参数—造影剂到达时间成像（P-MFI）技术在肝纤维化分期方面的应用价值

发布时间：2018-06-16 03:43

  本文选题：参数-造影剂到达时间成像 + 肝炎　； 参考：《中国人民解放军医学院》2014年硕士论文

【摘要】：目的：探讨参数-造影剂到达时间成像（P-MFI）技术在肝纤维化分期方面的应用价值。 材料和方法：前瞻性入组2013年3月至2014年2月受试者117例，其中包括拟行超声引导下肝组织穿刺活检且伴有乙型肝炎病毒（HBV）或（和）丙型肝炎病毒（HCV）感染的患者97例，以及健康者20例。全部正常受检者经肘前静脉团注超声造影剂声诺维（SonoVue）2.0ml，通过东芝Apilo500超声诊断仪采集第5或第6肋间肝脏右叶最大切面动态造影图像，，分为30秒组与10秒组，并利用commune软件进行彩色编码并定量分析获得相关参数，继而结合肝纤维化病理分期结果进行统计，分析各参数与肝纤维化分期之间的关系，得出各参数分别评估肝纤维化各期的诊断阈值，并判断其敏感性、特异性与准确性。30秒组的造影剂微泡灌注率（ratio of bubble region,%）为质控指标，该参数须达到90%以上，否则需再一次行超声造影重新获取造影动态图像。 结果：（1）参数在肝纤维化各分期中的组间比较：30s-slope值随着肝纤维化病理分期的增高而降低，而10s-slope值随着肝纤维化病理分期的增高而增高，且两组的各分期多组间比较均有统计学差异；30s-ratio at5s与10s-ratio at5s均随着肝纤维化病理分期的增高而增高，且两组的各分期多组间比较统计学有显著性差异。（2）受试者工作特征曲线评估各参数分别预测肝纤维化分期≥F2期及≥F3期的最佳临界值及其诊断能力。a）≥F2期：当30s-slope≤0.062、10s-slope≥0.109、30s-ratio at5s≥22.00%或10s-ratio at5s≥29.05%时诊断肝纤维化分期≥F2期的灵敏度、特异度、精确度、Youden指数、阳性预测值及阴性预测值分别为87.2%、84.6%、86.3%、71.8%、91.9%及76.7%；83.3%、74.4%、75.2%、57.7%、78.2%及66.7%；61.5%、74.4%、66.7%、35.9%、83.1%及50.0%；85.9%、89.7%、86.3%、75.6、93.1%及75.6%。b）≥F3期：当30s-slope≤0.059、10s-slope≥0.111、30s-ratioat5s≥26.85%、10s-ratio at5s≥30.35%时诊断肝纤维化分期≥F3期的灵敏度、特异度、精确度、Youden指数、阳性预测值及阴性预测值分别为87.9%、84.7%、86.3%、72.6%、85%及87.7%；89.7%、84.7%、86.3%、74.4%、83.9%及89.1%；62.1%、86.4%、75.2%、48.5%、83.7%及70.3%；89.7%、79.7%、87.2%、69.4%、84.1%及90.7%。 结论：参数30s-slope、10s-slope、30s-ratio at5s及10s-ratio at5s与肝纤维化的严重程度相关，其中30s-slope、10s-slope及10s-ratio at5s可以作为诊断肝纤维化严重程度的参数指标，对中重度肝纤维化的诊断能力较高。因此P-MFI技术对于指导病毒性肝炎患者的抗病毒治疗以及评估肝纤维化改善程度等方面有潜在的应用价值。
[Abstract]:Objective: to investigate the application value of parameter-contrast medium arrival time imaging (P-MFI) technique in the staging of hepatic fibrosis. Materials and methods: from March 2013 to February 2014, 117 patients with hepatitis B virus (HBV) or / and hepatitis C virus (HCV) infection were included in this study. And 20 healthy people. All normal subjects were injected with ultrasound contrast agent Sono Vueo 2.0 ml through the anterior elbow vein mass. The dynamic images of the right lobe of the 5th or 6th intercostal liver were collected by Toshiba Apilo500 ultrasound diagnostic instrument. The images were divided into 30 second group and 10 second group. The correlation parameters were obtained by color coding and quantitative analysis with commune software, and then the relationship between the parameters and hepatic fibrosis staging was analyzed by statistical analysis combined with the pathological staging results of liver fibrosis. The diagnostic threshold, sensitivity, specificity and accuracy of each stage of hepatic fibrosis were evaluated. The contrast medium microbubble perfusion ratio of bubble region in the 30-second group was used as the quality control index, and the parameter should be above 90%. Otherwise, it is necessary to perform contrast-enhanced imaging again and obtain the dynamic image again. Results compared with each stage of hepatic fibrosis, the ratio of: 30s-Slope decreased with the increase of pathological stage of hepatic fibrosis, while the value of 10s-slope increased with the increase of pathological stage of hepatic fibrosis. There was statistical difference between the two groups in each stage, and the at5s and 10s-ratio at5s increased with the increase of pathological stage of liver fibrosis. There was significant statistical difference between the two groups. 2) the parameters of the evaluation of the operating characteristic curve of the subjects were used to predict the optimal critical value and diagnostic ability of liver fibrosis stage 鈮

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