肝静脉直径、改良肝尾叶/右叶比值对肝纤维化和肝硬化病理学分期的诊断价值  

Diagnostic Value of Liver Vein Diameters and Caudate-Right Lobe Ratio Measurement for Liver Fibrosis and Liver Cirrhosis

作　　者：张洪[1] 张佳 周家龙[1] 赵卫[1] 边莉[2] 薛凤麟[2] 魏佳璐 何波[1] ZHANG Hong;ZHANG Jia;ZHOU Jialong;ZHAO Wei;BIAN Li;XUE Fenglin;WEI Jialu;HE Bo(Department of Radiology,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;不详)

机构地区：[1]昆明医科大学第一附属医院医学影像科,云南昆明650032 [2]昆明医科大学第一附属医院病理科,云南昆明650032

出　　处：《中国医学影像学杂志》2020年第7期529-532,534,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨肝静脉直径、改良肝尾状叶/右叶比值及其组合无创定量评价肝纤维化、肝硬化病理学分期的临床价值。资料与方法回顾性分析99例经病理穿刺证实的肝纤维化、肝硬化患者的MRI图像,其中S022例、S128例、S214例、S311例、S410例、肝硬化14例。所有患者均行MRI三期增强扫描。轴位增强图像在3支肝静脉汇入下腔静脉前最宽处分别测量肝左静脉、肝中静脉、肝右静脉直径(lhvd、mhvd、rhvd),并计算3支肝静脉直径之和(ld)。以门静脉右支发出第一分支处为分界,测量尾状叶和肝右叶的宽度,计算改良肝尾状叶/右叶横径比值(crl-r)。分析lhvd、mhvd、rhvd、ld、crl-r及ld/crl-r与肝纤维化、肝硬化病理学分期的相关性;采用受试者工作特征(ROC)曲线分析各参数值对肝纤维化、肝硬化病理分期的诊断效能。结果肝纤维化、肝硬化各分期组间lhvd、mhvd、rhvd、ld、crl-r、ld/crl-r值差异均有统计学意义(P<0.01)。不同肝纤维化、肝硬化分期与rhvd、mhvd、lhvd、ld、ld/crl-r呈负相关(r=-0.59、-0.45、-0.46、-0.61、-0.74,P<0.01);与crl-r值呈正相关(r=0.57,P<0.01)。ld/crl-r、rhvd诊断肝纤维化、肝硬化分期的ROC曲线下面积均>0.7,具有较高的诊断价值。ld/crl-r对应肝纤维化S≥2期、S≥4期及肝硬化期的诊断敏感度、特异度分别为86.0%、57.1%,84.0%、80.0%和88.2%、85.7%;rhvd对应肝纤维化S≥2期、S≥4期及肝硬化期的诊断敏感度、特异度分别为74.0%、64.3%,74.7%、80.0%和85.9%、78.6%。结论ld/crl-r、rhvd对肝纤维化、肝硬化的无创性评估具有一定的价值,ld/crl-r对肝纤维化、肝硬化分期具有较高的诊断效能。Purpose To investigate the clinical value of liver vein diameter,caudate-right lobe ratio and their combination for noninvasive quantitative evaluation of liver fibrosis and cirrhosis pathological staging.Materials and Methods The MRI images of 99 patients with liver fibrosis and cirrhosis confirmed by pathological puncture were retrospectively analyzed.Among them,22 were S0,28 were S1,14 were S2,11 were S3,10 were S4,and 14 were cirrhosis.All patients underwent three-phase enhanced MRI scans.The axially enhanced image measured the diameter of the left hepatic vein,middle hepatic vein and right hepatic vein(lhvd,mhvd,rhvd)at the widest point before the three hepatic veins merge into the inferior vena cava,and calculated the sum of the three hepatic veins(ld).Taking the first branch of the right branch of the portal vein as the boundary,the width of the caudate lobe and the right lobe of the liver were measured,and the ratio of the width of the caudate lobe to the right lobe(crl-r)was calculated.The correlation between lhvd,mhvd,rhvd,ld,crl-r,and ld/crl-r with liver fibrosis and cirrhosis pathological stages was analyzed;receiver operating characteristic(ROC)curve was used to analyze the value of each parameter for liver fibrosis and liver cirrhosis pathological stage.Results There were statistically significant differences in lhvd,mhvd,rhvd,ld,crl-r,ld/crl-r values between the stages of liver fibrosis and cirrhosis(P<0.01).Different liver fibrosis and cirrhosis stages were negatively correlated with rhvd,mhvd,lhvd,ld,ld/crl-r(r=-0.59,-0.45,-0.46,-0.61,-0.74,P<0.01);and positively correlated with crl-r(r=0.57,P<0.01).The area under the ROC curve for the diagnosis of liver fibrosis and cirrhosis stage by ld/crl-r and rhvd were all>0.7,which had a high diagnostic value.The diagnostic sensitivity and specificity of ld/crl-r corresponding to liver fibrosis S≥2,S≥4 and cirrhosis were 86.0%,57.1%,84.0%,80.0%and 88.2%,85.7%,respectively.The sensitivity and specificity of rhvd in the diagnosis of S≥2 stage,S≥4 sta

关 键 词：肝硬化 纤维化 磁共振成像 病理学 外科 诊断 鉴别 

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