磁共振扩散成像肝脾ADC比值评价肝纤维化程度的研究

目的探讨磁共振DWI成像肝脾ADC值之比评价肝纤维化严重程度的能力。方法采用超导型全身磁共振扫描系统对39例肝纤维化患者和15例正常志愿者,选择b值为200,400,600,800,1000s/mm2行DWI扫描,分别在肝右叶和脾脏测量ADC值,计算肝脾ADC值比值,进行统计学分析。结果肝纤维化S分期与肝脏及脾脏ADC值之间差异均有统计学意义(p<0.05)。随着纤维化程度的增加,与肝脏ADC值呈负相关,而脾脏ADC值只与S2期以上纤维化有显著相关性。肝脾ADC比值与肝纤维化S0及S1期无明显相关性(r值分别为:0.536,0.491,p>0.05),而与S2-S4期呈负相关(r值分别为:-0.681,-0.828,-0.385,p<0.05),且于b=800s/mm2相关性最强,评价效能最优(S2以上纤维化组AUC为0.842,灵敏度为0.819,特异度为0.947;S3以上纤维化组AUC为0.995,灵敏度0.857,特异度为1.000)。结论采用脾脏作为参考器官行DWI扫描,在b=800s/mm2时,评价肝纤维化效能最高。

The Research of the Ratio of the ADC Values of the Liver and Spleen of MRI Diffusion-weighted Imaging in Liver Fibrosis

Objective The study was to evaluate ADC values of the ratio of liver and spleen of DWI for liver fibrosis. Methods and Methods A total of 15 volunteers, 39 patients who had fibrosis in this study. They were scanned using GE 1.5 Tesla unit with b values of 200, 400, 600, 800, 1000s/mm2. Each group was analyzed in statistical methods. Results There were correlated between the right lobe of liver＇s and spleen＇s ADC values and S stage （p 〈 0.05）. With the increase of fibrosis score, liver＇s ADC and S staging were negatively correlated, spleen＇ ADC and S2 or greater were negatively correlated. There were no correlated between the ratio of the ADC values of the liver spleen and S staging in SO and S 1 （r were：0. 536, 0.491, p 〉 0.05）, but were better correlated in S2 or greater （ r were：-0.681, -0.828,- 0.385, p 〈 0.05）. When b value was 800s/mm2, it was negative correlation, performance and correlation were better than the other group（S2 or greater AUC was 0.842, sensitivity was 0.819, specificity was 0.947; S3 or greater AUC was 0.995, sensitivity was 0.857, specificity was 1.000）. Conclusion The spleen as a reference organ, when b value was 800 s/mm2, DWI scan can be the best effective evaluation for liver fibrosis.