扩散加权成像联合常规磁共振征象对慢性乙型肝炎炎症活动度的诊断价值  

Study of diffusion weighted imaging in combination with conventional MRI signs for inflammation activity of chronic hepatitis B

作　　者：任洪伟[1,3] 叶慧义[2] 安维民[1] 董景辉[1] 刘渊[1] 

机构地区：[1]解放军第三0二医院放射科,北京100039 [2]解放军总医院放射科 [3]解放军医学院

出　　处：《中华医学杂志》2017年第19期1484-1490,共7页National Medical Journal of China

基　　金：全军医学科技青年培育项目（14QNP111）;首都医学发展科研专项资助项目（2011-5001-05）

摘　　要：目的研究表观扩散系数（ADC）值与慢性乙型肝炎炎症活动度病理分级的相关性，再联合常规磁共振（MR）征象对慢性乙型肝炎炎症活动度的诊断效能评估。方法选取2014年1月至2015年12月在解放军第三〇二医院接受治疗的142例慢性乙型肝炎患者作为炎症组，同时选取20名健康人作为对照组，对各组分别进行MR常规平扫、动态增强及扩散加权成像（DWI）扫描（b值＝0、800 s/mm2），并对乙肝患者在MR检查后2 d内行肝脏穿刺活检，根据病理结果依炎症活动度（G），将炎症组分为G1、G2、G3～4级，测量各级的表观扩散系数（ADC）值，同时分析各级的MRI表现并与病理分级进行对照，对所有数据进行统计学分析。结果慢性乙型肝炎炎症活动度不同病理分级所得ADC值差异有统计学意义（F＝8.392，P〈0.01），并且ADC值与肝脏炎症活动度分级呈明显负相关（r＝－0.613, P〈0.01）。对照组与炎症组的ADC值分别为（1.31±0.16）、（1.12±0.15）×10－3 mm2/s，差异有统计学意义（P〈0.05）。炎症组G1、G2、G3～4的ADC值分别为（1.22±0.12）、（1.05±0.12）、（0.98±0.10）×10－3 mm2/s，G1与G2、G1与G3～4间ADC值差异有统计学意义（P〈0.05）。受试者工作特征（ROC）曲线示ADC值诊断炎症活动度≥G2级的曲线下面积（AUC）0.880，敏感度为82.4%，特异度为76.8%，诊断界值为1.09×10^－3 mm2/s。MRI表现门脉周围轨道征与胆囊壁水肿在炎症组间显示率差异有统计学意义（P〈0.05），而动脉期肝脏异常强化、肝门淋巴结增大及腹水在炎症组间显示率差异无统计学意义（P〉0.05）。ADC值联合MRI特征性表现诊断炎症≥G2的曲线下面积AUC＝0.938，敏感度为88.4%，特异度为88.9%。结论ADC值可以定量无创性预测慢性乙型肝炎炎症活动度病理分级情况，再结合常规MRI特征性影像表现，能提高对慢性乙型肝炎炎症活动度�ObjectiveTo study the correlation between ADC values of diffusion weighted imaging （DWI） and the pathological grading in inflammation activity of chronic hepatitis B, and combined with conventional MRI features to predict the diagnosis effectiveness. MethodsA total of 142 cases of patients with chronic hepatitis B were selected as inflammatory group in 302 Hospital of PLA from January 2014 to December 2015, while 20 cases of healthy subjects without history of liver disease were chosen as control group.All patients underwent MR plain scan and dynamic contrast enhancement and DWI examinations （b=0, 800 s/mm2） for liver, and were performed liver biopsy within two days.According to the degree of inflammation activity （G）, the inflammation group was divided into G1, G2 and G3-4 level.The apparent diffusion coefficient （ADC） value, and the MRI features of each group were analyzed.ResultsThe ADC values showed statistical difference （F=8.392, P〈0.01） within inflammation group of chronic hepatitis B from different pathologic grading, and there was significant negative correlation between ADC values and liver inflammation activity grading （r=-0.613, P〈0.01）. The ADC value of inflammation group and control group was （1.31±0.16）, （1.12±0.15）×10-3 mm2/s, the difference was statistically significant （P〈0.05）. The ADC value of G1, G2 and G3-4 level was （1.22±0.12）, （1.05±0.12）, （0.98±0.10）×10-3 mm2/s respectively, and there was statistical difference （P〈0.05） between G1 and G2, G1 and G3-4. The receiver operating characteristic （ROC） curve in diagnosis of equal and above G2 level showed the area under the curve （AUC） was 0.880, the sensitivity and the specificity was 82.4% and 76.8% respectively, the diagnostic cut-off value was 1.09×10^-3 mm2/s.Besides, the detection rate of portal around its orbit and gallbladder wall edema in inflammation group had statistical difference （P〈0.05）, and there was no statistical difference in the detection rate

关 键 词：肝炎 乙型  慢性 磁共振成像 扩散加权成像 炎症 

分 类 号：R445.2[医药卫生—影像医学与核医学] R512.62[医药卫生—诊断学]