应用磁共振DWI单指数、双指数和拉伸指数模型参数评估慢性乙型肝炎患者肝纤维化程度效能研究*

目的 探讨应用磁共振DWI单指数、双指数和拉伸指数模型参数评估慢性乙型肝炎（CHB）患者肝纤维化程度的临床价值。方法 2014年2月~2017年9月我院收治的CHB患者77例,选择同时期20例健康人作为对照,对CHB患者行肝活检,两组受试者接受磁共振检查,测量单指数模型、双指数模型和拉伸指数模型参数,其中ADCst为表面扩散系数,Dt为真实扩散系数,Dp为假性扩散系数,f为灌注相关体积分数,DDC为扩散分布指数,α为水分子扩散异质性指数。结果 CHB单指数模型的ADCst、双指数模型的Dt、拉伸指数模型的f和DDC分别为（0.899±0.080）×10^-3 mm²/s、（0.591±0.092）×10^-3 mm²/s、（32.374±7.472）×10^-3 mm²/s和（1.103±0.257）×10^-3 mm²/s,显著低于健康人【（0.986±0.095）×10^-3 mm²/s、（0.704±0.073）×10^-3 mm²/s、（39.686±5.871）×10^-3 mm²/s和（1.394±0.243）×10^-3 mm²/s,P<0.05】;在25例无显著肝纤维化、29例显著肝纤维化和23例肝硬化患者中,ADCst、Dt、f和DDC显著差异（P<0.05）;ADCst、Dt、f和DDC诊断肝纤维化的ROC曲线下面积分别为0.841、0.934、0.770和0.926。结论 应用磁共振双指数模型和拉伸指数模型诊断CHB患者肝纤维化比应用单指数模型具有更好的诊断效果,值得进一步研究验证。

Assessment of liver fibrosis with diffusion-weighted magnetic resonance imaging using single,double and stretch index model in patients with chronic hepatitis B

Objective To explore the clinical efficacy of single,double and stretch index model under diffusion weighted imaging （DWI） of MRI in evaluating liver fibrosis in patients with chronic hepatitis B （CHB）.Methods 77 patients with CHB and 20 healthy persons were recruited in this study between February 2014 and September 2017. All patients received liver biopsies and individuals in both groups received MRI examination,and the parameters,e.g. ADCst as surface diffusion coefficient,Dt as real diffusion coefficient,Dp as false diffusion coefficient,f as perfusion related volume fraction,DDC as diffusion distribution index and α as water molecule diffusion heterogeneity index.Results The ADCst,Dt,f and DDC in patients with CHB were（0.899±0.080）×10^-3 mm²/s,（0.591±0.092）×10^-3 mm²/s,（32.374±7.472）×10^-3 mm²/s and（1.103±0.257）×10^-3 mm²/s,significantly lower than【（0.986±0.095）×10^-3 mm²/s,（0.704±0.073）×10^-3 mm²/s,（39.686±5.871）×10^-3 mm²/s and （1.394±0.243）×10^-3 mm²/s,P<0.05】 in healthy persons;there were significantly statistical differences as respect to ADCst,Dt,f and DDC in 25 patients without liver fibrosis,29 with significant liver fibrosis and 23 with liver cirrhosis （P<0.05）;the AUC of ADCst,Dt,f and DDC in diagnosing liver fibrosis were 0.841,0.934,0.770 and 0.926,respectively. Conclusion The application of double and stretch index models in diagnosing liver fibrosis in patients with CHB have a promising results,which might be validated in multicentral clinical trials.