磁共振DWI在慢性病毒性肝炎患者肝纤维化和炎症程度评价中的价值

Value of DWI on the evaluation of liver fibrosis and inflammation in patients with chronic viral hepatitis

目的探讨磁共振扩散加权成像(diffusion-weighted imaging,DWI)对慢性病毒性肝炎患者肝纤维化和炎症程度的评价价值。方法选择2014年1月—2015年12月丽水市中心医院慢性病毒性肝炎患者93例作为研究对象,进行磁共振DWI检查,测量b=100、500和1 000 s/mm2时的ADC值。结果 b=100 s/mm2时,不同纤维化分期ADC值之间比较差异无统计学意义(P>0.05),b值=500和1 000 s/mm2时,不同纤维化分期ADC值之间比较差异有统计学意义(P<0.05),纤维化分期越高,ADC值越低。b=100、500、1 000 s/mm2时,纤维化分期和肝脏ADC之间均呈负相关(P<0.05)。b=100、500、1 000 s/mm2时DWI诊断肝纤维化≥3期(严重纤维化)的ROC曲线下面积分别为0.66±0.04、0.89±0.06、0.82±0.05,灵敏度分别为76.1%、87.7%、75.6%,特异度分别为58.4%、82.0%、83.6%。b=100 s/mm2时,不同炎症分级ADC值之间比较差异无统计学意义(P>0.05),b=500和1 000 s/mm2时,不同炎症分级ADC值之间比较差异有统计学意义(P<0.05),炎症分级越高,ADC值越低。b=500、1 000 s/mm2时,炎症分级和肝脏ADC之间均呈负相关(P<0.05)。结论磁共振DWI检查ADC值和慢性病毒性肝炎的肝纤维化和炎症程度呈负相关,在慢性病毒性肝炎肝纤维化和炎症程度的评价中具有一定价值。

Objective To investigate the value of diffusion-weighted imaging（DWI） on the evaluation of liver fibrosis and inflammation in patients with chronic viral hepatitis. Methods Selected 93 cases of chronic viral hepatitis and 25 cases of healthy people from January ,2014 to December,2015 in Lishui Central Hospital as research subjects. All subjects were given magnetic resonance DWI inspection,measured the ADC value at b = 100,500 and 1 000 s/mm2. Results When b = 100 s/mm2, there was no statistical significance of the ADC values at different stages （ P 〉 0.05 ） ; when b = 500 and 1 000 s/mm2, there was statistical significance of the ADC values at different stages （ P 〈 0.05 ）, the higher the stage of fi- brosis, the lower the ADC value. When b = 100,500,1 000 s/mm2 respectively, the ADC was negatively correlated with liver fibrosis stage （ P 〈 0.05 ）. When b = 100,500,1 000 s/mm2, the ROC curves of the DWI diagnosis of liver fibrosis ≥3 （severe fibrosis） were 0.66 ± 0.04,0.89 ± 0.06,0.82 ± 0.05, the sensitivity were 76.1% , 87.7% ,75.6% , and the specificity were 58.4% ,82.0% ,83.6%. When b = 100 s/mm2, there was no statistical difference of the ADC values at different grades of inflammation （P 〉 0.05 ） ;when b = 500 and 1 000 s/mm2, the difference of the ADC values at different grades of inflammation was statistically significant （ P 〈 0.05 ）, the higher the grade of inflammation, the lower the ADC value. Conclusion The ADC value of DWI MRI is in negative correlation with liver fibrosis and inflammation of chronic viral hepatitis. DWI examination has assessment value on chronic viral hepatitis liver fibrosis and inflammation.