MRI-DWI不同模型参数评估CHB肝纤维化分级的价值观察

目的探究磁共振弥散加权成像(MRI-DWI)不同模型参数评估慢性乙型病毒性肝炎(CHB)肝纤维化分级的价值。方法选择48例CHB患者(病例组)及30例健康志愿者(对照组),研究对象均设置不同b值进行MRI-DWI检查,病例组患者接受组织穿刺活检进行肝纤维化分级,比较研究对象MRI-DWI参数水平、参数水平与病例组肝纤维化分级的相关性,评估不同模型参数单指数模型参数的表观弥散系数(ADC)、双指数模型参数的真实扩散系数(Dt)和假性扩散系数(Dp)和灌注分数(f)、拉伸指数模型的扩散分布指数(DDC)和扩散异质性指数(α)]评估CHB肝纤维化分级的效能。结果病例组无纤维化患者各MRIDWI参数与对照组健康志愿者比较差异均无统计学意义(P>0.05);病例组中肝纤维化患者ADC、Dt、f、DDC水平低于对照组志愿者和病例组无纤维化患者,差异有统计学意义(P<0.05),Dp、α水平与对照组志愿者和病例组无纤维化患者比较差异无统计学意义(P>0.05);不同肝纤维化分级CHB患者ADC、Dt、f、DDC水平比较差异有统计学意义(P<0.05),Dp、α水平比较差异无统计学意义(P>0.05);Spearman相关分析结果显示,MRI-DWI多模型参数ADC、Dt、f、DDC水平与CHB患者肝纤维化分级均呈负相关关系(r=-0.535,-0.594,-0.474,-0.651,P<0.05),Dp、α水平与CHB患者肝纤维化分级无相关性(r=-0.238,-0.040,P>0.05);受试者工作特征曲线(ROC)结果显示,ADC、Dt、f、DDC评估CHB患者≥S2级肝纤维化的AUC对应为0.766、0.824、0.820和0.812,评估敏感性和特异性为74.29%和76.92%、82.86%和76.92%、74.29%和84.62%、82.86%和69.23%;ADC、Dt、f、DDC评估CHB患者≥S3级肝纤维化的AUC对应为0.766、0.760、0.694和0.851,评估敏感性和特异性为94.12%和58.06%、47.06%和100.00%、47.06%和93.55%、76.47%和83.87%。结论MRI-DWI模型参数中单模型参数ADC、双指数模型参数Dt和f、拉伸指数模型参数DDC均与CHB患者肝纤维化分级呈负相关关系,上述模型参数可评价CHB患者肝功能分级为临床诊疗提供参考,具有较高应用价值。

Value of Different Model Parameters of MRI-DWI in Evaluating CHB Liver Fibrosis Grading

Objective To explore the value of different model parameters of magnetic resonance diffusion weighted imaging(MRI-DWI)in evaluating liver fibrosis grading of chronic hepatitis B(CHB).Methods 48 CHB patients(case group)and 30 healthy volu nteers(control group)were selected.The study su bjects set different b values for MRI-DWI examination.Patients in case group were given tissue biopsy for liver fibrosis grading.The MRI-DWI para m eters of study subjects and correlation between parameters levels and the liver fibrosis grading case group were compared,and the efficacy of different model parameterssingle exponential model parameter of apparent diffusion coefficient(ADC),double exponential model parameters of true diffusion coefficient(Dt),false diffusion coefficient(Dp)and perfusion fraction(f),tensile exponential model of diffusion distribution index(DDC)and diffusion heterogeneity index(a)]in evaluating CHB liver fibrosis grading was assessed.Results There were no significa nt differences in the MRI-DWI pa ra meters of patients without fibrosis in case group compa red with those of healthy volunteers in control group(P>0.05).The levels of ADC,Dt,f,and DDC of patients with liver fibrosis in case group were lower than those of volunteers in control group and of patients without fibrosis in case groups(P<0.05).There were no significant differences in levels of Dp and a compared with those of volunteers in control group and of patients without fibrosis in case group(P>0.05).There were statistically significa nt differences in the levels of ADC,Dt,f,and DDC among CHB patients with different liver fibrosis grades while there were no statistically significant differences in the levels of Dp andα(P>0.05).Spearman correlation analysis results showed that MRI-DWI multimodel parameters ADC,Dt,f,and DDC were negatively correlated with liver fibrosis grading in CHB patients(r=-0.535,-0.594,-0.474,-0.651,P<0.05),and Dp and a were not correlated with liver fibrosis grading in CHB patients(r=-0.238,-0.040,P>0.05).Receiver operating characteristic curve(ROC)results showed that the AUC values of ADC,Dt,f,and DDC in evaluating CHB patients with liver fibrosis≥S2 grade were 0.766,0.824,0.820 and 0.812,and the sensitivities and specificities were 74.29%and 76.92%,82.86%a nd 76.92%,74.29%a nd 84.62%,a nd 82.86%a nd 69.23%.The AUC values of ADC,Dt,f,and DDC in assessing CHB patients with liver fibrosis≥S3 grade were 0.766,0.760,0.694 and 0.851,and the sensitivities and specificities were 94.12%and 58.06%,47.06%and 100.00%,47.06%and93.55%,and 76.47%and 83.87%.Conclusion Among the MRI-DWI model parameters,the single model parameter ADC,the double exponential model parameters Dt and f,and tensile exponential model parameter DDC are all negatively correlated with liver fibrosis grading of CHB patients.The above model parameters can evaluate the liver function grading of CHB patients and provide reference for clinical diagnosis and treatment,with high application value.