3.OT~1H-MRS及DWI在肝脏定量测量的临床应用研究

发布时间：2018-06-10 05:36

本文选题：3.0T~1H-MRS + 肝脏　；参考：《河北医科大学》2012年硕士论文

【摘要】：第一部分3.0T1H-MRS在正常肝脏与脂肪肝的定量研究目的:采用3.0T多射频核磁共振仪对正常志愿者及脂肪肝患者行1H-MRS检查，提出肝脏1H-MRS代谢物正常值范围，并进一步探讨其对脂肪肝的诊断价值。方法：38名正常志愿者，年龄25～75岁，平均年龄41.22±14.67岁，男19例，女19例；27名脂肪肝患者，年龄25～62岁，平均年龄45.86±9.49岁，男17例，，女10例，分别按年龄分为两组：≥45岁组及＜45岁组，按照性别分为男、女两组；采用3.0T磁共振仪对所有正常志愿者及脂肪肝患者行肝脏1H-MRS扫描，随机抽取16名志愿者重复2次扫描，统计其水峰峰值、水峰峰下面积、脂峰峰值、脂峰峰下面积及脂肪分数，并进行统计学比较分析。结果：①16名正常志愿者行2次1H-MRS扫描，取同一位置、相同大小ROI，2次测量代谢物数值无统计学差异（p＞0.05）；②按照年龄分组，≥45岁组及＜45岁组，两组正常志愿者水峰峰值、水峰下面积、脂峰峰值、脂峰下面积及脂肪分数均无统计学差异（p＞0.05）；③不同性别正常志愿者两组间进行比较，除水峰峰值外，余代谢物数值男女两组未见差别（p＞0.05）；④≥45岁和＜45岁组正常志愿者均与同年龄组脂肪肝患者间比较，除水峰峰值差别不明显外，其余水峰下面积、脂峰峰值、脂峰下面积及脂肪分数均存在统计学差异（p＞0.05）；⑤对于不同性别，正常志愿者与脂肪肝患者1H-MRS代谢物比较，男性组正常志愿者与脂肪肝患者水峰峰值差别不明显，余代谢物数值存在明显统计学差异；女性组正常志愿者与脂肪肝患者代谢物数值均显示明显差别（p＞0.05）；⑥正常肝脏MRS代谢物95%可信区间：水峰下面积为163.05±27.45，脂肪峰值为6.89±2.72，脂肪峰下面积为4.22±4.98，脂肪分数为2.51±2.61%；⑦得出判定正常肝脏与脂肪肝MRS代谢物阈值：脂肪峰值为9.55（敏感性0.909，1-特异性0），脂肪峰下面积为8.65（敏感性0.955，1-特异性0.029），脂肪分数4.97%（敏感性0.955，1-特异性0.029）。结论：3.0T1H-MRS可应用于正常人肝内代谢及脂肪肝的定量研究；肝脏水及脂肪含量的正常值范围对肝脏代谢性疾病诊断提供重要参考价值。第二部分3.0T磁共振弥散成像在正常肝脏的定量研究目的：采用3.0T多射频核磁共振仪对正常志愿者的肝脏行弥散加权成像，对肝脏ADC值进行定量测量；提出正常肝脏ADC值范围，并探讨与年龄及性别的相关性，研究其临床价值。方法：38名健康志愿者，年龄25～75岁，平均年龄41.22±14.67岁，男19例，女19例，分别按年龄≥45和＜45分为两组，并按性别分为男组、女组。采用3.0T核磁共振仪行DWI扫描，并采集b值分别为500，800，1000s/mm2时的ADC值，进行统计学分析比较。结果：b值分别为500、800、1000s/mm2时，正常人肝脏ADC值的95%可信区间分别为：1448.75±313.31mm2/s、1221.29±258.54mm2/s、1153.53±218.21mm2/s；同一b值时，不同年龄及不同性别之间的ADC值均无统计学差异。同一年龄段或同一性别间，其b值=500s/mm2时，均与b=800，1000s/mm2时存在差异（p＜0.05），而b=800s/mm2与b=1000s/mm2时均无统计学差异（p＞0.05）。结论：采用3.0T多射频核磁共振仪可以对正常肝脏的水分子弥散进行定量测量，对正常肝脏ADC值的范围正常参考值的提出，为肝脏弥漫性病变的诊断提供了重要参考价值。第三部分3.0T质子磁共振及DWI的联合应用对肝硬化的诊断研究目的：应用3.0T多射频磁共振1H-MRS及DWI对正常志愿者和肝硬化患者的肝脏进行定量研究，并从肝脏代谢及水分子弥散水平探讨肝硬化的机制。方法：38名正常志愿者，男19例，女19例，年龄25～75岁，平均年龄41.22±14.67岁；肝硬化患者30例，男22例，女8例，年龄34～65岁，平均年龄50.19±8.61岁。全部志愿者行~1H-MRS及DWI检查（其中，b值取500，800,1000s/mm~2），采集其水峰峰值、水峰下面积、脂肪峰峰值、脂肪峰下面积、脂肪分数以及肝脏弥散成像ADC值，并对正常志愿者组与肝硬化患者组所采集到的数据进行统计学分析。结果：正常志愿者组与肝硬化组之间，~1H-MRS所测得的水峰峰值、水峰下面积存在明显统计学差异（p＜0.05），肝硬化组水峰峰值、水峰下面积均低于正常组；而两组间脂肪峰高、脂肪峰下面积、脂肪分数无明显差异（p＞0.05）。正常志愿者组与肝硬化组之间，b=500s/mm~2时，两组间ADC值明显不同，肝硬化组存在水分子弥散障碍，但b=800s/mm~2和b=1000s/mm~2时，正常肝脏组及肝硬化组间ADC值差别不明显。结论：3.0T~1H-MRS及DWI可以作为一种检查肝硬化的新手段，可从分子水平进一步阐明肝硬化机制。~1H-MRS及DWI对临床肝硬化定性及定量诊断及治疗预后评估具有重要价值。
[Abstract]:Part one quantitative study of 3.0T1H-MRS in normal liver and fatty liver
Objective: to examine the normal volunteers and patients with fatty liver by 3.0T multi radiofrequency magnetic resonance imaging (1H-MRS), and to discuss the range of normal value of liver 1H-MRS metabolites, and to further explore the diagnostic value of the liver.
Methods: 38 normal volunteers, aged 25~75 years, with an average age of 41.22 + 14.67 years old, 19 males and 19 women, 27 fatty liver patients, 25~62 years old, average age 45.86 + 9.49 years, 17 men and 10 cases, were divided into two groups according to age, divided into male and female groups according to sex. The 3.0T magnetic resonance apparatus was used for all Liver 1H-MRS scan was performed in normal volunteers and patients with fatty liver. 16 volunteers were randomly selected to repeat 2 scans. The peak peak of water peak, the area under the peak of water peak, the peak of lipid peak, the area under the peak of lipid peak, and the fat fraction were statistically compared.
Results: (1) 16 normal volunteers were treated with 2 1H-MRS scans, the same size, the same size ROI, and the 2 measurements of metabolites (P > 0.05). (2) the peak value of the peak of water peak, the area under the peak of water, the peak of the fat peak, the area under the lipid peak and the fat fraction were not statistically different according to age group, the group of 45 years old and the 45 years old group. Difference (P > 0.05); (3) comparison between the two groups of normal volunteers, except for the peak value of the peak water peak, there was no difference between the two groups of the residual metabolite value (P > 0.05). (4) the normal volunteers over 45 years old and 45 years old were compared with the same age group of fatty liver, except the peak value of the water peak, the rest of the water peak area, the peak of fat peak, and the fat. There was a statistical difference between the area of the peak and the fat fraction (P > 0.05). 5. For the 1H-MRS metabolites of the normal volunteers and the fatty liver patients, there was no significant difference in the peak value of the peak water peak in the normal volunteers and the fatty liver patients. The number of metabolites showed significant differences (P > 0.05); (6) the 95% confidence interval of normal liver MRS metabolites: the area under the peak of water was 163.05 + 27.45, the peak of fat was 6.89 + 2.72, the area under the fat peak was 4.22 + 4.98 and the fat fraction was 2.51 + 2.61%, and the threshold of the MRS metabolite of the normal liver and fatty liver was determined: the peak of fat was 9.55 (sensitivity). The sensitivity 0.909,1- specificity was 0, the area under the fat peak was 8.65 (sensitivity 0.955,1- specificity 0.029), and the fat fraction was 4.97% (sensitivity 0.955,1- specificity 0.029).
Conclusion: 3.0T1H-MRS can be applied to the quantitative study of liver metabolism and fatty liver in normal people, and the normal range of liver water and fat content can provide important reference value for diagnosis of liver metabolic diseases.
The second part is a quantitative study of 3.0T diffusion weighted imaging in normal liver.
Objective: 3.0T multi radiofrequency magnetic resonance imaging (rfMRI) was used for the liver diffusion weighted imaging of normal volunteers, the quantitative measurement of liver ADC value, the ADC range of normal liver, and the correlation between age and sex, and its clinical value were studied.
Methods: 38 healthy volunteers, aged 25~75 years, average age 41.22 + 14.67 years old, male 19 cases and 19 women, were divided into two groups according to age > 45 and 45 respectively, and divided into male group and female group according to sex. 3.0T MRI was used for DWI scan, and the value of B was 5008001000s/ mm2 respectively, and the statistical analysis was compared.
Results: when the value of B was 5008001000s/mm2, the 95% confidence intervals of the normal liver ADC value were 1448.75 + 313.31mm2/s, 1221.29 + 258.54mm2/s, 1153.53 + 218.21mm2/s, and the ADC values of different ages and sexes were not statistically different when the same b value. The b value =500s/mm2 of the same age or the same sex, all and b=. There was a difference in 8001000s/mm2 (P < 0.05), but there was no significant difference between b=800s/mm2 and b=1000s/mm2 (P > 0.05).
Conclusion: the quantitative measurement of water molecular diffusion in normal liver can be measured by 3.0T multi radiofrequency MRI, and the normal reference value of normal liver ADC value provides an important reference value for the diagnosis of liver diffuse lesions.
The third part is the application of 3.0T proton magnetic resonance and DWI in the diagnosis of liver cirrhosis.
Objective: To study the liver of normal volunteers and patients with liver cirrhosis by 3.0T multiple radiofrequency MRI 1H-MRS and DWI, and to explore the mechanism of liver cirrhosis from liver metabolism and water molecular diffusion.
Methods: 38 normal volunteers, 19 male and 19 female, age 25~75 years old, with an average age of 41.22 + 14.67 years old, 30 cases of cirrhosis, 22 male, 8 women, 34~65 years old, average age 50.19 + 8.61 years, all volunteers were examined by ~1H-MRS and DWI (b value was 5008001000s/mm~2), and the peak of water peak, area under water peak and peak peak of fat were collected. The value, the area under the fat peak, the fat fraction and the ADC value of the liver diffusion imaging, and statistical analysis of the data collected from the normal volunteers and the patients with liver cirrhosis.
Results: the peak peak of water peak measured by ~1H-MRS between the normal volunteers and the liver cirrhosis group was significantly different (P < 0.05). The peak value of the water peak of the liver cirrhosis group was lower than that of the normal group. The fat peaks of the two groups were higher, the area under the fat peak and the fat fraction were not significantly different (P > 0.05). The ADC values between the two groups were significantly different between the two groups. There was a water diffusion barrier in the liver cirrhosis group, but there was no significant difference in the ADC value between the normal liver group and the liver cirrhosis group at the time of b=800s/mm~2 and b=1000s/mm~2.
Conclusion: 3.0T~1H-MRS and DWI can be used as a novice section of liver cirrhosis. It is of great value to further clarify the mechanism of liver cirrhosis.~1H-MRS and DWI from the molecular level to determine the qualitative and quantitative diagnosis of liver cirrhosis and to evaluate the prognosis of the liver cirrhosis.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.5

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