慢性乙肝和乙肝后肝硬化肝脏形态的变化

Hepatic morphologic changes of chronic hepatitis B and cirrhosis secondary to chronic hepatitis B

目的探讨慢性乙肝和乙肝后肝硬化肝脏MRI形态的变化。方法对慢性乙肝患者32例、乙肝后肝硬化患者17例及无肝脏疾病的患者(对照组)18例行MR轴位T1W、T2W及动态增强扫描,观察肝脏形态。结果肝脏表面不规则、肝脏边缘变钝、胆囊窝扩大、肝脏右后切迹征及再生结节能提示肝硬化(P<0.05),以其中任一种阳性诊断肝硬化,敏感度为99.85%,以其中任两种同时阳性诊断肝硬化,特异度为98.80%～99.96%;上述指标与炎症活动度无关(P>0.05);肝脏边缘变钝提示早期肝硬化(P<0.05),其余各指标在对照组和慢性乙肝不同分期、分级间差异无统计学意义(P均>0.05)。结论 MRI显示的肝脏形态变化能提示乙肝后肝硬化,与肝炎症活动度无关。

Objective To investigate hepatic morphologic changes in chronic hepatitis B and cirrhosis secondary to chronic hepatitis B with MRI.Methods Thirty-two patients with chronic hepatitis B,17with cirrhosis secondary to chronic hepatitis B and 18subjects without history of liver diseases underwent MR examination.The major imaging protocols included an axial breath-hold fast spoiled gradient echo T1-weighted,breath-trigger fat-suppressed fast recovery fast spin echo T2weighted and dynamic contrast-enhanced MR imaging.Hepatic shape and contours wwere observed.Results Irregular surface of liver,blunt edge,expanded gallbladder fossa,right posterior hepatic notch sign and regenerative nodules could predict liver cirrhosis（P〈0.05）,with sensitivity of 99.85% using one of these indexes diagnosing liver cirrhosis and specificity of 98.80% — 99.96%using two of these indexes diagnosing liver cirrhosis together.There was no significant difference for these indexes among grades or stages of chronic hepatitis B（P〉0.05）,except for blunt edge in early cirrhosis（P 〈0.05）.Conclusion Hepatic morphologic changes can predict cirrhosis secondary to chronic hepatitis B by MRI,but there is no significant correlation with inflammatory activity of chronic hepatitis B.