摘要
目的 探讨MRDWI对肝纤维化程度定量分析的能力。方法应用1．5TMR对12名志愿者、47例慢性乙型或丙型肝炎患者进行常规扫描及DWI检查，b值选择0、250、500、750及1000s／mm^2，联合b值b250-1000及b500～1000分别取b=250、500、750和1000s／mm^2及b=500、750和1000s／mm^2的ADC平均值。采用Scheuer法进行纤维化（S）分期和炎症（G）分级，探讨病理分期与ADC值的相关性，采用Mann—Whitney U检验及Logistic回归分析评价ADC预测不同纤维化分期的能力。结果当b=750s／mm^2时，S0、S1、S2、S3、S4期纤维化下ADC平均值分别为（1．41±0．11）×10^-3、（1．37±0．09）×10^-3（1．27±0．05）×10^-3、（1．26±0．04）×10^-3（1．224-0．06）×10^-3mm^2／s，ADC值在不同S分期间差异最大（F=18．31，P〈0．01）。随着S分期的增加，各b值下的ADC平均值逐渐下降，两者存在负相关性，b250-1000相关性最强（r=-0．727，P〈0．01）。选择b750及b250-1000、b500-1000时，ADC值在S2期以上（与S0和S1相比）及S3期以上（与S0和S1相比）纤维化时均明显降低（P〈0．01）；在预测S2期以上纤维化时，选择b750时曲线下面积（AUC）最大（0．909），敏感性85．7％，特异性100．0％（ADC标准≤1．35×10^-3mm2／s）；在预测S3期以上纤维化时，选择b250-1000时AUC最大（0．864），敏感性69．6％，特异性95．8％（ADC标准≤1．53×10^-3mm^2／s）。结论DWI对于预测S2期以上及S3期以上肝纤维化程度具有良好的效果，b值b250-1000或b500-1000均适合慢性病毒性肝炎患者的纤维化评价。
Objective The study was to evaluate DWI for quantifying liver fibrosis. Methods A total of 12 volunteers, 47 patients who had chronic HBV or HCV hepatitis and underwent liver biopsy [ Scheuer score for fibrosis（S） and inflammation（G） ] were enrolled in this study. They were scanned using a 1.5 T MR unit with b value of 0, 250, 500, 750, 1000 s/mm^2. ADCs at b250-1000 and b250-1000 were the average ADCs of b = 250, 500, 750, 1000 s/mm^2 and b = 500, 750, 1000 s/mm^2. The studied the correlation between Scheuer scores and ADC values, and conducted Mann-Whitney U test and Logistic regression to evaluate ADC for prediction of fibrosis scores. Results The average ADCs were （ 1.41 ±0.11）,（1.37±0.09）,（1.27 ±0.05）,（1.26 ±0.04）,（1.22±0.06） mm2/s respectively from SO to S4 stage at b = 750 s/mm^2 （ F = 18.31, P 〈 0. 01 ）. With the increase of fibrosis score, the average ADC decreased gradually, the two were better negatively correlated at b250-1000 （ r = - 0. 727, P 〈 0.01 ） than other b values. Using b750 and the two combined b values, the found significantly lower ADCs in S2 or greater versus S1 or less and inS3 or greater versus S2 or less fibrosis （P 〈 0. 01 ）. The best predictor for S2 or greater was b7s0 with the largest AUC of 0. 909, sensitivity of 85.7% , and specificity of 100. 0% （ ADC ≤1.35× 10^-3 mm^2/s）. The best predictor for S3 or greater was b250-1000 with the largest AUC of 0. 864, sensitivity of 69. 6%, and specificity o（95. 8% （ ADC ≤1. 53 ×10^-3 mm^2 /s ） . Conclusion D WI can be a good predictor for scorig liver fibrosis for s2 or s3 stage above, while b750 and the combined b values are suitable for evaluation.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2010年第1期65-69,共5页
Chinese Journal of Radiology
基金
基金项目：国家自然科学基金资助项目（30670593）
关键词
肝硬化
纤维化
磁共振成像
扩散
肝炎
Liver cirrhosis
Fibrosis
Diffusion magnetic resonance imaging
Hepatitis
