慢性弥漫性肝病的MR研究与临床
发布时间：2018-08-02 21:25
【摘要】：第一部分单纯性脂肪肝的磁敏感加权成像 目的：探讨肝脏脂肪沉积在3.0T MRI磁敏感序列上的表现。 材料与方法：15例单纯性脂肪肝患者和20例正常健康志愿者行3.0T MR常规腹部序列和腹部磁敏感加权成像Eswan多回波序列扫描。扫描所得Eswan图像经后处理工作站生成校正相位图和融合幅度图,观察相位图上脂肪肝组和正常组肝实质的表现,在幅度图上测量肝实质、邻近椎旁肌肉及椎体的信号强度(Slvertebr, SImuscle),以椎旁肌肉及椎体信号为参照,分别计算肝实质相对信号强度rSI1、rSI2。采用SPSS17.0统计软件处理数据,采用两独立样本t-检验比较脂肪肝组与正常组间上述诸信号强度均数,检验水准为P0.05。 结果：单纯性脂肪肝患者Eswan幅度图肝实质信号减低,相位图呈杂乱颗粒状失相位改变,类似邻近椎体信号。两组间SIliver、rSI1、rSI2鐕均数有显著性差异；两组间SIvertebr、SImuscle均数未见显著性差异。 结论：磁敏感序列相位图及幅度图上肝组织的失相位和短T2*改变可能与脂肪沉积有关。 第二部分慢性弥漫性肝病患者肝铁过载与HCC 目的：研究慢性肝病患者肝脏脂肪沉积及含铁结节在3.0T MRI磁敏感序列上的表现；探讨慢性肝病患者HCC与肝脏含铁结节之间的联系；分析肝硬化背景、年龄及性别与HCC、肝脏含铁结节之间的关系。 材料与方法：55例慢性肝病患者(肝硬化38例,慢性肝炎17例)患者和20例正常健康志愿者行MR常规腹部序列和腹部磁敏感加权成像Eswan多回波序列扫描。扫描所得Eswan图像经后处理工作站处理后生成独立的校正相位图和融合幅度图,观察慢性肝病组和正常组幅度图、相位图肝实质的表现,在幅度图上测量慢性肝病组肝实质和邻近椎体信号强度(SIliver、SIvertebr),以椎体信号为参照,计算肝实质相对信号强度rSI2。采用SPSS17.0统计软件处理数据,各组间SIliver、rSI2均数比较采用单因素方差分析并q检验及两独立样本t-检验；在慢性肝病患者组中,采用卡方检验-Fisher精确概率法,分析HCC与年龄、含铁结节、肝硬化背景之间的关系,分析性别与肝脏含铁结节之间的关系；采用Mann-Whitney U秩和检验,对HCC(+)与(—)组间肝脏含铁结节严重程度进行比较；检验水准为P0.05。 结果：慢性肝病组脂肪沉积和含铁沉积分为四种改变：a.仅有肝脏脂肪变性；b.肝脏脂肪变性并含铁结节沉积；c.仅有肝脏含铁结节；d.脂肪变性及肝脏含铁结节均无；在P=0.05水准下,a与b、 c与d分别为相同子集,两子集间两种肝脏信号强度均数有显著性差异,a、b及Part1单纯性脂肪组间肝脏信号强度均数无显著性差异。HCC的发生率在含铁结节组间有显著性差异;绝经前后肝脏含铁结节发生率有显著性差异。肝硬化背景、年龄较大、肝脏含铁结节严重程度在HCC组间无显著性差异； 结论：腹部Eswan序列对肝脏含铁结节显示良好；慢性肝病肝脏脂肪变性与含铁结节可以并存,含铁结节不一定导致背景肝组织的短T2*效应；肝脏含铁结节与HCC的发生有显著联系；雌激素与HCC、含铁结节的形成有显著关联；肝硬化背景及年龄较大与HCC的发生无显著关联。 第三部分慢性弥漫性肝病在体肝脏质子波谱初探 目的：研究慢性肝病患者肝脏3.0T质子波谱1H-MRS的表现,探讨胆碱复合物峰(CCC)与血清生化指标及肝脏贮备功能之间的联系。 材料与方法：33例慢性肝病患者(肝硬化22例,慢性肝炎11例)和10例正常健康志愿者行肝脏1H MRS扫描。使用Sage软件对所得肝脏谱线进行后处理,观察正常组与慢性肝病组肝脏波谱表现,以肝组织水峰为内标,计算CCC峰与水峰的比值。采用SPSS17.0统计分析软件处理数据,在慢性肝病患者中,采用卡方检验-Fisher精确概率法,比较高大CCC组与微小或无CCC峰组间血清转氨酶、直接胆红素的差异；采用Mann-Whitney U秩和检验,比较两组间血清白蛋白计分和肝脏Child-Pugh分级的分布差异：检验水准均为P0.05。 结果：正常组肝脏1H-MRS未见CCC峰；慢性肝病组24例可见CCC峰,14例表现为高大CCC峰,CCC/水峰比值的均数0.371±0.066；10例为微小CCC峰,CCC/水峰的比值均数0.070±0.016。慢性肝病组5例未见CCC峰,4例患者谱线不合格。组间血清胆红素、Child-Pugh分级有显著性差异,组间白蛋白计分、血清转氨酶无显著性差异。 结论：慢性肝病患者高大CCC峰与肝内胆汁淤积有显著关联,胆汁淤积时胆汁成分、脂肪代谢异常、肝细胞的有丝分裂可能导致了CCC峰的升高。 第四部分磁敏感加权成像评价肝硬化脾脏含铁结节 目的：运用腹部磁敏感序列Eswan,探讨肝硬化患者脾脏含铁结节的发生率及其与脾亢、脾脏增大、门静脉侧枝静脉曲张及肝脏贮备功能分级之间的联系。 材料与方法：4l例肝硬化患者和20例正常健康志愿者行MR常规腹部序列和腹部磁敏感加权成像Eswan多回波序列扫描。扫描所得Eswan图像经后处理工作站处理后生成独立的校正相位图和融合幅度图。测量肝硬化患者脾脏容积,对脾脏容积及Eswan幅度图上脾脏含铁结节数量进行分度和分级。采用SPSS17.0统计分析软件处理数据,采用独立样本t-检验比较脾亢组间、脾脏含铁结节组间脾脏容积的均数；采用Mann-Whitney U秩和检验比较脾亢组间脾脏容积增大程度、脾内含铁结节数量的分布及脾脏含铁结节组Child-Pugh分级和侧枝静脉曲张的形成情况；采用Spearman-rho相关分析,分析脾脏容积与脾脏含铁结节数量间的相关性；检验水准为P0.05。 结果：Eswan序列肝硬化患者脾脏含铁结节发生率为78%；脾脏容积在脾亢组间、脾脏含铁结节组间均有显著性差异,脾脏容积与含铁结节数量间有显著性正相关；脾脏含铁结节组间Child-Pugh分级有显著差异；侧枝循环组间脾脏含铁结节严重程度的分布有显著差异。 结论：腹部Eswan序列检测脾脏含铁结节明显优于其他序列；肝硬化脾脏含铁结节与血小板减少、脾脏增大、肝脏贮备功能分级均有显著联系；重度脾脏增大和脾脏弥漫多发含铁结节(Eswan2级图像)能可靠的反映脾脏功能亢进；脾脏含铁结节与侧枝静脉曲张有显著关联,出现脾脏弥漫多发含铁结节时,要警惕侧枝静脉曲张出血事件的发生。
[Abstract]:The first part is susceptibility weighted imaging of simple fatty liver.
Objective: To investigate the expression of hepatic fat deposition on 3.0T MRI magnetic susceptibility sequence.
Materials and methods: 15 cases of simple fatty liver and 20 normal healthy volunteers were performed 3.0T MR routine abdominal sequence and abdominal magnetic sensitive weighted imaging Eswan multiple echo sequence scanning. The Eswan images were generated by the postprocessing workstation to generate the corrected phase map and the fusion amplitude map, and to observe the fatty liver group and the normal liver parenchyma on the phase map. The liver parenchyma, adjacent muscle and vertebral signal intensity (Slvertebr, SImuscle) were measured on the amplitude map, and the relative signal intensity rSI1 of the liver parenchyma was calculated with the paravertebral muscles and vertebral signals as reference. The data were processed by SPSS17.0 statistical software, and the two independent samples t- test was used to compare the above results between the fatty liver group and the normal group. The signal intensity is all, the test level is P0.05.
Results: the hepatic parenchyma signal of Eswan amplitude was decreased in the patients with simple fatty liver, and the phase diagram showed a random granular phase change, similar to the adjacent vertebral signal. There were significant differences in the number of SIliver, rSI1 and rSI2 between the two groups; there was no significant difference in the number of SIvertebr and SImuscle among the two groups.
Conclusion: the change of phase and short T2* of hepatic tissue phase and amplitude map may be related to fat deposition.
The second part is iron overload and HCC in patients with chronic diffuse liver disease.
Objective: To investigate the expression of liver fat deposition and iron bearing nodules on 3.0T MRI magnetic sensitive sequence in patients with chronic liver disease, and to explore the relationship between HCC and iron nodules in the liver of patients with chronic liver disease, and to analyze the relationship between liver cirrhosis background, age and sex with HCC, and liver iron bearing nodules.
Materials and methods: 55 patients with chronic liver disease (38 cases of liver cirrhosis, 17 cases of chronic hepatitis) and 20 normal healthy volunteers were performed MR routine abdominal sequence and abdominal magnetic sensitive weighted imaging Eswan multiple echo sequence scanning. The Eswan images were processed by the post processing workstation to generate an independent correction phase map and a fusion amplitude map. The amplitude map of the chronic liver disease group and the normal group, the manifestation of the liver parenchyma, the amplitude of the liver parenchyma and the adjacent vertebral signal intensity (SIliver, SIvertebr) were measured on the amplitude graph, and the relative signal intensity of the liver parenchyma was calculated by the SPSS17.0 statistical software with the reference of the vertebral signal, and the number of SIliver and rSI2 in each group was compared. Single factor ANOVA, q test and two independent sample t- test; in patients with chronic liver disease, chi square test -Fisher accurate probability method was used to analyze the relationship between HCC and age, iron bearing nodules, liver cirrhosis background, analysis of the relationship between sex and liver iron nodules; Mann-Whitney U rank sum test, between HCC (+) and (-) groups The severity of liver iron nodules was compared; the inspection level was P0.05.
Results: there were four changes in fat deposition and iron inclusion integration in chronic liver disease group: A. only liver fatty degeneration, B. liver fatty degeneration and iron nodule deposit; C. only liver containing iron nodules; D. fatty degeneration and liver iron nodules were not; at P=0.05 level, a and B, C and D were the same subsets, and two kinds of liver letters between the two subsets. There was significant difference in the number of intensity. There was no significant difference in the liver signal intensity between a, B and Part1. The incidence of.HCC was significantly different between the iron nodules group. The incidence of iron nodules in the liver before and after menopause was significantly different. The liver cirrhosis background, the older age, and the severity of liver bearing iron nodules were not significant in the HCC group. Sexual differences;
Conclusion: the abdominal Eswan sequence is good for the iron bearing nodules of the liver; liver fatty degeneration and iron nodules can coexist in chronic liver disease, and iron nodules do not necessarily lead to the short T2* effect of the background liver tissue; the iron nodules in the liver have a significant relationship with the occurrence of HCC; estrogen has a significant association with the formation of HCC and iron bearing nodules; the liver cirrhosis is on the back of the liver. There was no significant correlation between the age and the age of HCC.
The third part is the proton spectroscopy of liver in chronic diffuse liver disease.
Objective: To study the expression of 3.0T proton spectrum 1H-MRS in the liver of patients with chronic liver disease, and to explore the relationship between the choline complex peak (CCC) and serum biochemical indexes and liver reserve function.
Materials and methods: liver 1H MRS scan was performed in 33 patients with chronic liver disease (22 liver cirrhosis, 11 chronic hepatitis) and 10 normal healthy volunteers. The liver spectral lines of the normal and chronic liver disease groups were treated by Sage software, and the liver tissue water peak was used as the internal standard to calculate the ratio of the CCC peak to the water peak. The SPS was used to calculate the ratio of the peak of the liver to the water peak. S17.0 statistical analysis software processing data, in chronic liver disease patients, using chi square test -Fisher accurate probability method, compare the difference of serum transaminase and direct bilirubin between the large CCC group and the small or no CCC peak group, and compare the distribution difference of serum albumin score and liver Child-Pugh classification between the two groups using Mann-Whitney U rank sum test. The test level is P0.05.
Results: there was no CCC peak in normal liver 1H-MRS, 24 cases of chronic liver disease showed CCC peak, 14 cases were high CCC peak, CCC/ water peak ratio was 0.371 + 0.066, 10 cases were small CCC peak, the ratio of CCC/ water peak was 0.070 + 0.016. chronic liver disease group 5 cases did not see CCC peak, 4 patients were disqualified. Serum bilirubin, Child-Pugh points between the group. There was significant difference between the two groups. Albumin score and serum aminotransferase were not significantly different between the two groups.
Conclusion: there is a significant association between high CCC peak and intrahepatic cholestasis in patients with chronic liver disease. Bile composition and lipid metabolism are abnormal in cholestasis, and the mitosis of liver cells may lead to the increase of CCC peak.
The fourth part is susceptibility weighted imaging to evaluate the splenic iron nodules in liver cirrhosis.
Objective: To investigate the incidence of iron bearing nodules in the liver of patients with liver cirrhosis and the association between the incidence of iron bearing nodules in the patients with liver cirrhosis and its relationship with the hypersplenism, the splenomegaly, the varicose veins of the portal vein and the grading of the liver function by using the abdominal magnetic sensitive sequence Eswan.
Materials and methods: 4L patients with liver cirrhosis and 20 normal healthy volunteers were performed MR routine abdominal sequence and abdominal magnetic sensitive weighted imaging Eswan multiple echo sequence scan. The Eswan images were processed by the post-processing workstation to generate an independent correction phase map and a fusion amplitude map. The spleen volume and spleen volume were measured in patients with liver cirrhosis. The number of the spleen containing iron nodules on the Eswan amplitude map was divided and graded. The data were processed by the SPSS17.0 statistical analysis software. The splenic volume was compared between the hypersplenism group and the splenic iron nodule group by the independent sample t- test. The degree of splenomegaly between the hypersplenism group was compared with the Mann-Whitney U rank test. The iron nodules in the spleen were compared. The distribution of the quantity and the formation of Child-Pugh grade and lateral branch varicosity in the iron bearing group of the spleen; the correlation between the spleen volume and the number of the spleen containing iron nodules was analyzed by Spearman-rho correlation analysis; the test level was P0.05.
Results: the incidence of iron nodules in the spleen of the patients with Eswan sequence was 78%, the spleen volume was between the splenomegaly group and the iron nodule group, the spleen volume was significantly correlated with the number of iron nodules, and the Child-Pugh classification between the splenic iron nodules group was significantly different, and the iron nodules between the splenic circulation groups were with iron nodules. There were significant differences in the distribution of severity.
Conclusion: the abdominal Eswan sequence is superior to the other sequences in detecting the iron bearing nodules of the spleen. The iron nodules of the liver cirrhosis and the thrombocytopenia, the enlargement of the spleen and the classification of the liver reserve function have significant relation. The severe spleen enlargement and the spleen diffuse multiple iron bearing nodules (Eswan2 grade images) can reliably reflect the hyperfunction of the spleen; the spleen contains the spleen. Iron nodules are significantly associated with varicose collateral veins. When multiple iron nodules appear in the spleen, it is necessary to be alert to the occurrence of hemorrhage from varicose collateral veins.
【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R575.2
本文编号：2160780
[Abstract]:The first part is susceptibility weighted imaging of simple fatty liver.
Objective: To investigate the expression of hepatic fat deposition on 3.0T MRI magnetic susceptibility sequence.
Materials and methods: 15 cases of simple fatty liver and 20 normal healthy volunteers were performed 3.0T MR routine abdominal sequence and abdominal magnetic sensitive weighted imaging Eswan multiple echo sequence scanning. The Eswan images were generated by the postprocessing workstation to generate the corrected phase map and the fusion amplitude map, and to observe the fatty liver group and the normal liver parenchyma on the phase map. The liver parenchyma, adjacent muscle and vertebral signal intensity (Slvertebr, SImuscle) were measured on the amplitude map, and the relative signal intensity rSI1 of the liver parenchyma was calculated with the paravertebral muscles and vertebral signals as reference. The data were processed by SPSS17.0 statistical software, and the two independent samples t- test was used to compare the above results between the fatty liver group and the normal group. The signal intensity is all, the test level is P0.05.
Results: the hepatic parenchyma signal of Eswan amplitude was decreased in the patients with simple fatty liver, and the phase diagram showed a random granular phase change, similar to the adjacent vertebral signal. There were significant differences in the number of SIliver, rSI1 and rSI2 between the two groups; there was no significant difference in the number of SIvertebr and SImuscle among the two groups.
Conclusion: the change of phase and short T2* of hepatic tissue phase and amplitude map may be related to fat deposition.
The second part is iron overload and HCC in patients with chronic diffuse liver disease.
Objective: To investigate the expression of liver fat deposition and iron bearing nodules on 3.0T MRI magnetic sensitive sequence in patients with chronic liver disease, and to explore the relationship between HCC and iron nodules in the liver of patients with chronic liver disease, and to analyze the relationship between liver cirrhosis background, age and sex with HCC, and liver iron bearing nodules.
Materials and methods: 55 patients with chronic liver disease (38 cases of liver cirrhosis, 17 cases of chronic hepatitis) and 20 normal healthy volunteers were performed MR routine abdominal sequence and abdominal magnetic sensitive weighted imaging Eswan multiple echo sequence scanning. The Eswan images were processed by the post processing workstation to generate an independent correction phase map and a fusion amplitude map. The amplitude map of the chronic liver disease group and the normal group, the manifestation of the liver parenchyma, the amplitude of the liver parenchyma and the adjacent vertebral signal intensity (SIliver, SIvertebr) were measured on the amplitude graph, and the relative signal intensity of the liver parenchyma was calculated by the SPSS17.0 statistical software with the reference of the vertebral signal, and the number of SIliver and rSI2 in each group was compared. Single factor ANOVA, q test and two independent sample t- test; in patients with chronic liver disease, chi square test -Fisher accurate probability method was used to analyze the relationship between HCC and age, iron bearing nodules, liver cirrhosis background, analysis of the relationship between sex and liver iron nodules; Mann-Whitney U rank sum test, between HCC (+) and (-) groups The severity of liver iron nodules was compared; the inspection level was P0.05.
Results: there were four changes in fat deposition and iron inclusion integration in chronic liver disease group: A. only liver fatty degeneration, B. liver fatty degeneration and iron nodule deposit; C. only liver containing iron nodules; D. fatty degeneration and liver iron nodules were not; at P=0.05 level, a and B, C and D were the same subsets, and two kinds of liver letters between the two subsets. There was significant difference in the number of intensity. There was no significant difference in the liver signal intensity between a, B and Part1. The incidence of.HCC was significantly different between the iron nodules group. The incidence of iron nodules in the liver before and after menopause was significantly different. The liver cirrhosis background, the older age, and the severity of liver bearing iron nodules were not significant in the HCC group. Sexual differences;
Conclusion: the abdominal Eswan sequence is good for the iron bearing nodules of the liver; liver fatty degeneration and iron nodules can coexist in chronic liver disease, and iron nodules do not necessarily lead to the short T2* effect of the background liver tissue; the iron nodules in the liver have a significant relationship with the occurrence of HCC; estrogen has a significant association with the formation of HCC and iron bearing nodules; the liver cirrhosis is on the back of the liver. There was no significant correlation between the age and the age of HCC.
The third part is the proton spectroscopy of liver in chronic diffuse liver disease.
Objective: To study the expression of 3.0T proton spectrum 1H-MRS in the liver of patients with chronic liver disease, and to explore the relationship between the choline complex peak (CCC) and serum biochemical indexes and liver reserve function.
Materials and methods: liver 1H MRS scan was performed in 33 patients with chronic liver disease (22 liver cirrhosis, 11 chronic hepatitis) and 10 normal healthy volunteers. The liver spectral lines of the normal and chronic liver disease groups were treated by Sage software, and the liver tissue water peak was used as the internal standard to calculate the ratio of the CCC peak to the water peak. The SPS was used to calculate the ratio of the peak of the liver to the water peak. S17.0 statistical analysis software processing data, in chronic liver disease patients, using chi square test -Fisher accurate probability method, compare the difference of serum transaminase and direct bilirubin between the large CCC group and the small or no CCC peak group, and compare the distribution difference of serum albumin score and liver Child-Pugh classification between the two groups using Mann-Whitney U rank sum test. The test level is P0.05.
Results: there was no CCC peak in normal liver 1H-MRS, 24 cases of chronic liver disease showed CCC peak, 14 cases were high CCC peak, CCC/ water peak ratio was 0.371 + 0.066, 10 cases were small CCC peak, the ratio of CCC/ water peak was 0.070 + 0.016. chronic liver disease group 5 cases did not see CCC peak, 4 patients were disqualified. Serum bilirubin, Child-Pugh points between the group. There was significant difference between the two groups. Albumin score and serum aminotransferase were not significantly different between the two groups.
Conclusion: there is a significant association between high CCC peak and intrahepatic cholestasis in patients with chronic liver disease. Bile composition and lipid metabolism are abnormal in cholestasis, and the mitosis of liver cells may lead to the increase of CCC peak.
The fourth part is susceptibility weighted imaging to evaluate the splenic iron nodules in liver cirrhosis.
Objective: To investigate the incidence of iron bearing nodules in the liver of patients with liver cirrhosis and the association between the incidence of iron bearing nodules in the patients with liver cirrhosis and its relationship with the hypersplenism, the splenomegaly, the varicose veins of the portal vein and the grading of the liver function by using the abdominal magnetic sensitive sequence Eswan.
Materials and methods: 4L patients with liver cirrhosis and 20 normal healthy volunteers were performed MR routine abdominal sequence and abdominal magnetic sensitive weighted imaging Eswan multiple echo sequence scan. The Eswan images were processed by the post-processing workstation to generate an independent correction phase map and a fusion amplitude map. The spleen volume and spleen volume were measured in patients with liver cirrhosis. The number of the spleen containing iron nodules on the Eswan amplitude map was divided and graded. The data were processed by the SPSS17.0 statistical analysis software. The splenic volume was compared between the hypersplenism group and the splenic iron nodule group by the independent sample t- test. The degree of splenomegaly between the hypersplenism group was compared with the Mann-Whitney U rank test. The iron nodules in the spleen were compared. The distribution of the quantity and the formation of Child-Pugh grade and lateral branch varicosity in the iron bearing group of the spleen; the correlation between the spleen volume and the number of the spleen containing iron nodules was analyzed by Spearman-rho correlation analysis; the test level was P0.05.
Results: the incidence of iron nodules in the spleen of the patients with Eswan sequence was 78%, the spleen volume was between the splenomegaly group and the iron nodule group, the spleen volume was significantly correlated with the number of iron nodules, and the Child-Pugh classification between the splenic iron nodules group was significantly different, and the iron nodules between the splenic circulation groups were with iron nodules. There were significant differences in the distribution of severity.
Conclusion: the abdominal Eswan sequence is superior to the other sequences in detecting the iron bearing nodules of the spleen. The iron nodules of the liver cirrhosis and the thrombocytopenia, the enlargement of the spleen and the classification of the liver reserve function have significant relation. The severe spleen enlargement and the spleen diffuse multiple iron bearing nodules (Eswan2 grade images) can reliably reflect the hyperfunction of the spleen; the spleen contains the spleen. Iron nodules are significantly associated with varicose collateral veins. When multiple iron nodules appear in the spleen, it is necessary to be alert to the occurrence of hemorrhage from varicose collateral veins.
【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R575.2
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