非酒精性脂肪肝患者IDEAL-IQ与MRS定量评估及比较

发布时间：2018-03-29 08:37

本文选题：脂肪肝　切入点：IDEAL-IQ　出处：《郑州大学》2016年硕士论文

【摘要】：背景和目的脂肪肝又称肝细胞脂肪变性,指脂肪主要是甘油三酯在肝细胞内的异常、过度沉积。脂肪肝按病因分类,可分为酒精性肝病(alcoholic fatty liver disease,AFLD)与非酒精性脂肪肝病(nonalcoholic fatty liver disease,NAFLD),这是其最常见的分类类型。脂肪肝发病率较高,据统计在普通人群中发病率为20-30%,在糖尿病及肥胖人群中发病率高达75-100%。脂肪肝发病率因地域差异而不同,欧美国家经济发达,脂肪肝发病率略高于平均水平;在我国发展中国家中,脂肪肝发病率相对较低,但近年来随着生活水平和质量的提升,我国脂肪肝发病率逐年增加,类型也趋于多样化,严重影响了人们的生活,故早期诊断脂肪肝至关重要。诊断脂肪肝最常见的方法是超声,可用于筛查和随访,但其诊断结果对于操作者的依赖性很大;其次是计算机断层扫描(computed tomography,CT)通过测量肝实质密度可快速诊断脂肪肝,但其存在电离辐射,且容易受肝脏其他沉淀物影响,其应用受到限制;近年来,磁共振成像(magnetic resonance imaging,MRI)技术对软组织的显示较以上两种手段清晰,优势结合了优异的软组织对比度,无创性,功能成像和无电离辐射。以往文献探讨磁共振波谱成像(magnetic resonance spectroscopy,MRS)与病理结果的相关性,亦有文献报道磁共振检查分别与超声、CT诊断脂肪肝的对比研究,但并未涉及到定量研究,本研究综合探讨磁共振定量诊断脂肪肝的效能,并引入MRI新定量方法IDEAL-IQ进一步来探讨其定量诊断脂肪肝的效能。故本研究目的探讨:1、制定IDEAL-IQ、MRS定量评估肝脏脂肪变性的分级标准;2、探讨磁共振新技术IDEAL-IQ与MRS量化肝脏脂肪含量的相关性材料与方法采用GE Discovery750 3.0T MR扫描仪,对87例NAFLD患者及20例正常健康人进行前瞻性研究,嘱被检查者禁食禁水6-8h。常规扫描序列采用冠状位屏气单次激发快速自旋回波(T2WI/TSE)及轴位呼吸触发脂肪抑制;快速扰相梯度双回波序列(FSPGR-dual echo)。弥散加权成像(diffusion-weighted imaging,DWI):传统DWI序列选取b=0、800 s/mm2;功能成像肝脏MRS采用单体素点分辨选择性波谱(point resolved selective spectroscopy,PRESS)序列、“非对称回波的最小二程估算法迭代水脂分离”技术(iterative decomposition of water and fat with Echo asymmetry and the Least Squares Estimation Quantification sequence,IDEAL-IQ)序列扫描。统计方法:所有数据利用SPSS17.0软件包进行处理。结果1.107个受试者(87个脂肪肝患者,20个正常志愿者)中,IDEAL-IQ扫描成功者占95.8%(102/107);MRS扫描成功者占71.0%(76/107),其中脂肪肝患者60个,正常志愿者16个;扫描时间,IDEAL-IQ、MRS扫描时间分别为(21±1)s、(253.8±21.6)s,平均值分别为21s、253.8s。2.以CT作为金标准,分为脂肪肝组和正常人组,绘制ROC曲线,得到RLC、FF诊断脂肪肝的最佳阈值,分别为7.24%、8.50%;以此阈值判断RLC、FF诊断脂肪肝的敏感度和特异度,敏感度分别为90.0%、90.0%,特异度分别为87.5%、93.7%。3.以CT作为金标准,将脂肪肝组分为轻、中、重度组,分别获得IDEAL-IQ、MRS诊断轻度与中度、中度与重度脂肪肝的ROC曲线,获得IDEAL-IQ诊断阈值分别为15.27%、27.00%;MRS诊断阈值分别为17.58%、26.04%;其中IDEAL-IQ、MRS鉴别轻度与中度的敏感度分别为97.0%、69.7%,特异度分别为94.4%、61.1%;二者鉴别中度与重度的敏感度分别为100%、66.7%,特异度分别为72.7%、81.8%。4.60例病例由MRS、IDEAL-IQ两种方法测得RLC、FF分别为21.04±9.07、19.72±8.73,二者比较统计学无显著差异(P=0.344),由散点图可知二者有线性关系,Pearson相关性分析得到RLC和FF呈正相关(r=0.784,P=2.613)。结论1.MRS、IDEAL-IQ均可定量精确诊断脂肪肝。2.IDEAL-IQ与MRS定量评估脂肪肝的相关系数r为0.784;IDEAL-IQ、MRS诊断脂肪肝的阈值分别为8.50%、7.24%;二者诊断轻度与中度、中度与重度的阈值分别为15.27%、27.00%和17.58%、26.04%。3.在扫描成功率、扫描时间上,IDEAL-IQ均优于MRS,可取代步骤繁琐的MRS,作为诊断脂肪肝的独立标准。
[Abstract]:Background and objective: fatty liver and fatty degeneration of liver cells, the fatty triglyceride is abnormal in liver cells. The excessive deposition of fatty liver according to the etiology, classification, can be divided into alcoholic liver disease (alcoholic fatty liver disease, AFLD) and non alcoholic fatty liver disease (nonalcoholic fatty liver disease, NAFLD), which is the most common type. Fatty liver disease incidence rate is high, according to statistics in the general population incidence of 20-30% in diabetes and obesity incidence rate is as high as 75-100%. incidence of fatty liver due to geographical differences and different European countries, developed economy, the incidence of fatty liver is slightly higher than the average level in China in developing countries;, the incidence of fatty liver is relatively low, but in recent years, with the quality of life and enhance the quality of our country, the incidence of fatty liver increased year by year, types tend to be diversified, serious impact on people's lives, so early The diagnosis of fatty liver is very important. The most common method of diagnosis of fatty liver is ultrasound, can be used for screening and follow-up, but its diagnosis result for large dependence on the operator; followed by computed tomography (computed tomography, CT) by measuring liver parenchyma density rapid diagnosis of fatty liver, but the existence of ionizing radiation, and are easily affected by influence of other liver sediment, its application is limited; in recent years, magnetic resonance imaging (magnetic resonance, imaging, MRI) technology for soft tissue display more than two kinds of means clear, combined with the advantages of excellent soft tissue contrast, non-invasive functional imaging and non ionizing radiation. The previous literature on magnetic resonance spectroscopy (magnetic resonance spectroscopy, MRS) associated with the pathological results, there are reports of MRI and ultrasound respectively, comparative study of CT diagnosis of fatty liver, but did not involve quantitative Study, this study to explore the effectiveness of magnetic resonance imaging in quantitative diagnosis of fatty liver, and the introduction of IDEAL-IQ MRI to further explore the new quantitative method for the quantitative diagnosis of fatty liver performance. The purpose of this study was to explore: 1, making IDEAL-IQ, grading of hepatic steatosis MRS quantitative assessment; 2, to investigate the correlation between the materials and methods of new magnetic resonance the technology of IDEAL-IQ and MRS to quantify liver fat content by GE Discovery750 3.0T MR scanner in 87 NAFLD patients and 20 healthy people were included in a prospective study, will be checked fasting water routine sequence 6-8h. scanning with coronal after single shot fast spin echo (T2WI/TSE) and axial respiratory triggered fat suppression; fast spoiled gradient echo sequence (FSPGR-dual echo) double. Diffusion weighted imaging (diffusion-weighted imaging, DWI): the traditional DWI sequence selected b=0800 s/mm2; functional imaging of the liver by MRS Single voxel spectroscopy (point resolved selective spectroscopy selectivity, PRESS) sequence, "minimum two-way asymmetric echo estimation method, iterative water fat separation technique (iterative decomposition of water and fat with Echo asymmetry and the Least Squares Estimation Quantification sequence, IDEAL-IQ) sequences. Statistical methods: all data using SPSS17.0 software package for processing. The results of 1.107 subjects (87 patients with fatty liver and 20 normal volunteers), IDEAL-IQ scan successfully accounted for 95.8% (102/107); MRS scan successfully accounted for 71% (76/107), including 60 patients with fatty liver and 16 normal volunteers; scanning time, scanning time IDEAL-IQ, MRS respectively (21 + 1) s, (253.8 + 21.6) s, respectively 21s, 253.8s.2. with CT as the gold standard, divided into fatty liver group and normal group, RLC, ROC curve, FF diagnosis of fatty liver The optimal threshold values were 7.24%, 8.50%; the threshold RLC, the diagnosis of fatty liver FF sensitivity and specificity, sensitivity was 90% and 90% respectively, the specificity was 87.5%, 93.7%.3. to CT as a gold standard, the fatty liver group was divided into mild and severe group, IDEAL-IQ, respectively. MRS diagnosis of mild and moderate, moderate and severe fatty liver ROC curve, IDEAL-IQ diagnostic thresholds were 15.27%, 27%; MRS diagnostic thresholds were 17.58%, 26.04%; IDEAL-IQ, MRS in the differential diagnosis of mild and moderate sensitivity was 97%, specificity was 94.4%, 69.7%, 61.1% and two respectively; identify and moderate severe sensitivity was 100%, specificity 66.7%, 72.7% cases respectively, 81.8%.4.60 by MRS, IDEAL-IQ two methods to measure the RLC, FF = 21.04 + 9.07,19.72 + 8.73, there was no significant difference among the two statistics (P=0.344), by the scatter diagram two is linear The relationship between Pearson, RLC and FF correlation analysis were positively correlated (r=0.784, P=2.613). Conclusion: 1.MRS, correlation coefficient R IDEAL-IQ can accurately quantitative diagnosis of fatty liver and.2.IDEAL-IQ MRS quantitative evaluation of fatty liver was 0.784; IDEAL-IQ, the diagnosis of fatty liver MRS thresholds were 8.50%, 7.24%; two cases were diagnosed with mild and moderate, moderate and severe thresholds were 15.27%, 27% and 17.58%, the success rate of 26.04%.3. in the scanning, scan time, IDEAL-IQ was superior to MRS, MRS can replace the cumbersome steps, as independent criteria for the diagnosis of fatty liver.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R575.5

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