扩散加权成像对慢性乙型肝炎炎症活动度的研究

发布时间：2018-06-03 12:12

本文选题：乙型肝炎 + 慢性　；参考：《中国人民解放军医学院》2017年硕士论文

【摘要】：目的:研究表观扩散系数(ADC )值与慢性乙型肝炎炎症活动度病理分级的相关性,再联合常规MRI征象对慢性乙型肝炎炎症活动度的诊断效能评估。材料与方法:选取2014年]月至2015年12月在我院接受治疗的142例慢性乙型肝炎患者作为炎症组,并选取20例健康成人作为对照组,对两组分别进行磁共振常规平扫、动态增强及DWI扫描(b值=0、800s/mm2),并在MR检查后两天内行肝脏穿刺活检,根据病理结果依炎症活动度(G),将炎症组分为G1级、G2级、G3-4级,测量各级的表观扩散系数(ADC )值,同时分析炎症组的MRI特征性表现并与病理分级进行对照,对所有数据进行统计学分析。结果:慢性乙型肝炎炎症活动度不同病理分级所得ADC值差异有统计学意义(F=8.392, P0.001 ),并且ADC值与肝脏炎症活动度分级呈明显负相关(r = -0.613,P0.001)。对照组与炎症组的ADC值分别为1.31±0.16、1.12±0.15,差异有统计学意义(P0.05);炎症组G1、G2、G3-4的ADC值分别为 1.22±0.12、1.05±0.12、0.98±0.10,G1与G2、G1与G3-4间ADC值差异有统计学意义(P0.05)。绘制受试者工作特征曲线,ADC值诊断炎症活动度≥G2级的曲线下面积AUC=0.880,敏感度为82.4%,特异度为76.8%,诊断界值为1.09。MRI特征性影像表现门脉周围轨道征与胆囊壁水肿在炎症组间显示率有显著性差异(P0.05),而动脉期肝脏异常强化、肝门淋巴结增大及腹水在炎症组间显示率无显著性差异(P0.05) ; ADC值联合MRI特征性表现诊断炎症≥G2的曲线下面积AUC=0.938,敏感度为88.4%,特异度为88.9%。结论:ADC值可以定量无创性预测慢性乙型肝炎炎症活动度病理分级情况,再结合常规MRI特征性影像表现,能提高对慢性乙型肝炎炎症活动度的诊断效能。目的:研究体素内不相干运动扩散加权成像(IVIM-DWI)相关参数与慢性乙型肝炎炎症活动度病理分级的相关性。材料与方法:前瞻性对临床确诊的220例慢性乙型肝炎患者进行MRI常规平扫及11 个 b 值(0,25,50,75,100,150,200, 400,600,800,1000s/mm2 )的肝脏扩散加权成像扫描,同时选取20名健康志愿者作为对照组进行扫描。在GE图像后处理工作站采用双指数模型进行标准ADC值、真扩散系数(D)值、假扩散系数(D*)值、灌注分数(f)的测量。根据炎症活动度将肝炎组分为G1、G2、G3-4三组,采用方差分析对不同肝炎活动度病理分级的ADC值、D值、D*值和f值进行差异分析,各参数值与肝炎活动度分级间的相关性采用Spearman相关性检验。用受试者工作特征曲线(ROC)进行诊断效能评估。结果:对照组与炎症组ADC、D、D*、f分别为(1.32±0.09×10-3mm2/s、1.19±0.11×10-3mm2/s )、 ( 0.86 ± 0.17×10-3mm2/s、0.77± 0.19×10-3mm2/s )、 (128.2±32.3×10-3mm2/s、105.3±37.6×10-3mm2/s)、 (34.1±8.9%、 27.5 ± 8.7% ),差异均有统计学意义(P0.05)。炎症组不同病理分级间ADC、D*、f值差异均有统计学意义(P0.05),并且ADC、D*、f值均与肝炎活动度病理分级呈显著负相关(r=-0.377,P=0.001; r=-0434, P=0.001; r=-0.226, P=0.003),而 D 值与炎症活动度病理分级无明显相关性(r=-0.076,P=0.138)。ADC值、D*及ADC联合D*值诊断G2级炎症活动度的ROC曲线下面积(AUC)分别为0.735、0.748、0.837,灵敏度与特异度分别为 85.5%、48.3%,55.7%、87.2%, 75.4%、81.6%; f 值诊断≥G3-4 级炎症活动度的ROC曲线下面积(AUC)为0.600,灵敏度与特异度分别为69.8%、51.3%。结论:通过IVIM-DWI所得参数ADC、D*及f值与慢性乙型肝炎炎活动度病理分级有显著负相关,且ADC值联合D*值在诊断≥ G2级炎症活动度有较高的诊断效能。
[Abstract]:Objective: To study the correlation between apparent diffusion coefficient (ADC) value and pathological grade of chronic hepatitis B inflammatory activity, and to evaluate the diagnostic efficacy of conventional MRI signs for chronic hepatitis B inflammatory activity. Materials and methods: 142 patients with chronic hepatitis B treated in our hospital from 2014 to December 2015 were selected as inflammation. In the group, 20 healthy adults were selected as the control group. The two groups were performed routine magnetic resonance scan, dynamic enhancement and DWI scan (b value =0800s/mm2), and the liver biopsy was performed within two days after the MR examination. According to the pathological results, the inflammation group was divided into G1 grade, G2 grade and G3-4 grade, and the apparent diffusivity (ADC) values at all levels were measured. At the same time, the characteristics of MRI in the inflammatory group were analyzed and compared with the pathological grades, and all the data were statistically analyzed. Results: the difference of ADC value of the inflammatory activity of chronic hepatitis B with different pathological grades was statistically significant (F=8.392, P0.001), and the ADC value was negatively correlated with the grade of liver inflammatory activity (r = -0.613, P0.). 001). The ADC values of the control group and the inflammatory group were 1.31 + 0.16,1.12 + 0.15 respectively, and the difference was statistically significant (P0.05). The ADC values of G1, G2 and G3-4 in the inflammatory group were 1.22 + 0.12,1.05 + 0.10, G1 and G2. The area under the curve was AUC=0.880, the sensitivity was 82.4%, the specificity was 76.8%. The diagnostic value of the diagnostic boundary was 1.09.MRI, and there was a significant difference (P0.05) between the peripheral orbital orbital sign and the gallbladder wall edema (P0.05), but there was no significant difference between the hepatic abnormal enhancement, the hilar lymph node enlargement and the ascites in the inflammatory group (P 0.05): ADC value combined with MRI characteristics to diagnose the area AUC=0.938 under the curve of inflammation more than G2, the sensitivity is 88.4%, the specificity is 88.9%. conclusion: the ADC value can quantificationally predict the pathological grade of the inflammatory activity of chronic hepatitis B, and then combined with the routine MRI feature image, it can improve the inflammatory activity of chronic hepatitis B Objective: To study the correlation between the parameters of incoherent motion diffusion-weighted imaging (IVIM-DWI) in voxel and the pathological grading of chronic hepatitis B inflammatory activity. Materials and methods: MRI routine plain scan and 11 b values (0,25,50,75100150200, 400600800,10) in 220 patients with clinically confirmed chronic hepatitis B 00s/mm2) liver diffusion weighted imaging scan, and 20 healthy volunteers were scanned as the control group. In the GE image post processing workstation, the standard ADC value, the true diffusion coefficient (D) value, the false diffusion coefficient (D*) value, and the perfusion fraction (f) were measured. The hepatitis group was divided into groups of G1, G2, and G3-4, according to the degree of inflammatory activity. The variance analysis was used to analyze the ADC value, D value, D* value and F value of the pathological grades of different hepatitis activity. The correlation between the parameters and the degree of hepatitis activity was examined by Spearman correlation test. The diagnostic efficacy was evaluated with the subjects' working characteristic curve (ROC). The results were as follows: ADC, D, D* and F were (1.32 + 0.09, respectively) in the control group and the inflammatory group. X 10-3mm2/s, 1.19 + 0.11 x 10-3mm2/s), (0.86 + 0.17 x 10-3mm2/s, 0.77 + 0.19 x 10-3mm2/s), (128.2 + 32.3 * 10-3mm2/s, 105.3 + 37.6 * 10-3mm2/s), (34.1 + 8.9%, 27.5 +), the difference was statistically significant (P0.05). The difference of ADC, D*, f values between the inflammatory groups were statistically significant (P0.05), and ADC, ADC, values, values were all There was a significant negative correlation with the pathological grade of hepatitis activity (r=-0.377, P=0.001; r=-0434, P=0.001; r=-0.226, P=0.003), but there was no significant correlation between the D value and the pathological grade of inflammatory activity (r=-0.076, P=0.138).ADC value. The specificity was 85.5%, 48.3%, 55.7%, 87.2%, 75.4%, 81.6%; the area (AUC) under the ROC curve for the diagnosis of G3-4 grade of inflammatory activity was 0.600, and the sensitivity and specificity were 69.8% respectively. 51.3%. conclusion: the parameters ADC, D* and F values were negatively correlated with the pathological grade of chronic hepatitis B, and ADC value combined D*. The diagnostic value is higher than that of G2 grade in inflammatory activity.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62;R445.2

【相似文献】