磁共振弥散加权成像评价肝纤维化的临床病理对照研究

Objective To evaluate the clinical practical value of apparent diffusion coefficient (ADC) measurements based on diffusion-weighted MR imaging (DWI) for quantification of liver fibrosis and inflammation for hepatitis viral infection.Methods Diffusion-weighted MRI with parallel imaging was prospectively performed on 85 patients with chronic hepatitis and on 22 healthy volunteers within a single breath-hold using a single-shot spin-echo echo-planar sequence at b values of 100, 300, 500,800 and 1000 s/mm2 respectively. ADC values of liver were measured with five different b values. The inflammation grades and fibrosis stages were evaluated histologically by biopsy. One-way analysis of variance and Spearman' s rank correlation test were used for statistical analysis. Receiver operating characteristics analysis was used to assess the performance of ADC in predicting the presence of stage ≥2 and stage ≥3 hepatic fibrosis, and grade ≥1 hepatic inflammation. Results There was moderate negative correlation between hepatic ADC values and fibrosis stage. And the best correlation was obtained for a b value of 800 s/mm2 (r = - 0. 697, P=0.000). At all b values there was a significant decrease in hepatic ADC in patients with stage ≤1versus stage ≥2 fibrosis and stage ≤2 versus stage ≥3 fibrosis (P <0. 05). Hepatic ADC was a significant predictor of stage ≥2 and ≥3 fibrosis. The areas under the curve were 0. 909 vs 0. 917, sensitivity 76. 6% vs 80. 0% and specificity 88. 3% vs 91.5% (ADC with a b value of 800 s/mm2, 1.26 × 10<'3> mm2/s or less and 1.19 × 10-3 mm2/s or less). There was weak to moderate negative correlation between ADCs and inflammation grade. Hepatic ADC was a significant predictor of grade ≥1 inflammation with an area under the curve of 0. 781, sensitivity of 60. 0% and specificity of 86. 4% (ADC with a b value of 500 s/mm2, 1.54 × 10-3 mm2/s or less). Conclusion The D WI measurement of hepatic ADC can be used to quantify liver fibrosis and inflammation. It will be a new approach for early diagnosis and therapeutic follow-up of hepatic fibrosis.

Comparative study on clinical and pathological changes of liver fibrosis with diffusion-weighted imaging