磁共振张量成像对闭合性隐匿肝损伤诊断价值分析  

Study of MRI Diffusion Tensor Imaging in Diagnosis of the Occult Blunt Hepatic Traum

作　　者：孙文超 张乐 郭成伟 高红丽 张丽艳 沈文超 陈为军 沈三弟 SUN Wen-chao;ZHANG-le;GUO Cheng-wei;GAO Hong-li;ZHANG Li-yan;SHEN Wen-chao;CHEN Wei-jun;SHEN San-di(Department of medical imaging,the 82 group hospital of PLA,Baoding 071000,Hebei Province,China;Breast and Thyroid Surgery,the Sixth Affiliated Hospital of Guangzhou Medical University,Qingyuan People’s Hospital,Qingyuan 511518,China)

机构地区：[1]陆军第八十二集团军医院医学影像科,河北保定071000 [2]广州大学附属第六医院/清远市人民医院乳腺甲状腺外科,广东清远511518

出　　处：《中国CT和MRI杂志》2023年第5期88-90,共3页Chinese Journal of CT and MRI

基　　金：河北省医学科研项目(20221908,20210445)。

摘　　要：目的 探讨磁共振张量成像(Diffusion tensor imaging,DTI)对闭合性隐匿肝损伤的诊断价值。方法 回顾性分析闭合性隐匿肝损伤患者43例,分析其DTI不同时间段(48h、72h及7d)影像变化特点,平均扩散系数(average diffusion coefficient,DCavg)及各向异性系数(fractional anisotropy,FA)值、肝酶(AST/ALT)变化规律及其之间相关性。采用SPSS22.0软件进行统计分析,以P<0.05为差异有统计学意义。结果 闭合性隐匿肝损伤表现肝实质内信号不均(T_(2)WI/DTI示高信号),DTI诊断闭合性隐匿肝损伤阳性率显著高于T_(2)WI/T_(1)WI(χ^(2)=24.08,P<0.01)及AST/ALT (χ^(2)=4.49,P<0.05);DCavg(b=100、 300 s/mm^(2))于24h、48h组与对照组比较均显著性升高(P<0.05);而FA(b=100、300、600s/mm^(2))值呈下降趋势,对照组与24h、48h、7d组均存在显著性差异(P<0.05);DCavg与AST间存在高度负相关(b=100s/mm^(2),R=-0.71,P<0.01), FA与AST、ALT间均亦存在显著负相关(b=300s/mm^(2),R=-0.70,P<0.01)。结论 DTI能较早的发现闭合性肝损伤肝内隐匿性病灶,其参数Dcavg及FA客观反映闭合性隐匿肝损伤的病理变化特点,对闭合性隐匿肝损伤的准确诊断具有重要的临床价值。Objective To analyze the value of magnetic resonance tensor imaging(DTI)in the occult blunt hepatic traum(BHT).Methods Forty-three BHT patients were collected.The MRI/DTI features of BHT,the values of mean diffusion coefficient(DCavg)and anisotropy coefficient(FA),the changes of liver enzymes(AST/ALT)correspondingly in different time periods(48h,72h and 7d)and their correlation were analyzed at the same time.SPSS 22.0 software was used for statistical analysis and P values lower than 0.05 were considered statistically significant.Results There showed uneven signal in liver parenchyma(T_(2)WI/DTI showed spotted high signal)of BHT patients.The positive rate of DTI was significantly higher than that of T_(2)WI/T_(1)WI(χ^(2)=24.08,P<0.01)and AST/ALT(χ^(2)=4.49,P<0.05)in the diagnosis of BHT;DCavg(b=100,300 s/mm^(2))increased significantly in 24h and 48h groups compared with the control group(P<0.05),in the contrast,the value of FA(b=100,300,600s/mm^(2))decreased.There were significant differences between the control group and the 24h,48h and 7d groups(P<0.05);There existed a high negative correlation between DCavg and AST(b=100s/mm^(2),R=-0.71,P<0.01).There was also a significant negative correlation between FA,AST and ALT(b=300s/mm^(2),R=-0.70,P<0.01).Conclusion MRI-DTI can detect the mild intrahepatic lesions on the patient of BHT at the relatively early stage,and the parameters DCavg and FA can reflect the pathological changes of BHT objectively,which have important value for the accurate clinical diagnosis of BHT.

关 键 词：闭合性肝损伤 肝损伤 磁共振弥散成像 磁共振张量成像 X-线断层摄影 

分 类 号：R445.2[医药卫生—影像医学与核医学]