真实稳态进动快速成像在脂肪肝诊断中的临床应用  

Application of true-FISP in diagnosis of fatty liver

作　　者：仝开军[1] 舒荣宝[1] 金元贞[1] 何永胜[1] 潘少辉[1] 朱阳阳[1] 

机构地区：[1]马鞍山市人民医院影像科,安徽243000

出　　处：《放射学实践》2017年第6期620-624,共5页Radiologic Practice

摘　　要：目的:探讨真实稳态进动快速成像(true-FISP)序列在脂肪肝诊断中的临床应用价值。方法:回顾性分析528例患者的MRI和CT影像学表现,测量true-FISP序列上肝/腰大肌信号强度比值(S_(L/PM)),并与非增强CT检查肝/脾CT值比值(CT_(L/S))结果对比。结果:528例患者CT检查诊断脂肪肝阳性病例组107例,阴性组421例,两组间肝脏CT值(CT_L)、CT_(L/S)、S_(L/PM)均有显著性差异,脾脏CT值(CT_S)无统计学差异,CT_L、CT_S、CT_(L/S)、S_(L/PM)分别为(38.88±12.66)HU、(60.80±5.66)HU(t=-17.46,P<0.001);(53.22±3.85)、(52.49±3.65)(t=1.832,P=0.07);(0.73±0.24),(1.16±0.10)(t=-18.43,P<0.001);(0.73±0.24)、(1.56±0.28)(t=-23.02,P<0.001)。S_(L/PM)与CT_(L/S)正相关(r=0.43,P<0.001)。S_(L/PM)最佳诊断分界点为1.14,ROC曲线下面积(AUC)为0.949(P<0.001),Kappa值0.797(P<0.001),敏感度为88.8%,特异度为94.3%,误诊率5.7%、漏诊率11.2%、总的符合率93.2%、Youden指数83.1%、比数积130.95、阳性预测值88.8%、阴性预测值94.3%。对轻、中、重度脂肪肝诊断的AUC分别为0.857、0.942、0.983(P<0.001),敏感度82.6%、100%、100%,特异度86.5%、80.5%、80.2%。结论:true-FISP序列对脂肪肝的诊断具有重要的临床应用价值,当发现肝脏信号强度减低且接近或低于腰大肌时可作为诊断标准,对中、重度脂肪肝的诊断效果高于轻度脂肪肝。Objective：To explore the application value of true fast imaging with steady state precession （true FISP） in diagnosis of fatty liver. Methods： MRI and CT findings of 528 patients were analyzed retrospectively. Liver to-psoas major signal intensity ratio （SL/PM） was measured by using true-FISP sequence while liver--to spleen attenuation ratio （CTL/s） was compared by using unenhanced CT. Results： 107 cases were diagnosed as fatty liver by CT （positive group）,and 421 cases were diagnosed as non-fatty liver （negative group）. There was significant statistical difference in CT attenuation value of liver （CTI.）, CTL/s and SL/pM between two groups. There was no statistical significant difference in CT attenuation value of spleen （CTs） between two groups. CT1,CTs,CTI./S and SL/pM were （38. 88±12. 66）HU and （60. 80±5. 66）HU （t= -17.46,P〈0. 001）,53.22±3.85 and 52.49±3.65 （t=1. 832,P=0.07）,0.73±0.24 and 1.16±0. 10 （t=18.43,P〈 0.001）,0.73!0.24 and 1.56±0.28 （t=-23.02,P〈0.001）,respectively. SL/PM was positively related to CTL/s（r 0.43, P〈0.001 ）. The optimal diagnostic cut-off of SL/FM was 1. 14, the area under curve, Kappa value, sensitivity, specificity, rate of misdiagnosis, rate of missed diagnosis, the total consistent rate, Youden index, odd product, positive predictive value and negative predictive value were 0.949 （P%0. 001）,0. 797 （P〈0. 001）,88.8%,94. 3%,5. 7%,11. 2%,93.2%,83. 1%, 130.95,88.8 % and 94.3 %, respectively. AUC, sensitivity and specificity in the mild, moderate and severe fatty liver were 0. 857,0. 942 and 0. 983 （P〈0. 001）,82.6%,100% and 100%,86.5%,80.5% and 80.2%,respectively. Conclusion：True FISP has important clinical application value in diagnosis of fatty liver. The diagnosis criterion is that the signal intensity of liver decreases near to or lower than that of psoas major muscle. The efficiency in diagnosing moderate and severe fatty liver is higher than that in mild farty liver.

关 键 词：脂肪肝 磁共振成像 体层摄影术 X线计算机 

分 类 号：R445.2[医药卫生—影像医学与核医学] R575.5[医药卫生—诊断学] R816.5[医药卫生—临床医学]