摘要
目的探讨磁共振(MR)动态增强扫描肝纤维化及肝硬化门静脉强化达峰时间范围,及以其为基础的规范化门静脉成像系统管径对肝纤维化及肝硬化的诊断价值。方法采用实验专用健康中国小型猪16只,建立肝纤维化及肝硬化疾病模型,造模开始后第0、5、9、16及21周分别行肝脏MR动态增强扫描,测量门静脉强化达峰时间(TTP),以此时间规范门静脉成像时间窗,在规范后的门静脉成像测量门静脉主干(MPV)、肠系膜上静脉(SMV)、脾静脉(SPV)管径。分析用于规范肝纤维化及肝硬化门静脉成像的TTP范围,以及MPV、SMV、SPV管径对肝纤维化及肝硬化的鉴别诊断价值。结果 (1)门静脉TTP、门静脉系统管径与疾病阶段的相关性:从肝正常到肝纤维化再到肝硬化过程中,动态增强扫描门静脉TTP逐渐延长(r=0.714);MPV(r=0.402)、SMV(r=0.33)、SPV(r=0.644)管径呈逐渐增加的趋势,其中以TTP和SPV管径递增最为明显(各P<0.05)。(2)诊断性分析:用于规范肝纤维化及肝硬化门静脉成像的TTP临界点分别为34.45s、39.15s。用MPV、SMV和SPV管径分别诊断肝纤维化ROC曲线下面积依次为0.696、0.711和0.848,诊断肝硬化的ROC曲线下面积依次为0.733、0.631和0.861,其中SPV管径曲线下面积最大(各P<0.05)。结论 MR动态增强扫描有助于规范MR门静脉成像扫描时间窗,规范化MR门静脉成像SPV管径对诊断肝纤维化及肝硬化具有重要应用价值。
Objective Magnetic resonance （MR） portovenography standardized by the time to peak （TTP） of por- tal vein obtained from dynamic contrast-enhanced scans, and determine whether the calibers of the main portal vein as well as its principal branches shown on the standard MR portovenography could identify hepatic fibrosis and cirrhosis. Methods 16 minipigs were prospectively used to model liver fibrosis and cirrhosis, and underwent MR dynamic contrast- enhancement scans on 0, 5th, 9th, 16th and 21st weekend after the beginning of modeling the disease to obtain TTP of portal vein, and standard MR portovenography was subsequently carried out based on the TTP. On the axial portovenog- raphy, diameters of main portal vein （MPV）, superior mesenteric vein （SMV） or splenic vein （SPV） were measured. The range of TTP was statistically obtained for the standard scan time of MR portovenography in hepatic fibrosis and cir- rhosis. Diameters of the above veins were statistically analyzed to determine how to determine hepatic fibrosis and cirrho- sis. Results From hepatic normality to fibrosis and to cirrhosis, the values of TTP （r= 0. 714）, and the diameters of MPV （r=0. 402）, SMV （r=0.33） and SPV （r=0. 644） increased （all P〈0.05）, and the diameters of SPV increased more greatly than any other diameter. For standard MR portovenography in hepatic fibrosis and cirrhosis, the cutoff of TTP was 34.45 s and 39.15 s, respectively. For diagnosis of hepatic fibrosis, the areas under receiver operating charac- teristic （ROC） curves of MPV, SMV and SPV were 0. 696, 0. 711 and 0. 848, respectively. For diagnosis of cirrhosis, the areas under ROC curves of MPV, SMV and SPV were 0. 733, 0. 631 and 0. 861, respectively. The diameter of SPV could he the better index for diagnosis of hepatic fibrosis and cirrhosis than any other diameter （all P〈0.05）. Conclusions The TTP of portal vein on dynamic contrast-enhanced MR scans could standardize MR portovenography, and the diameter of SPV could he a
作者
杨振峰
王丽英
赵琼惠
陈天武
YANG Zhenfeng WANG Liying ZHAO Qionghui CHEN Tianwu(Department of Radiology, The Third Affiliated Hospital of Xinxiang Medical College, Xinxiang 453000, Henan, China Department of Radiology, Changsha Central Hospital, Changsha 410004, Hunan, China Sichuan Key Laboratory of Medical Imaging, Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan, China)
出处
《西部医学》
2017年第4期474-478,483,共6页
Medical Journal of West China
基金
国家自然科学基金(81050033)
四川省科技支撑计划项目(2011SZ0237)
关键词
磁共振成像
动态增强
门静脉成像
肝纤维化
肝硬化
Magnetic resonance imaging
Dynamic contrast-enhancement
Portovenography
Hepatic fibrosis
Liver cirrhosis
