3.0T磁共振定量评估HBV相关慢加急性肝衰竭

发布时间：2018-06-12 13:01

本文选题：肝功能衰竭 + 磁共振成像　；参考：《西南医科大学》2016年硕士论文

【摘要】：目的:探讨肝脏磁共振成像对慢性乙型病毒性肝炎所致慢加急性肝衰竭的评估价值。方法:收集我院2015年1月至2016年1月符合标准的病例39例,包括慢加急性肝衰竭患者28例、慢性肝炎患者11例,同时收集正常对照组14例。分别对其进行3.0T肝脏磁共振检查,检查序列包括Dual FFE、TSE/T2WI/SPAIR、THRIVE、DWI、m-GRASE和VEN-BOLD序列,并分别计算出相应的影像指标(rSⅠ、rSⅡ、SⅢT2WI、SⅡTHRIVE、ADC值、T2值或R2值、SⅡSWI)。同时收集病例组磁共振检查前后2天内血液生化指标。采用单因素方差分析或非参数秩和检验分析三组间各影像指标的组间差异,采用Spearman秩相关分析各影像指标与三组肝功能等级的相关性,采用接受者工作特性(ROC)曲线评价部分影像指标对慢加急性肝衰竭的诊断效能。结果:三组间rSⅠ、SⅡT2WI、ADC值、T2/R2值及SⅡSWI的差异有统计学意义。rSⅠ、SⅡT2W1及T2值随着肝功能损害的加重而升高,其秩相关系数分别为0.410、0.370和0.637, ADC值、R2及SⅡSWI随着肝功能损害的加重而降低,其秩相关系数分别为-0.505、-0.637和-0.455,余rSⅡ及SⅡTHRIVE与三组肝功能等级无相关性。两两比较显示:R2值及ADC值能同时区别正常对照组与慢加急性肝衰竭组及肝炎组与慢加急性肝衰竭组;rSⅠ、SⅡT2WI及SⅡSWI仅能区别正常对照组与慢加急性肝衰竭组。ROC曲线示T2诊断慢加急性肝衰竭曲线下面积=0.863,P=0.000,最佳诊断界点57.73ms (R2 =0.0173)。ADC值诊断慢加急性肝衰竭曲线下面积=0.794,P =0.001,最佳诊断界点ADC=1.1261×10-3mm2/s,但该诊断截值与慢性肝炎组ADC值平均值明显重叠。删除慢性肝炎组后ROC曲线显示,rSⅠ、SⅡT2WI及SⅡSWI诊断慢加急性肝衰竭的曲线下面积分别为0.799、0.737、0.798, P值分别为0.002、0.013、0.003,诊断截值分别为1.5786、0.9856、0.5871。五个影像指标中任意两个指标之一阳性时,诊断为慢加急性肝衰竭的敏感性提高的范围为:86.74%至99.19%;当五个影像指标中任意两个影像指标同时阳性时,诊断慢加急性肝衰竭其特异性提高的范围为:92.85%至100%。T2与INR、PT及HA呈中度正相关(rs=0.651、0.666、0.390, P=0.000、0.000、0.025),与PTA、ALB、PA呈中度负相关(rs=-0.667、-0.480、-0.373, P=0.000、0.004、0.030),余各影像指标只与少部分实验室指标有相关性。结论:(1) rSⅠ、SⅡT2WI、SⅡSWI、ADC图及T2图均可较好的反映肝脏功能情况,其中T2/R2值对肝功能的评估效果较好,SⅡTHRIVE不能反映肝脏的功能状态;(2) R2值及ADC值能同时区别正常对照组与慢加急性肝衰竭组及肝炎组与慢加急性肝衰竭组,其中,慢加急性肝衰竭的ADC值诊断截值与慢性肝炎组有明显重叠,故其运用价值有限。(3) rSⅠ、SⅡT2WI及SⅡSWI仅能区别正常对照组与慢加急性肝衰竭组,但联合运用两个或多个影像指标可增加肝衰竭的诊断敏感性或特异性。(4) T2或R2值能够较好的诊断或预测慢加急性肝衰竭,并且与较多的实验室指标均均有相关性,可作为定量评估慢性肝炎肝脏功能的理想指标之一。
[Abstract]:Objective: To evaluate the value of liver magnetic resonance imaging (MRI) for chronic hepatitis B caused by chronic hepatitis B and acute liver failure. Methods: 39 cases were collected from January 2015 to January 2016 in our hospital, including 28 patients with chronic acute liver failure, 11 cases of chronic hepatitis, and 14 cases of normal control group. The 3.0T liver was carried out respectively. The examination sequence included Dual FFE, TSE/T2WI/SPAIR, THRIVE, DWI, m-GRASE and VEN-BOLD sequences, and calculated the corresponding image indexes (rS I, rS II, S III T2WI, S II). The difference between the three groups of the three groups was analyzed by the nonparametric rank sum test. The correlation between the image indexes and the three groups of liver function grades was analyzed by the Spearman rank correlation analysis. The diagnostic efficiency of the partial image index for the chronic acute liver failure was evaluated by the receiver working characteristic (ROC) curve. Results: the three groups were rS I, S II T2WI, ADC value, T2/R2 value and the value of T2/R2 value. The difference of S II SWI was statistically significant.RS I, S II T2W1 and T2 value increased with the aggravation of liver function damage, and its rank correlation coefficients were 0.410,0.370 and 0.637, ADC value, R2 and S II SWI decreased with the aggravation of liver function damage. No correlation. 22 comparison showed that R2 and ADC values can distinguish between normal control group and chronic acute liver failure group and hepatitis group and chronic acute liver failure group. RS I, S II T2WI and S II SWI can only distinguish between normal control group and slow addition acute liver failure group,.ROC curve shows T2 diagnosis slow plus acute liver failure curve area =0.863, P=0.000, the best. The diagnostic boundary point 57.73ms (R2 =0.0173).ADC value was diagnosed as =0.794, P =0.001, and the best diagnostic point ADC=1.1261 x 10-3mm2/s under the curve of slow plus acute liver failure, but the diagnostic value overlapped with the average value of ADC in the chronic hepatitis group. The area under the line was 0.799,0.737,0.798, and the P value was 0.002,0.013,0.003 respectively. When the diagnostic cut-off value was one of the two indexes of 1.5786,0.9856,0.5871. five, the sensitivity of the diagnosis of slow and acute liver failure was 86.74% to 99.19%, while any two of the five image indexes was simultaneous. When the diagnosis was positive, the range of specific enhancement in the diagnosis of slow and acute hepatic failure was: 92.85% to 100%.T2 and INR, PT and HA had moderate positive correlation (rs=0.651,0.666,0.390, P=0.000,0.000,0.025), and had moderate negative correlation with PTA, ALB, PA (rs=-0.667, -0.480, -0.373,). Conclusion: (1) rS I, S II T2WI, S II SWI, ADC map and T2 map can better reflect the liver function, and T2/R2 value is better for evaluating liver function, S II THRIVE can not reflect the liver function state; (2) R2 value and ADC value can simultaneously distinguish between normal control group and chronic acute liver failure group and hepatitis group and chronic acute liver failure group. The value of ADC value diagnosis of slow and acute liver failure overlapped with chronic hepatitis, so its application value is limited. (3) rS I, S II T2WI and S II SWI can only distinguish between normal control group and chronic acute liver failure group, but combined use of two or more imaging indicators can increase the diagnostic sensitivity or specificity of liver failure. (4) T2 or R2 value can be used. Better diagnosis or prediction of chronic acute liver failure, and the correlation with many laboratory indicators, can be used as one of the ideal indicators for quantitative evaluation of liver function in chronic hepatitis.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R512.62;R575.3;R445.2

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