肝脾磁共振动态增强扫描评估肝纤维化的实验研究

发布时间：2018-03-15 17:31

  本文选题：磁共振　切入点：动态增强　出处：《川北医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨肝脏及脾脏磁共振动态增强成像（dynamiccontrast-enhanced magnetic resonance imaging, DCE-MRI)评价肝纤维化分期的可行性及应用价值。 方法：实验专用健康中国小型猪16只，体重20-24kg，采用40%四氯化碳建立肝纤维化疾病模型。造模之前及造模开始后第5、9、16、21周末，分别依次对所有存活的动物行肝脏及脾脏DCE-MRI检查。获得对应肝脏及脾脏血流参数：达峰时间（time to peak,TTP)、阳性增强积分(positive enhancement integral, PEI)、最大上升斜率(maximum slope ofincrease, MSI)、最大下降斜率(maximum slope of decrease, MSD)。DCE-MRI检查结束后，24小时内在超声引导下行肝脏穿刺活检，所取得肝组织标本行Masson染色，并参照METAVIR分期标准对小型猪肝纤维化进行分期。所测DCE-MRI数据采用SPSS17.0统计软件包进行统计学分析。 结果：（1）随着肝纤维化程度的进展，肝脏TTP值逐渐增加，肝脏MSI、MSD和PEI逐渐降低，（r=0.689、-0.820、-0.343、-0.492，P 0.05）。其中肝PEI从F3期至F4期轻度升高, MSD从F1期至F3期轻度升高（P0.05）。肝脏TTP和MSI可用于区分肝纤维化区分肝纤维化F0与F1-4期，F0-1和F2-4期，F0-2与F3-4期和F0-3与F4期（P 0.05）；肝脏PEI可以区分F0与F1-4期，F0-1和F2-4期，F0-3与F3-4期（P 0.05）；肝脏MSD可用于区分肝纤维化F0与F1-4期、F0-3与F4期（P 0.05）。肝脏MSI是区分肝纤维化F≥1期、≥2期、≥3期的最好指标，当MSI临界值分别为11.591/s、9.651/s、8.931/s，其诊断效能曲线下面积(area underreceiver operating characteristic curve, AUC)分别为0.920、0.913、0.917。当肝脏TTP以临界值20.92s区分肝纤维化F4期时，其诊断效能曲线下面积最大，AUC值为0.963。 （2）随着肝纤维化程度的进展，脾脏TTP从正常至F4期逐渐增大(r=0.647, P 0.001)；脾PEI从正常至F4期逐渐降低(r=-0.709, P 0.001)；脾MSD从正常至F2期逐渐增大(P0.05)，F2期至F4期逐渐降低(P 0.05)；脾MSI从正常至F1期先轻度增加，F1期到F4期再降低(P0.05)。脾TTP和PEI能区分肝纤维化F≥1期、≥2期、≥3期及第4期（P0.05）。MSD仅能区分肝纤维化F≥3期(P=0.006)、4期(P=0.012)。当脾TTP以临界值70.82s、73.75s诊断肝纤维化F≥1、2期时，其诊断效能最好，，其AUC值分别为0.851和0.783；当以5.46、4.75作为脾脏PEI临界值诊断肝纤维化F≥3、4期时，能获得较高诊断效能，AUC为分别为0.903和0.968。 结论：肝脏及脾脏DCE-MRI可用于评价肝纤维化病变的严重程度，其中肝脏血流动力学参数MSI能更好的用于区分肝纤维化≥F1、2、3期，脾脏血流动力学参数PEI能更好的用于区分肝纤维化F4期。
[Abstract]:Objective: to evaluate the feasibility and value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in evaluating hepatic fibrosis staging. Methods: a total of 16 healthy Chinese miniature pigs, weighing 20-24 kg, were used to establish hepatic fibrosis model with 40% carbon tetrachloride. The liver and spleen blood flow parameters of all living animals were examined by DCE-MRI in turn. The corresponding blood flow parameters of liver and spleen were obtained as follows: peak time to peak-tpp, positive enhancement integral of positive enhancement, pei, maximum ascending slope of maximum slope ofincrease, maximum decrease of maximum slope. Slope of decrease, liver biopsy guided by ultrasound within 24 hours after MSD).DCE-MRI examination, The liver tissue samples were stained with Masson, and the small pig liver fibrosis was staging according to the standard of METAVIR staging. The DCE-MRI data were statistically analyzed by SPSS17.0 statistical software package. Results with the progression of liver fibrosis, the TTP value of liver increased gradually. Liver PEI increased slightly from F3 to F4. Liver TTP and MSI could be used to distinguish hepatic fibrosis from F0, F1-4, F0-1, F2-4 and F3-4, respectively, and liver TTP and MSI could be used to differentiate hepatic fibrosis from F0, F1-4, F0-1 and F2-4, F0-2 and F3-4 phases respectively, and liver TTP and MSI could be used to distinguish hepatic fibrosis from F0, F1-4, F0-1, F2-4, F0-2 and F3-4 phases, and liver TTP and MSI could be used to distinguish hepatic fibrosis from F0, F1-4, F0-1, F2-4, F0-2 and F3-4 phases. Liver PEI could distinguish F0 from F1-4 and F2-4 from F3-F0-3 from F3-4, and liver MSD could be used to distinguish hepatic fibrosis from F0 and F1-4 stages of F0-3 and F4 stages (P 0.05). Liver MSI could differentiate hepatic fibrosis from F0 and F1-4 phases (P 0.05), and hepatic MSI could be used to distinguish hepatic fibrosis from F0 and F1-4 phases. Liver MSI could differentiate hepatic fibrosis F 鈮

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