应用磁共振DWI单指数、双指数和拉伸指数模型参数评估慢性乙型肝炎患者肝纤维化程度效能研究
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摘要
目的探讨应用磁共振DWI单指数、双指数和拉伸指数模型参数评估慢性乙型肝炎(CHB)患者肝纤维化程度的临床价值。方法 2014年2月～2017年9月我院收治的CHB患者77例,选择同时期20例健康人作为对照,对CHB患者行肝活检,两组受试者接受磁共振检查,测量单指数模型、双指数模型和拉伸指数模型参数,其中ADCst为表面扩散系数,Dt为真实扩散系数,Dp为假性扩散系数,f为灌注相关体积分数,DDC为扩散分布指数,α为水分子扩散异质性指数。结果 CHB单指数模型的ADCst、双指数模型的Dt、拉伸指数模型的f和DDC分别为(0.899±0.080)×10~(-3)mm~2/s、(0.591±0.092)×10~(-3)mm~2/s、(32.374±7.472)×10~(-3)mm~2/s和(1.103±0.257)×10~(-3)mm~2/s,显著低于健康人【(0.986±0.095)×10~(-3)mm~2/s、(0.704±0.073)×10~(-3)mm~2/s、(39.686±5.871)×10~(-3)mm~2/s和(1.394±0.243)×10~(-3)mm~2/s,P<0.05】;在25例无显著肝纤维化、29例显著肝纤维化和23例肝硬化患者中,ADCst、Dt、f和DDC显著差异(P<0.05);ADCst、Dt、f和DDC诊断肝纤维化的ROC曲线下面积分别为0.841、0.934、0.770和0.926。结论应用磁共振双指数模型和拉伸指数模型诊断CHB患者肝纤维化比应用单指数模型具有更好的诊断效果,值得进一步研究验证。
Objective To explore the clinical efficacy of single,double and stretch index model under diffusion weighted imaging(DWI)of MRI in evaluating liver fibrosis in patients with chronic hepatitis B(CHB).Methods 77 patients with CHB and 20 healthy persons were recruited in this study between February 2014 and September 2017.All patients received liver biopsies and individuals in both groups received MRI examination,and the parameters,e.g.ADCst as surface diffusion coefficient,Dt as real diffusion coefficient,Dp as false diffusion coefficient,f as perfusion related volume fraction,DDC as diffusion distribution index andαas water molecule diffusion heterogeneity index.Results The ADCst,Dt,f and DDC in patients with CHB were(0.899±0.080)×10~(-3)mm~2/s,(0.591±0.092)×10~(-3)mm~2/s,(32.374±7.472)×10~(-3)mm~2/s and(1.103±0.257)×10~(-3)mm~2/s,significantly lower than【(0.986±0.095)×10~(-3)mm~2/s,(0.704±0.073)×10~(-3)mm~2/s,(39.686±5.871)×10~(-3)mm~2/s and(1.394±0.243)×10~(-3)mm~2/s,P<0.05】in healthy persons;there were significantly statistical differences as respect to ADCst,Dt,f and DDC in25 patients without liver fibrosis,29 with significant liver fibrosis and 23 with liver cirrhosis(P<0.05);the AUC of ADCst,Dt,f and DDC in diagnosing liver fibrosis were 0.841,0.934,0.770 and 0.926,respectively.ConclusionThe application of double and stretch index models in diagnosing liver fibrosis in patients with CHB have a promising results,which might be validated in multicentral clinical trials.
Objective To explore the clinical efficacy of single,double and stretch index model under diffusion weighted imaging(DWI)of MRI in evaluating liver fibrosis in patients with chronic hepatitis B(CHB).Methods 77 patients with CHB and 20 healthy persons were recruited in this study between February 2014 and September 2017.All patients received liver biopsies and individuals in both groups received MRI examination,and the parameters,e.g.ADCst as surface diffusion coefficient,Dt as real diffusion coefficient,Dp as false diffusion coefficient,f as perfusion related volume fraction,DDC as diffusion distribution index andαas water molecule diffusion heterogeneity index.Results The ADCst,Dt,f and DDC in patients with CHB were(0.899±0.080)×10~(-3)mm~2/s,(0.591±0.092)×10~(-3)mm~2/s,(32.374±7.472)×10~(-3)mm~2/s and(1.103±0.257)×10~(-3)mm~2/s,significantly lower than【(0.986±0.095)×10~(-3)mm~2/s,(0.704±0.073)×10~(-3)mm~2/s,(39.686±5.871)×10~(-3)mm~2/s and(1.394±0.243)×10~(-3)mm~2/s,P<0.05】in healthy persons;there were significantly statistical differences as respect to ADCst,Dt,f and DDC in25 patients without liver fibrosis,29 with significant liver fibrosis and 23 with liver cirrhosis(P<0.05);the AUC of ADCst,Dt,f and DDC in diagnosing liver fibrosis were 0.841,0.934,0.770 and 0.926,respectively.ConclusionThe application of double and stretch index models in diagnosing liver fibrosis in patients with CHB have a promising results,which might be validated in multicentral clinical trials.
引文
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[15]Chen C,Fu F,Zhang J,et al.Evaluation of liver fibrosis with a monoexponential model of intravoxel incoherent motion magnetic resonance imaging.Oncotarget,2018,9(37):24619-24626.
[16]Yang L,Rao S,Wang W,et al.Staging liver fibrosis with DWI:is there an added value for diffusion kurtosis imaging.Eur Radiol,2018,28(7):3041-3049.
[17]Cao Z,Li Z,Wang H,et al.Algorithm of Golgi protein 73 and liver stiffness accurately diagnoses significant fibrosis in chronic HBV infection.Liver Int,2017,37(11):1612.
[18]Jiang H,Chen J,Gao R,et al.Liver fibrosis staging with diffusion-weighted imaging:a systematic review and Meta-analysis.Abdom Radiol,2016,42(2):1-12.
[19]Hu G,Liang W,Wu M,et al.Staging of rat liver fibrosis using monoexponential,stretched exponential and diffusion kurtosis models with diffusion weighted imaging-magnetic resonance.Oncotarget,2018,9(2):2357-2366.
[20]鲁果果,高雪梅,程敬亮,等.单、双指数模型扩散加权成像鉴别诊断肝脏良、恶性肿瘤的价值.中华放射学杂志,2015,49(1):47-51.
[2]Kocakoc E,Bakan AA,Poyrazoglu OK,et al.Assessment of liver fibrosis with diffusion-weighted magnetic resonance imaging using different b-values in chronic viral hepatitis.Med Princ Pract,2015,24(6):522-526.
[3]Seo YS,Kim MY,Kim SU,et al.Accuracy of transient elastography in assessing liver fibrosis in chronic viral hepatitis:A multicentre,retrospective study.Liver Int,2015,35(10):2246-2255.
[4]陈宵瑜,杨长青.肝纤维化发生机制研究新进展.实用肝脏病杂志,2016,19(1):121-124.
[5]Schreiberdietrich D,Pohl M,Cui XW,et al.Perihepatic lymphadenopathy in children with chronic viral hepatitis.J Ultrason,2015,15(61):137.
[6]Inchingolo R,Gaetano AM,Curione D,et al.Role of diffusionweighted imaging,apparent diffusion coefficient and correlation with hepatobiliary phase findings in the differentiation of hepatocellular carcinoma from dysplastic nodules in cirrhotic liver.Eur Radiol,2015,25(4):1087-1096.
[7]李鸽,王洁,鲍艳婷,等.慢性乙型肝炎HBs Ag及HBs Ag/HBVDNA比值与组织病理炎症活动度的相关性.中华肝脏病杂志,2015,23(1):40-45.
[8]Chung YH,Kim JA,Song BC,et al.Expression of transforming growth factor-alpha m RNA in livers of patients with chronic viral hepatitis and hepatocellular carcinoma.Cancer,2015,89(5):977-982.
[9]Ma LN,Liu XY,Luo X,et al.Serum high-sensitivity C-reactive protein are associated with HBV replication,liver damage and fibrosis in patients with chronic hepatitis B.Hepatogastroenterology,2015,62(138):368.
[10]Meng Y,Liang Y,Liu M.The value of MRI in the diagnosis of primary biliary cirrhosis and assessment of liver fibrosis.Plos One,2015,10(3):e0120110.
[11]Ayvaz S,Tuncel SA,Can G,et al.Efficacy of diffusion-weighted magnetic resonance imaging in the evaluation of extrahepatic cholestasis-related hepatic fibrosis.Turk J Med Sci,2015,45(3):686.
[12]Galal SM,Aal FH,Mohammed ED,et al.Chronic viral hepatitis C in pediatric age group;assessment of viral activity and hepatic fibrosis by 1 H magnetic resonance spectroscopy and diffusion weighted imaging in asymptomatic patient.EJRNM,2016,47(3):739-748.
[13]Clark P,Filho HL,Chua-Anusorn W,et al.Potential MRI biomarkers of liver fibrosis and inflammation in NAFLD with dual R2 and R2*mapping.J Hepatol,2016,64(2):S737-S737.
[14]Zhang Z,Wang G,Kang K,et al.The diagnostic accuracy and clinical utility of three noninvasive models for predicting liver fibrosis in patients with HBV infection.Plos One,2016,11(4):e0152757.
[15]Chen C,Fu F,Zhang J,et al.Evaluation of liver fibrosis with a monoexponential model of intravoxel incoherent motion magnetic resonance imaging.Oncotarget,2018,9(37):24619-24626.
[16]Yang L,Rao S,Wang W,et al.Staging liver fibrosis with DWI:is there an added value for diffusion kurtosis imaging.Eur Radiol,2018,28(7):3041-3049.
[17]Cao Z,Li Z,Wang H,et al.Algorithm of Golgi protein 73 and liver stiffness accurately diagnoses significant fibrosis in chronic HBV infection.Liver Int,2017,37(11):1612.
[18]Jiang H,Chen J,Gao R,et al.Liver fibrosis staging with diffusion-weighted imaging:a systematic review and Meta-analysis.Abdom Radiol,2016,42(2):1-12.
[19]Hu G,Liang W,Wu M,et al.Staging of rat liver fibrosis using monoexponential,stretched exponential and diffusion kurtosis models with diffusion weighted imaging-magnetic resonance.Oncotarget,2018,9(2):2357-2366.
[20]鲁果果,高雪梅,程敬亮,等.单、双指数模型扩散加权成像鉴别诊断肝脏良、恶性肿瘤的价值.中华放射学杂志,2015,49(1):47-51.
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