3.0T MR磁化传递成像评价慢性乙型肝炎肝纤维化

Preliminary study of 3.0T MR magnetization transfer imaging in evaluating chronic hepatitis B fibrosis

目的:初步探讨3.0T MR磁化传递成像(MTI)技术评价肝纤维化程度的价值。方法:选取肝穿诊断肝纤维化者27例,代偿期肝硬化患者14例及健康人10例行磁化传递成像(MTI)检查,据肝纤维化程度分6组:S0(健康人,10例)、S1(5例)、S2(7例)、S3(8例)、S4(7例)、S5(代偿期肝硬化,14例),通过测量MR信号强度,计算获得各受试者肝脏磁化传递率(MTR),分析各组间MTR值差异及其与肝脏纤维化、炎症程度的相关性;采用受试者工作特征曲线(ROC曲线)分析MTR值诊断肝纤维化、肝硬化程度的能力。结果:MTR值与肝纤维化程度及炎症程度均有正相关趋势(P≤0.001),S0、S1、S2组间及S3、S4、S5组间MTR值无统计学差异,S0与S3、S4、S5之间及S1+2与S3+4+5之间MTR值有统计学差异;ROC曲线显示MTR值评价中重度肝纤维化(S3+4+5)有统计学意义(P=0.000),以MTR≥0.077诊断S≥3的敏感性为69.0%、特异性为90.9%。结论:MTR尚不能诊断早期轻度肝纤维化,但对鉴别轻度肝纤维化与中重度肝纤维化及肝硬化有一定的临床价值,可与临床生化等检查结合作为诊断肝纤维化的补充手段。

Aim ： To investigate the value of 3.0T MR magnetization transfer imaging （MTI） for evalu- ating liver fibrosis. Methods： Magnetization transfer imaging （MTI） was performed in 27 liver fibrosis biopsy proven, 14 patients with decompensated cirrhosis and 10 healthy volunteers. All subjects were divided into 6 groups according to the degree of liver fibrosis, including SO （normal, 10 eases）, S1 （5 cases）, S2 （7 eases）, S3 （8 cases）, S4 （7 cases）, S5 （decompensated cirrhosis, 14 eases）. The liver magnetization transfer ratio （MTR） of each subject was calculated, by measuring the MR signal intensi- ty. Analyzed the difference of MTR value between the groups, and the correlation between liver MTR and stage of fibrosis, grade of inflammation. Receiver operating characteristics （ROC） analysis was used to assess the performance of MTR in prediction of liver fibrosis and cirrhosis. Results： There was moderate but significant positive correlation between MTR and fibrosis stage（P~〈0. 001 ）. The MTR values were significant different between SO versus S3 ,S4 ,S5 fibrosis and between S1 ＋ 2 versus S3 ＋ 4 ＋ 5 fibrosis.But there were no significant difference among SO, $1, $2 group and among $3, $4, $5 group. ROC a- nalysis showed that liver MTR was a significant predictor of moderate and severe liver fibrosis （ stage 3 or greater） （P = 0. 000）, with areas under the curve 0. 817, sensitivity 69. 0%, and specificity 90. 9%, When MTR ≥ 0. 077. Conclusion： MTI can be used for prediction of the presence of moderate and advanced liver fibrosis. It can be used as an additional means of diagnosis of liver fibrosis.