HISTO、Six-echo DIXON技术对NAFLD患者肝脏脂肪变性及铁沉积的定量研究

发布时间：2018-05-07 09:01

本文选题：非酒精性脂肪性肝病 + 磁共振波谱成像　；参考：《山东大学》2017年硕士论文

【摘要】：目的本研究主要目的是利用六回波Dixon技术、HISTO技术及肝活检三种方法量化分析非酒精性脂肪性肝病(Nonalcoholic fatty liver disease,NAFLD)患者肝内脂肪沉积及铁沉积情况,评估三者之间的相关性,探讨非酒精性脂肪肝患者使用非侵入性方法定量分析肝脏脂肪变性及铁沉积的可行性。方法选取30名到我院就诊的NAFLD患者,患者中26例为男性患者,4例为女性患者,在行肝活检前使用西门子3.0T MR设备进行六回波Dixon序列及HISTO序列扫描肝脏,HISTO序列会自动根据扫描前选择的感兴趣区绘制曲线并计算曲线下面积,得出目标区域脂肪含量及R2值。六回波Dixon序列测量区域选择肝右叶Ⅴ、Ⅵ段,尽可能避免血管和胆管进入选择区,在得到的脂肪分数图和R2*弛豫图中分别测定脂肪分数(HFF)及铁含量相对值(R2*),且测量的兴趣区位置与面积与HISTO尽量一致。同时进行肝穿刺病理检查,根据组织学检查测定脂肪含量及铁含量,其中脂肪含量使用NASH标准将肝脂肪变性分级由0级到3级。0级脂肪变比例小于5%,1级轻度脂肪变为5%-33%之间,2级中度脂肪变为33%-66%,重度3级脂肪变为66%以上。并以此做为金标准,使用单因素方差分析HISTO(HFF)及六回波Dixon序列(HFF)不同病理等级下肝脏脂肪分数的均数差异性;同时应用Spearman相关分析六回波Dixon技术及HISTO技术对肝脏脂肪堆积及铁过载的量化测定与病理测定值间的相关性,并探讨HISTO序列与六回波Dixon序列两种方法测定值的准确性差异。结果此项实验中包含30名NAFLD患者,平均年龄为46.4± 13.7岁(25-80岁),根据肝组织学评估,共有15名患者为1级(轻度脂肪变性),7名为2级(中度脂肪变性),2名为3级(重度脂肪变性),6名为FO级(无脂肪变性),病理测得平均脂肪变性百分数为23.1%±22.0%(中位12.1%,范围1.6%-78.8%),平均肝脏铁沉积量为22.3μmol/g±7.2μmol/g(中位 21.1μmol/g,范围 10.8μmol/g-38.4μmol/g)。肝活检和 MRI检查的中位间隔时间为21天(0-46天)。HISTO序列测得平均肝内脂肪分数为8.6%±7.0%(中位5.0%,范围 0.6%-27.6%),平均R2值为 34 9±6.7s-1(中位34.5 s-1,20.4 s-1-50.8 s-1),六回波Dixon序列测得平均肝内脂肪分数8.2%± 7.1%(中位5.4%,范围0.7%-24.9%),平均 R2*值为 47.3 s-1±11.9 s-1(中位 47.0 s-1,20.6 s-1-73.4 s-1)。在不同病理级别间HISTO序列与六回波Dixon序列测得肝内脂肪分数均数的差异均有统计学意义(F值分别为24.817,24.254,p值均0.05),且病理级别越高,两种方法测得的HFF值也随之升高。HISTO及六回波Dixon序列测得肝内脂肪分数与病理测定脂肪变性百分度有良好的相关性(r=0.901,p0.05;r=0.855,p0.05),HISTO测得R2值及六回波DIXON测得R2*值与病理铁含量有良好的相关性(r=0.636,p0.05;r=0.502,p0.05),并且HISTO序列与组织学脂肪定量及铁沉积量相关性略优于DIXON序列。结论两种方法测得肝内脂肪分数与组织学脂肪变性百分数有良好的相关性,HISTO技术测得R2值及六回波DIXON技术测得R2*值分别与病理铁沉积量之间具有一定相关性,且HISTO序列与组织学脂肪定量及铁沉积量相关性均略优于DIXON序列。在不同病理级别间HISTO序列与六回波Dixon序列测得肝内脂肪分数均数的差异均有统计学意义。
[Abstract]:The purpose of this study was to quantify the intrahepatic fat deposition and iron deposition in patients with non-alcoholic fatty liver disease (Nonalcoholic fatty liver disease, NAFLD) by using six echo Dixon techniques, HISTO technique and liver biopsy, and to evaluate the correlation between the three and non-alcoholic fatty liver patients. Methods to analyze the feasibility of hepatic steatosis and iron deposition. Methods 30 NAFLD patients in our hospital were selected, 26 were male patients and 4 were female patients. Before liver biopsy, the SIEMENS 3.0T MR equipment was used for six echo Dixon sequence and HISTO sequence scanning of the liver. The HISTO sequence would be automatically selected before the scan. The area in the region of interest was plotted and the area under the curve was calculated. The fat content and R2 value of the target area were obtained. Six echo Dixon sequence was used to measure the right lobe of the liver to select the V, VI segment, and to avoid the entry of the blood vessels and bile ducts into the selected area. The fat fraction (HFF) and the relative value of iron content (R2*) were determined respectively in the obtained fat fraction and the R2* relaxation map, and the measurement of the relative value of the iron content (R2*) was also measured. The location and area of the area of interest were the same as that of HISTO. At the same time, the liver biopsy was performed and the fat content and iron content were measured according to the histological examination. The fat content used NASH standard to make the liver fatty degeneration grade from grade 0 to grade 3.0 fat less than 5%, 1 grade mild fat into 5%-33%, and 2 grade medium fat to 33%- 66%, severe 3 fat became more than 66%, and used as the gold standard, using single factor analysis of variance analysis HISTO (HFF) and six echo Dixon sequence (HFF) the difference of liver fat fraction in different pathological grades, and Spearman correlation analysis six echo Dixon technology and HISTO technique for quantitative determination of liver fat accumulation and iron overload The correlation between the measured values and the diagnostic value of the HISTO sequence and the two methods of the six echo Dixon sequence. Results the experiment included 30 NAFLD patients with an average age of 46.4 + 13.7 years (25-80 years old). According to the liver histology, 15 patients were grade 1 (mild fatty degeneration), 7 was moderately fatty (moderate fatty change). The average fat denaturation percentage was 23.1% + 22% (median 12.1%, range 1.6%-78.8%), and the average liver iron deposition was 22.3 u mol/g + 7.2 mu mol/g (median 21.1 u mol/g, range 10.8 mol/g-38.4 mol/g). The median interval time of liver biopsy and MRI examination was 2. The average intrahepatic fat fraction was 8.6% + 7% (median 5%, range 0.6%-27.6%) for 21 days (0-46 days).HISTO sequence, and the average R2 value was 349 + 6.7s-1 (median 34.5 s-1,20.4 s-1-50.8 s-1). The average intrahepatic fat fraction was 8.2% + 7.1% (median 5.4%, 0.7%-24.9%), and the average R2* value was 47.3 S-1 + 11.9 S-1 (median), and the average R2* value was 47.3 S-1 + 11.9 S-1 (median). 47 s-1,20.6 s-1-73.4 s-1). The difference in the average number of intrahepatic fat scores between the HISTO sequence and the six echo Dixon sequence at different pathological grades were statistically significant (F value was 24.817,24.254, P value was 0.05), and the higher the pathological grade, the two methods of HFF also measured the intrahepatic fat with.HISTO and six echo Dixon sequence. There was a good correlation between the score and the percentile of fatty degeneration (r=0.901, P0.05; r=0.855, P0.05). The R2 value of HISTO and the R2* value measured by six echo DIXON had a good correlation with the pathological iron content (r=0.636, P0.05; r=0.502, P0.05), and the correlation between the sequence and the quantitative and iron deposits of the histology was slightly better than that of the sequence. There is a good correlation between the two methods to measure the fat fraction in the liver and the percentage of histological fatty degeneration. The R2 value and the six echo DIXON technique measured by HISTO technique have a certain correlation with the pathological iron deposit, and the correlation between the HISTO sequence and the histological fat quantitative and the iron deposit is slightly better than that of the DIXON sequence. The difference of liver fat fraction between HISTO sequence and six echo Dixon sequence was statistically significant.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R575

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