磁共振成像对慢性乙型肝炎肝功能的评估价值

Multiple factor associativity initial study between magnetic resonance image and liver function of chronic type B hepatitis

目的将肝功能终末期肝病模型(model for end-stage liver disease,MELD)评分与肝右叶横径、肝实质表观扩散系数值(apparent diffusion coefficient values,ADC)、肝门静脉主干平均血流速度(the mean flow velocity of portal vein,PV)、每分血流量(the flow volume per minutes of portal vein,PVOL)的相关性进行多因素相关分析,探讨磁共振成像评价肝功能的可能最佳指标,为临床评估肝功能提供新的影像学信息。方法对30例正常志愿者和30例慢性乙型肝炎患者肝脏磁共振平扫及扩散加权成像、相位对比法成像,测量并比较组间肝右叶横径、肝实质ADC值、PV、PVOL的差异,同时将所得磁共振成像(MR)数据与患者MELD评分进行多元回归分析。结果病例组肝右叶横径、肝实质ADC值较正常组降低(P<0.05),PV、PVOL较正常组增高(P<0.01),肝脏ADC值和PV与MELD评分显著性负相关(r=-0.470、-0.570,均P<0.01),PV对MELD评分的影响贡献最大。肝右叶横径、肝门静脉主干PVOL与MELD评分无显著性相关。亦即,肝实质ADC值、PV值高的患者,MELD评分多较低,肝功能损害较轻。结论肝实质ADC值、PV与慢性乙型肝炎肝功能高度相关,且测量无创、快捷、可重复运用。可为临床评估肝功能,判断预后提供新的有价值信息。

Objective To do multiple factor associativity analysis between liver function model for end stage liver disease（MELD） score and transverse diameter of right hepatic lobe,apparent diffusion coefficient values（ADC） of liver parenchyma,the mean flow velocity of portal vein（PV）, the flow volume per minutes of portal vein（PVOL）. In order to approach the probably best index of estimating liver function by magnetic resonance image（MRI）, offer new image information to clinical assessment about liver function. Methods Thirty normal volunteers and 30 chronic type B hepatitis patients underwent on MRI examination including diffusion weighted image（DWI） and phasecontrast image （PC）, and then transverse diameter of right hepatic lobe, ADC, PV, PVOL were measured in normal group and patients group to compare the MRI data. Multiple factor analysis was done Between liver function MELD score of patients group and MRI data of patients group. Results Transverse diameter of right hepatic lobe and ADC of patients group were lower than those of normal group（ P 〈0.05）. PV and PVOL of patients group were higher than those of normal group （P 〈0.01）. There were significant negative correlation between MELD score and ADC, MELD score and PV, coefficient association were -0. 470;-0. 570 （P 〈0.01）,respectively. Impact on MELD score by PV was largest. There were not significant correlation between MELD score and transverse diameter of right hepatic lobe, MELD score and PVOL i. e,the patients had higher ADC and PV,their MELD score were lower usually,liver function damage of patients also were slight. Conclusion ADC of liver parenchyma and PV had high correlation with liver function of chronic type B hepatitis. Measuring ADC and PV were noninvasive and rapid and repeatable, can offer new valuable information to evaluate liver function in clinic.