SE-EPI磁共振弹性成像评价肝硬化食管胃底静脉曲张

Spin-echo echo planar imaging MR elastography in evaluation of gastroesophageal varices in liver cirrhosis

目的 探讨SE-EPI磁共振弹性成像（MRE）评价肝硬化患者食管胃底静脉曲张（GEV）程度的价值。方法对89例肝硬化患者行SE-EPI序列MRE扫描、实验室及胃镜检查。以胃镜检查GEV程度为金标准,对诊断GEV、轻/中重度GEV的可能影响因素进行判定,并进行GEV分级与影响因素的相关性分析。结果 脾容积及肝、脾弹性值均为诊断GEV的独立影响因素,诊断比值比分别为1.02（95%CI 1.01~1.03）、2.37（95%CI 1.50~3.75）及2.76（95%CI1.59~4.82,P均〈0.01）。仅脾弹性值为鉴别轻度与中重度GEV的独立影响因素,诊断比值比为2.42（95%CI 1.71~3.43,P〈0.01）。GEV分级与血小板与天冬氨酸氨基转移酶比值指数、肝弹性值具有中等程度相关性（r=0.42、0.55,P均〈0.001）,与脾弹性值、脾容积具有较高相关性（r=0.77、0.60,P均〈0.001）。结论 SE-EPI MRE是一种简单、无创的评估GEV的方法。

Objective To explore the value of spin-echo echo planar imaging （SE-EPI） MR elastography （MRE） in evaluation of gastroesophageal varices （GEV） in liver cirrhosis patients. Methods SE-EPI MRE, laboratory and gastroendoscopic examinations were performed in 89 patients with liver cirrhosis. Taking the results of gastroendoscopic examination as golden standard, possible influence factors were analyzed to diagnose GEV or differentiate mild GEV from moderate and severe. The correlation between the grade of GEV and the influence factors to differentiate GEV were also analyzed. Resuits Spleen volume, stiffness value of liver and spleen were all independent influence factors in diagnosing GEV, and odds ratio were 1.02 （95%CI 1.01-1.03）, 2.37（95%CI 1.50-3.75） and 2.76 （95%CI 1.59-4.82, all P〈0.01）, respectively. Spleen stiffness value was the only independent influence factor to differentiate mild GEV from moderate and severe GEV, and the odds ratio was 2.42 （95%CI 1.71-3.43, P〈0.01）. The grade of GEV was moderately correlated with the ratio of platele and aspartate aminotransferase, liver elasticity value （r=0.42, 0.55, both P〈0. 001）, and strongly correlated with spleen stiffness value and spleen volume （r=0.77, 0.60, both P〈0. 001）. Conclusion SE-EPI MRE is a sim ple and non-invasive method to evaluate GEV.