肝脏ADC值在慢性肝炎肝纤维化诊断中的价值  

The Value of ADC in the Diagnosis of Chronic Hepatitis and Liver Fibrosis

作　　者：黄列彬 龙晚生[1] 崔恩铭[1] 胡茂清[1] 兰勇[1] 罗学毛[1] 李青[2] 阮健秋[3] 

机构地区：[1]广东省江门市中心医院放射科,529030 [2]广东省江门市中心医院病理科,529030 [3]广东省江门市中心医院超声科,529030

出　　处：《临床放射学杂志》2015年第9期1422-1426,共5页Journal of Clinical Radiology

摘　　要：目的探讨肝脏表观扩散系数（ADC）值在慢性肝炎活动度分级和肝纤维化分期中的临床应用价值。方法对符合纳入标准的55例慢性病毒性肝炎患者和28名正常人进行肝脏MR扩散加权成像（DWI）检查,b值选取0,600 s/mm2,并重组相应ADC图。在MR检查后1-5天内,病例组行肝穿刺活检术或肝脏病变切除术。肝穿刺活检在超声引导下进行,记录穿刺点所在肝段及对穿刺点进行标记;肝脏手术病例取病变周围的肝组织做肝纤维化病理检查,并记录取材点在大体标本上的空间位置,测量取材点与肝脏病变间的距离。利用Imagej图像处理软件对肝脏ADC值进行测量并记录。病例组肝脏ADC值测量时感兴趣区（ROI）的位置根据穿刺点或手术标本取材点的空间结构信息进行设置。病例组按肝纤维化程度将患者分为S1-S4四组,按肝脏炎症活动度将患者分为G1-G4四组。对不同G分级、S分期之间的肝ADC值进行统计分析,并对G分级、S分期与肝ADC值进行相关分析。运用受试者工作特性曲线（ROC）评估肝ADC值预测≥S1期、≥S2期及≥S3期纤维化的效能。结果肝脏ADC值随着G分级及S分期的增高而减低,G分级及S分期与肝脏ADC值之间均具有良好的负相关（r=-0.741,P=0.000及r=-0.708,P=0.000）。肝脏ADC值能区分正常组与S1-S4各组（P〈0.05）、≥S2与〈S2期纤维化（P〈0.05）、正常组与G1-G3各组（P〈0.05）、G1组与G2、G3组（P〈0.05）。肝脏ADC值诊断≥S1、≥S2、≥S3期纤维化的曲线下面积（AUC）、敏感性及特异性均较高,相应阈值分别为1.29×10-3mm2/s、1.27×10-3mm2/s、1.24×10-3mm2/s。结论肝脏ADC值对慢性肝炎活动度分级和肝纤维化分期的诊断具有一定的敏感性与特异性,对肝纤维化早期诊断及慢性肝炎症活动度评估有一定的参考价值。Objective To explore the clinical value of apparent diffusion coefficient（ ADC） in the grading of chronic hepatitis and staging of liver fibrosis. Methods（ 1） DWI was performed with b factors of 0 and 600 s / mm2 within 55chronic virus hepatitis patients and 28 normal cases which in accordance with the inclusive criteria,and the ADC maps were reconstructed.（ 2） Within 1 to 5 days after the MR exams,the cases of patient group underwent liver biopsy or liver resection. Liver biopsy was performed under the ultrasound guided,and the spatial location of the puncture point was marked. The normal liver tissue around the lesions was taken to do the pathological examination of the cases which underwent liver resection,and the distance between the normal liver tissue and the lesions was measured and recorded.（ 3） Use the image processing software Image j to measure the liver values. The location of the ROIs was based on the spatial location of the puncture points or the surgical specimens when measuring the liver ADC values of patient group.（ 4） The patient group was divided into four groups（ S1 to S4 or G1 to G4） according to the degree of hepatic fibrosis or inflammation activity. The liver ADC values of different grades and different stages were statistically analyzed. The spearman’s rank correlation analysis was used to explore the correlation between the ADC values and the stage of hepatic fibrosis,and between the ADC values and the degree of inflammation activity. Receiver operating characteristic（ ROC） curve analysis was used to evaluate the effectiveness of ADC values in predicting stage 1 or greater（ ≥S1）,stage 2 or greater（ ≥S2）,stage 3 or greater（ ≥S3） hepatic fibrosis. Results Liver ADC were negatively correlated with the staging of liver fibrosis and the grading of liver inflammation activity（ r =- 0. 741,P = 0. 000 and r =- 0. 708,P = 0. 000）. Liver ADC can distinguish normal group from S1- S4,distinguish group which smaller than Stage 2（ 〈 S2） from th

关 键 词：肝脏 纤维化 扩散加权成像 表观扩散系数 

分 类 号：R575[医药卫生—消化系统] R445.2[医药卫生—内科学]