MR弹性成像对慢性乙型肝炎肝纤维化的诊断价值  

A study of diagnostic performance of MR elastography in liver fibrosis with chronic hepatitis B

作　　者：沈萍 马盛元[2] 许华宇 杨玲[1] 朱默[1] 邱苏豪[2] 赵雪峰 赵卫峰[3] 冯原[2] 胡春洪[1] Shen Ping;Ma Shengyuan;Xu Huayu;Yang Ling;Zhu Mo;Qiu Suhao;Zhao Xuefeng;Zhao Weifeng;Feng Yuan;Hu Chunhong(Department of Radiology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Center for Molecular Imaging and Nuclear Medicine,School of Radiological and Interdisciplinary Sciences (RAD-X),Soochow University,Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions,Suzhou 215123,China;Department of Infectious Disease,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Radiology,the Suzhou Kowloon Affiliated Hospital of Shanghai Jiaotong University Medical School,Shanghai 215021,China)

机构地区：[1]苏州大学附属第一医院放射科,215006 [2]苏州大学放射医学及交叉科学研究院分子影像与核医学研究中心,215123 [3]苏州大学附属第一医院感染科,215006 [4]上海交通大学附属苏州九龙医院,215021

出　　处：《中华放射学杂志》2019年第8期680-684,共5页Chinese Journal of Radiology

摘　　要：目的探讨MR弹性成像(MRE)和DWI对慢性乙型肝炎肝脏纤维化的诊断价值。方法前瞻性收集2017年7月至12月苏州大学附属第一医院,肝病病程超过6个月且乙肝表面抗原阳性的24例慢性乙型病毒性肝炎患者。所有患者均行超声瞬时弹性检查及常规MRI、MRE和DWI检查,超声和MRI检查时间间隔不超过1周。测量肝脏的超声弹性值,并在MRI图像上测量相应肝脏MRE弹性值及ADC值。按FibroTouch推荐分级阈值进行MRE肝脏纤维化严重程度分组,分别为无或轻度肝纤维化(F0~1级)组、显著肝纤维化(F2~3级)组、肝硬化(F4级)组。采用Spearman相关性分析评价肝脏超声弹性值与MRE弹性值、ADC值间的相关性。采用单因素方差分析评价MRE肝脏纤维化严重程度分组间MRE弹性值及ADC值的差异,利用ROC评价MRE弹性值、ADC值鉴别诊断肝纤维化及肝硬化的效能。结果24例患者均顺利完成超声弹性检查及MRI检查,图像质量良好。无或轻度肝纤维化组、显著肝纤维化组和肝硬化组3组间的肝脏MRE弹性值分别为(2.32±0.31)、(3.43±1.05)、(4.77±0.68)kPa,差异有统计学意义(F=61.690,P<0.01);上述3组患者的肝脏ADC值分别为(1.31±0.14)×10^-3、(1.23±0.15)×10^-3、(1.22±0.12)×10^-3mm^2/s,差异无统计学意义(F=1.074,P=0.360)。3组患者的肝脏超声弹性值分别为(5.61±1.05)、(9.56±0.57)、(17.25±3.55)kPa,肝脏超声弹性值与MRE弹性值呈正相关(r=0.858,P<0.01),而与ADC值间不具有相关性(r=-0.326,P=0.120)。MRE弹性值诊断≥F2级和F4级肝纤维化的ROC下面积分别为0.96、1.00,而ADC值的ROC下面积均不足0.70,分别为0.67、0.62。结论MRE可作为评估慢性乙型肝炎引起的肝纤维化及肝硬化的无创影像检查手段,而DWI在评价肝脏纤维化方面的作用有限。Objective To explore the diagnostic value of MR elastography and diffusion-weighted imaging in patients with liver fibrosis in the context of chronic hepatitis B.Methods Twenty-four patients with chronic hepatitis B,whose course of liver disease was more than 6 months and hepatitis B surface antigen was positive,were prospectively enrolled in the First Affiliated Hospital of Soochow University from July to December 2017.All of the patients underwent abdominal transient elastography (TE),routine MRI,magnetic resonance elastography (MRE) and DWI examination,TE and MRI were performed within one week.TE liver stiffness was measured,the MRE liver stiffness and ADC value were measured on MR imagings.All patients were divided into three groups: mild and non fibrosis (F0 to 1),significant fibrosis(F2 to 3) and cirrhosis (F4),according to the recommended standard of FibroTouch.Correlation between TE liver stiffness,MRE liver stiffness and ADC values were identified by using Spearman correlation test.The difference of the MRE liver stiffness and ADC value among the three groups was tested using independent sample t test.The overall predictive ability of MRE and DWI in assessment of liver fibrosis and cirrhosis was analyzed by constructing ROC curve.Results TE and MRI were successfully performed in all subjects,and the image quality was good.The MRE liver stiffness in mild and non fibrosis,significant fibrosis and cirrhosis was (2.32±0.31),(3.43±1.05),(4.77±0.68) kPa with statistically significant difference (F=61.690,P<0.01).The ADC values in three groups were (1.31±0.14)×10^-3,(1.23±0.15)×10^-3,(1.22±0.12)×10^-3mm^2/s without significant difference (F=1.074,P=0.360).The TE liver stiffness in three groups was (5.61±1.05),(9.56±0.57),(17.25±3.55)kPa,respectively,there was significant correlation between the MRE liver stiffness and the TE liver stiffness(t=0.858,P<0.01),but no significant correlation between the TE liver stiffness and the ADC value was found (r=-0.326,P=0.120).The area under ROC of MRE liver stif

关 键 词：肝纤维化 磁共振弹性成像 扩散加权成像 

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] R575.2[医药卫生—临床医学]