3.0T磁共振动态增强扫描对乙肝肝纤维化的评估  

Evaluation of hepatic fibrosis using dynamic contrast enhanced MRI(3.0 T)in patients with chronic hepatitis B

作　　者：许尚文[1] 陈自谦[1] 夏加林[1] 钟群[1] 陈秀丽[2] 洪俊峰[3] 李东良[4] 刘学兵[1] 

机构地区：[1]南京军区福州总医院医学影像中心,福州350025 [2]南京军区福州总医院二部超声科,福州350025 [3]南京军区福州总医院超声科,福州350025 [4]南京军区福州总医院肝胆内科,福州350025

出　　处：《功能与分子医学影像学（电子版）》2015年第4期22-28,共7页Functional and Molecular Medical Imaging(Electronic Edition)

基　　金：福建省自然科学基金项目(2015J01490);福建省科技计划重点项目(2015Y0027)

摘　　要：目的探讨动态增强磁共振成像（DCE-MRI）评估慢性乙型肝炎肝纤维化的价值。方法前瞻性分析符合入组标准和排除标准且检查资料完整并行肝脏穿刺活检的慢性乙型病毒性肝炎患者43例,正常对照组13例。所有被试均行改良的脂肪抑制三维容积梯度回波序列的腹部DCE-MRI。根据时间-信号强度曲线（TIC）,参照文献计算出肝动脉灌注指数（HPI）。采用ROC特征曲线分析HPI的诊断效能,用单因素方差分析和相关分析进行统计学处理。结果对照组与S0？~？S4肝纤维化组的平均HPI值分别为0.23±？0.04、0.23±？0.03、0.26±？0.03、0.29±？0.04、0.36±？0.07、0.40±？0.06,不同组间HPI值差异有统计学意义。HPI值与肝脏纤维化程度、炎症活动度及脂肪肝分级的相关性系数分别为：0.825、0.364、0.280;P值分别为0.000、0.017、0.068。ROC曲线分析显示,HPI值诊断肝纤维化程度分期≥S1、≥S2、≥S3和S4期的准确性分别为：0.725、0.756、0.860、0.723。单因素方差分析结果显示F？=？25.799,P？=？0.000。结论HPI值对肝纤维化程度区分有较高的诊断价值,而对炎症活动度和脂肪肝分级的诊断价值不大。Objective To investigate the feasibility of using dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） in evaluating hepatic fibrosis in patients with chronic hepatitis B. Methods A prospective analysis of the DCE-MRI examinations was conducted in acontrol group （n = 13） and a hepatic fibrosis group （n = 43） with pathologically confirmedhepatic fibrosis of hepatitis B. Using a modified fat suppressed 3D volumetric gradient echo sequence （3DVIBE）, DCE-MRI images were acquired and time signal-intensity curve （TIC） was generated automatically. The HPI was calculated in accordance with literatures. ROC analysis was performed for assessing the diagnostic performance of HPI values. Results The average HPI values of the control group and hepatic fibrosis groups （from SO to S4） were 0.23 ± 0.04, 0.23 ± 0.03, 0.26 ± 0.03, 0.29 ± 0.04, 0.36 ± 0.07 and 0.40 ± 0.06, respectively. There were statistically significant difference between the HPI values of different groups. The spearman rank correlation coefficients between HPI and hepatic fibrosis level, inflammation level, and steatosis level were 0.825, 0.364, 0.280, respectively, and P values were 0.000, 0.017, 0.068, respectively. Using ROC curve analysis, we found that accuracies of HPI in prediction of hepatic fibrosis level（≥ S 1, ≥ S2, ≥ S3 and S4）were 0.725, 0.756, 0.860, 0.723, respectively. One-way ANOVA was performed （F = 25.799, P = 0.000）. Conclusions HPI values had the potential in the application of hepatic fibrosis diagnosis, and could be useful in distinguishing inflammation level and steatosis level.

关 键 词：动态增强磁共振 肝动脉灌注指数 肝纤维化 

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