MRI在评价慢性乙型病毒性肝炎随访人群肝脏炎症及纤维化程度中的价值  

Value of MRI Fndings in Evaluating Degree of Hepatic Inflammation and Fibrosis in Chronic Virus Hepatitis B Patients

作　　者：吕志彬[1] 闫铄 关春爽 谢汝明[1] 陈步东 赵丽琴[2] 贺文[2] LV Zhibin;YAN Shuo;GUAN Chunshuang(Department of Radiology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,P.R.China)

机构地区：[1]首都医科大学附属北京地坛医院,100015 [2]首都医科大学附属北京友谊医院,100050

出　　处：《临床放射学杂志》2020年第1期73-77,共5页Journal of Clinical Radiology

摘　　要：目的探讨MRI影像特征对于慢性乙型病毒性肝炎随访人群肝脏炎症及纤维化程度评估的价值。方法搜集接受腹部MRI检查和肝脏穿刺活检的慢性乙型病毒性肝炎定期随访患者51例,对MRI 5组征象进行有或无评价:肝实质T2WI信号增高、肝内门静脉周围间隙增宽、胆囊壁增厚水肿、肝周淋巴结、肝实质异常强化,其结果与肝脏穿刺活检病理炎症(G1、G2、G3)和纤维化(S1、S2、S3)程度分级进行比较。结果肝实质T2WI信号增高在G1/G2/G3(4/6/15,χ^2=13.456,P=0.001)、G2/G3(6/15,χ^2=8.407,P=0.004)、G1/G3(4/15,χ^2=11.691,P=0.001)、S1/S2/S3(4/12/9,χ^2=8.262,P=0.016)、S1/S2(4/12,χ^2=5.546,P=0.0019)、S1/S3(4/9,χ^2=6.850,P=0.009)各组比较中差异具有统计学意义。肝实质异常强化在S1/S2(3/10,χ^2=4.677,P=0.031)比较中差异具有统计学意义。肝内门静脉周围间隙增宽在G1/G2/G3(0/0/4/χ^2=7.957,P=0.019)、G2/G3(0/4,χ^2=4.265,P=0.039)各组比较中差异具有统计学意义。肝脏周围淋巴结在G1/G2/G3(1/7/11,χ^2=11.07,P=0.004)、G1/G2(1/7,χ^2=5.475,P=00019)、G1/G3(1/11,χ^2=11.163,P=0.001)各组比较中差异具有统计学意义。结论肝实质T2WI信号增高提示明显的肝脏炎症(G>2级)及纤维化程度较高(2级)。肝脏周围淋巴结的出现提示肝脏炎症活动度较高(G2级),与肝纤维化程度无关。肝内门静脉周围间隙增宽提示明显的肝脏炎症(G>2级)。Objective To detect the value of MRI findings in evaluating the degree of hepatic inflammation and fibrosis in Chronic Virus Hepatitis B Patients.Methods Fifty-one cases of chronic virus hepatitis B patients who had abdominal MRI and liver puncture biopsy conducted were recruited.Five groups of manifestations on MR images were evaluated:increased signal intensity of hepatic parenchyma on T2WI,intrahepatic periportal space widening,edema in wall of gall bladder,perihepatic lymph nodes and abnormal enhancement of hepatic parenchyma.A comparative study was conducted between MRI findings and grades of inflammation(G1,G2,G3)and fibrosis(S1,S2,S3)proved by liver biopsy.Results Increased signal intensity of hepatic parenchyma on T2WI in G1/G2/G3(4/6/15,χ^2=13.456,P=0.001),G2/G3(6/15,χ^2=8.407,P=0.004),G1/G3(4/15,χ^2=11.691,P=0.001),S1/S2/S3(4/12/9,χ^2=8.262,P=0.016),S1/S2(4/12,χ^2=5.546,P=0.0019),S1/S3(4/9,χ^2=6.850,P=0.009).Abnormal enhancement of hepatic parenchyma in S1/S2(3/10,χ^2=4.677,P=0.031).Presence of widened intrahepatic periportal space in G1/G2/G3(0/0/4/,χ^2=7.957,P=0.019),G2/G3(0/4,χ^2=4.265,P=0.039).Presence of perihepatic lymph nodes in G1/G2/G3(1/7/11,χ^2=11.07,P=0.004),G1/G2(1/7,χ^2=5.475,P=00019),G1/G3(1/11,χ^2=11.163,P=0.001).Conclusion Increased signal intensity of hepatic parenchyma on T2WI indicates obvious hepatic inflammation(G>2)and higher grades of fibrosis(S≥2).Presence of perihepatic lymph nodes suggests a higher level of activation of inflammation(G≥2),and is not correlated with grades of fibrosis.Widened intrahepatic periportal space indicates obvious hepatic inflammation(G>2).

关 键 词：慢性乙型病毒性肝炎 磁共振成像 经皮肝脏穿刺 病理分级 

分 类 号：R512.62[医药卫生—内科学] R445.2[医药卫生—临床医学]