient（ADC） values of the liver. Portal flow parameters with phase contrast（PC） were obtained at main portal vein, portal velocity and portal flow were measured. Serum markers included hyaluronic acid [ HA ],type- Ⅲ -procollagen [ PC Ⅲ ], laminin [ LN ] and type- Ⅳ-collagen [ CⅣ ] were also detected. Results （ 1 ） The mean ADC3 had significant difference between normal liver and child A, B, C cirrhosis （ P = 0. 024,0. 031,0. 016 ）. The mean ADC3 also had significant difference, in child C cirrhosis and chronic hepatitis （P = 0. 044）. （2） There was a significant decrease in portal velocity in cirrhotic patient compared to controls and chronic hepatitis （ P = 0. 000,0.000,0.000 ; P =0. 000,0. 000,0.000 ）. （ 3 ） HA, PCⅢ, CIV, LN were obvious negative relevant to the portal velocity（ r = -0. 545 ,P =0. 000;r = -0. 420,P =0. 001 ;r = -0. 336 ,P =0. 011 ;r = -0. 458 ,P =0.000）. HA, PCIII ,CIV, LN were obvious negative relevant to the ADC3 value （ r = - 0. 326, P = 0. 013 ; r = - 0. 287, P =0. 031 ; r = -0. 271 ,P = 0. 042;r = -0. 334 ,P = 0.011 ）. There was negative correlation between the ADC1 value and HA and LN（ r =- 0. 362,P = 0. 006 ;r = - 0. 406,P = 0.002）. Conclusion Diffusion and portal flow parameters can reflect some changes of chronic hepatitis and cirrhosis, which are valuable for clinical diagnosis and treatment.

关 键 词：乙型肝炎 肝硬化 扩散加权成像 相位对比法 磁共振成像 血清标志物 

分 类 号：R445.2[医药卫生—影像医学与核医学] R512.6[医药卫生—诊断学]