核磁共振弹性成像技术在肝纤维化诊断中的应用价值

The value of magnetic resonance elastography in the diagnosis of hepatic fibrosis

目的探讨核磁共振弹性成像技术(magnetic resonance elastography,MRE)在诊断肝病肝纤维化分期中的价值,为临床诊断提供理论依据。方法回顾性分析长春市人民医院在2014-09至2017-02收治的124例肝纤维化患者临床诊断资料,所选患者均采用磁共振扩散加权成像(diffusion weighted imaging,DWI)和MRE进行检查,分别测量肝组织弹性值(以下简称弹性值)和表观扩散系数(apparent diffusion coefficient,ADC)值,分析二者与肝纤维化分期的相关性;采用受试者工作特征(receiver operator characteristic,ROC)曲线比较二者诊断肝病肝纤维化分期的效能。结果 (1)不同肝纤维化分期之间弹性值及ADC值的比较差异均具有统计学意义(F=250.757,P<0.001;F=2.352,P=0.035),其中弹性值与肝纤维化分期呈正相关(r=0.994,P<0.001),ADC值与肝纤维化分期呈负相关(r=-0.594,P<0.001);(2)在诊断≥S_1(t=22.416,P<0.001)、≥S_2(t=18.461,P<0.001)、≥S_3(t=52.369,P<0.001)期肝纤维化时,弹性值的ROC的曲线下面积显著大于ADC值,诊断S_4期肝纤维化时,弹性值的ROC曲线下面积数值大于ADC值,但差异无统计学意义(Z=1.863,P=0.127)。结论 MRE对肝纤维化分期及诊断价值优于DWI技术,具有临床推广价值。

Objective This study objective was to investigate the value of magnetic resonance elastography（MRE） in the diagnosis of hepatic fibrosis, and to provide a theoretical basis for its role in clinical diagnosis. Methods A sample of 124 patients admitted to Changchun Hospital with hepatic fibrosis, between September 2014 to February 2017, were chosen as study sample and were retrospectively analyzed. Patients were examined using diffusion weighted imaging（DWI） and MRE respectively to measure liver tissue elasticity（hereinafter referred to as the elastic value） and the apparent diffusion coefficient（ADC） and analyze their correlation with the staging of liver fibrosis; the receiver operating characteristic（ROC） curve was used to compare the efficacy of the two diagnostic methods for hepatic fibrosis. ResultsThe difference in value of liver elasticity and ADC in different stages of liver fibrosis was statistically significant（F=250.757,P0.001;F=2.352,P=0.035）. The value of liver elasticity showed positive correlation with the stages of liver fibrosis（r =0.994,P〈0.001）, while ADC showed negative correlation with the stages of liver fibrosis（r=-0.594,P〈0.001）.（2） In diagnosing ≥S1（t=22.416,P〈0.001）, ≥S2（t=18.461,P〈0.001）, ≥S_3（t=52.369,P〈0.001） stages of liver fibrosis, the areas under ROC of elasticity were significantly greater than that of the ADC value（PM〈0.05）. In diagnosing ≥S4 stage, the area under ROC of elasticity was greater than that of the ADC value, but the difference was not statistically significant（Z=1.863, P=0.127）. Conclusions MRE is more effective in staging and diagnosing liver fibrosis than DWI, which is worthy of clinical promotion.