氢质子波谱在乙型肝炎相关慢性肝病的研究

Proton magnetic resonance spectroscopy in chronic liver diseases related with hepatitis B

目的评价正常肝脏、乙型肝炎后肝硬化、乙型肝炎后肝癌氢质子波谱的表现及意义,探讨消除呼吸运动对肝脏波谱影响的方法。方法使用GE1.5T磁共振仪单体素定点分辨波谱(PRESS)序列加呼吸门控技术,采集46名受检者肝脏氢质子波谱。根据临床资料、MR征象及病理诊断分为男性健康组(10名)、女性健康组(10名)、男性乙型肝炎后肝硬化组(14例)、男性乙型肝炎后肝癌组(12例)。以谷氨酰胺和谷氨酸复合物(Glx)峰高为参照物,判定胆碱峰(Cho)是否升高,分析Cho在各组间的差异。结果正常男性组Cho峰均低于Glx峰,正常女性组80%Cho峰高于Glx峰,男性乙型肝炎后肝硬化组78.57%Cho峰高于Glx峰,男性乙型肝炎后肝癌组83.33%Cho峰高于Glx峰。正常男女组之间、男性肝硬化组与正常男性组之间、男性肝癌组与正常男性组之间胆碱峰的差异均有统计学意义。结论正常男性Cho峰低于Glx峰,大部分正常女性Cho峰高于Glx峰,男性乙型肝炎后肝硬化、男性乙型肝炎后肝癌Cho峰升高。使用呼吸门控可以有效地消除呼吸运动对肝脏波谱的影响。

Objective To evaluate the application of 1^H-MRS in chronic liver diseases related with hepatitis B, and to investigate the method of eliminating breathing influence to proton MR spectroscopy （1^H-MRS） on liver. Methods Liver spectroscopy of 46 subjects were obtained by single-voxel PRESS sequence with respiratory gating with GE 1.5T scanner. The subjects were divided into 4 groups： the normal male group （10 cases）, the normal female group （10 cases）, the male hepatitis B cirrhosis group （14 cases） and the male liver cancer after hepatitis B group （12 cases） according to clinical data, MR manifestations and pathologic findings. Glutamine and glutamate complex （Glx） peak height served as a reference standard to judge the choline （Cho） peak height. The differences of Cho peak height of each group were compared. Results The peaks of Cho were lower than those of Glx in normal male group. The peaks of Cho were higher than those of Glx in 8 women of normal female group. The peaks of Cho were higher than those of Glx in 11 patients of the male hepatitis B cirrhosis group. The peaks of Cho were higher than those of Glx in 10 patients of the male liver cancer after hepatitis B group. The differences of Cho peak were statistically significant between normal male group and normal female group, the male hepatitis B cirrhosis group and the normal male group, the male liver cancer after hepatitis B group and the normal male group. Conclusion The peaks of Cho in normal males are lower than those of Glx. The peaks of Cho in the majority of normal females are higher than those of Glx. The peaks of Cho increase in male hepatitis B cirrhosis and liver cancer after hepatitis B. Respiratory gating can effectively eliminate the impact of breathing movement on proton MR spectroscopy of liver.