磁共振扩散加权成像联合Gd-EOB-DTPA定量分析肝纤维化  

Quantitative evaluation of liver fibrosis with combination of DWI and Gd-EOB-DTPA

作　　者：崔恩铭[1] 龙晚生[1] 李卓永[1] 兰勇[1] 黄列彬 梁启堂[2] 李青[2] 

机构地区：[1]江门市中心医院放射科,广东江门529030 [2]江门市中心医院病理科,广东江门529030

出　　处：《实用放射学杂志》2016年第11期1702-1705,共4页Journal of Practical Radiology

基　　金：江门市科学技术项目[2013]81-44.

摘　　要：目的探讨磁共振扩散加权成像（DWI）联合肝特异性对比剂Gd-EOB-DTPA评估肝纤维化的价值。方法对79例慢性肝炎患者行DWt及Gd-EOB-DTPA肝胆期成像，分别测量及计算其表观扩散系数（ADC）和肝胆期相对强化值（RE）。采用Logistic回归分析RE、ADC与肝纤维化病理分期的相关性。以肝纤维化s≥2和s≥3为阳性标准，分别对ADC组、RE组及ADC＋RE组行受试者工作特征曲线（ROC）分析，曲线下面积（AUC）两两分析采用Z检验。结果经Logistic回归分析，RE、ADC均为S≥2和s≥3级肝纤维化的独立影响因素。在诊断s≥2时，ADC组AUC为0．861，以ADC=0．56×10^-3mm2／s为阈值，其敏感度为83．33％，特异度为85．71％；RE组AUC为0．771，以RE=1.03为阈值，其敏感度为86．67％，特异度为71．43％；ADC＋RE组AUC为0．922，以Logit（P）=8．16为阈值，其敏感度为90．。0％，特异度为91．84％。在诊断肝纤维化S≥3时，ADC组AUC为0．807，以ADC=0．53×10^-3mm^2／s为阈值，其敏感度为86．96％，特异度为78．57％，；RE组AUC为0．748，以RE=0．89为阈值，其敏感度为78．26％，特异度为76．79％；ADC＋RE组AUC为0．906，以Logit（P）=8．73为阈值，其敏感度为82．61％，特异度为89．29％。除诊断s≥3时ADC组敏感度最高外，ADc＋RE组在诊断肝纤维化s≥2、s≥3时敏感度、特异度及AUC均较单一指标更高，且其AUC分别与ADC组（Zs2=2．352、Zs2=2．158）和RE组（Zs2=2．465、Zs2=2．487）两两比较有统计学差异（P〈0．05）。结论ADc及RE均能用于量化评估肝纤维化，2个指标联合评估能明显提高判定效能。Objective To explore the value of combination of diffusion weight imaging （DWI） and G＆EOB-DTPA in the staging of liver fibrosis. Methods 79 patients with chronic hepatitis underwent DWI and Gd-EOB-DTPA MRI, meanwhile the apparent dif- fusion coefficient （ADC） with DWI of the liver were measured and relative enhancement ratio （RE） with hepatohiliary phase imaging of Gd-EOB-DTPA were also calculated. Logistic regression analysis was used to analyze the correlation between the pathological sta- ges of liver fibrosis and the values of ADC and RE. According to the pathological stages of liver fibrosis, the abilities of ADC, RE and ADC＋RE in the staging of liver fibrosis were assessed by using receiver operating characteristic （ROC） curve. Moreover, the Z statistics were used to analyze the area under the curve {AUC} between each two groups. Results The results of Logistic regression analysis showed that both RE and ADC were independent variables in the staging of liver fibrosis （S≥2, S≥3 ）. In diagnosis of liver fibrosis S≥2, the AUC was 0. 861, and the sensitivity and specificity were 88.33% and 85.71% with cutoff of ADC=0.56X 10^-3 mm^2/s in ADC group. Meanwhile, the AUC was 0. 771, and the sensitivity and specificity were 86.67% and 71.43% with cutoff of RE= 1.03 in RE group. The AUC was 0. 922, and the sensitivity and specificity were 90.00% and 91.84% with cutoff of Logit （P）=8.16 in ADC＋RE group. Moreover, in diagnosis of liver fibrosis S≥3, the AUC was 0. 807, and the sensitivity and specificity were 86.96% and 78.57% with cutoff of ADC=0.53X 10^-3mm^2/s in ADC group. The AUC was 0. 748, and the sensitivity and specificity were 78.26% and 76.79M with cutoff of RE=0.89 in RE group. The AUC was 0. 906, and the sensitivity and specificity were 82.61% and 89.29M with cutoff of Logit（P） =8.73 in ADC＋RE group. In addition, the combination of ADC＋RE achieved higher sensitiv- ity, specificity and AUC than single ADC or RE besides the hightest sensitivity of ADC in diagnosis

关 键 词：肝纤维化 磁共振成像 扩散加权成像 GD-EOB-DTPA 

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