超声声速匹配联合磁共振弥散加权成像技术评估慢性乙型肝炎患者肝纤维化程度价值分析

Diagnostic value of ultrasonic velocity matching and MR diffusion imaging in evaluating liver fibrosis in patients with chronic hepatitis B

目的研究超声声速匹配联合磁共振弥散加权成像技术评价慢性乙型肝炎(CHB)患者肝纤维化程度的应用价值。方法2017年2月~2020年2月我院收治的78例CHB患者,均采用超声声速匹配技术计算区域速度指数,并使用磁共振弥散加权成像技术测量表观弥散系数(ADC)。行肝活检,经病理学检查将纤维化程度分为汇管区纤维化(S 1)、汇管区周围纤维化(S 2)、纤维间隔形成伴小叶结构紊乱(S 3)和肝硬化(S 4)四期,比较不同分期肝纤维化患者ADC值和区域速度指数的差异。采用受试者工作特征曲线(ROC)分析ADC、区域速度指数或两者联合判断肝纤维化程度的价值。结果经组织病理学检查,在78例CHB患者中,发现S 1期20例,S 2期18例,S 3期24例和S 4期16例;S 1期患者区域速度指数为(21.7±5.9)m/s,显著低于S 2期[(26.8±7.3)m/s,P<0.05]、S 3期[(33.5±8.1)m/s,P<0.05]或S 4期[(36.0±9.2)m/s,P<0.05];S 1期患者ADC值为(1.3±0.2)×10^-3 mm^2/s,显著高于S 2期[(1.2±0.2)×10^-3 mm^2/s,P<0.05]、S 3期[(1.1±0.1)×10^-3 mm^2/s,P<0.05)]或S 4期[(0.9±0.1)×10^-3 mm^2/s,P<0.05];ROC分析显示区域速度指数判断S 4期肝纤维化的曲线下面积(AUC)为0.724(95%CI=0.597~0.851),其诊断>S 2期肝纤维化的敏感度为0.750,特异度为0.532。ADC值判断>S 2期肝纤维化AUC为0.715(95%CI=0.569~0.861),其敏感度为0.758,特异度为0.625。两者联合判断>S 2期肝纤维化AUC为0.809(95%CI=0.678~0.910),其敏感度为0.813,特异度为0.710。区域速度指数与ADC值联合判断>S 2期肝纤维化AUC显著高于任何一项检测(P<0.05)。结论CHB患者定期接受超声声速匹配和磁共振弥散加权成像检查可动态监测肝纤维化程度,可指导临床早期作出合理的病情判断,值得进一步研究。

Objective The purpose of this study was to investigate the diagnostic value of ultrasonic velocity matching and MR diffusion imaging in evaluating liver fibrosis in patients with chronic hepatitis B(CHB).Methods 78 patients with CHB were admitted in our hospital between February 2017 and February 2020,and all received ultrasonic velocity matching check-up for regional velocity index and MR diffusion imaging for apparent diffusion coefficient(ADC)measurement.The liver biopsies were performed in all patients and the liver fibrosis were divided into four stages,e.g.portal area fibrosis for S 1,fibrosis around the portal area for S 2,fibrous septum formation with lobular structure disorder for S 3 and early liver cirrhosis for S 4.The ADC value and regional velocity index were compared in different stages.The diagnostic value of ADC and regional velocity index and their combination in judging liver fibrosis were analyzed by receiver operating characteristic curve(ROC).Results There were 20 cases of S 1 stage,18 cases of S 2 stage,24 cases of S 3 stage and 16 cases of S 4 stages in our 78 patients after histopathological examination;the regional velocity index in patients with S 1 was(21.7±5.9)m/s,which was significantly lower than[(26.8±7.3)m/s,P<0.05]in patients with S 2,or[(33.5±8.1)m/s,P<0.05]in patients with S 3 or[(36.0±9.2)m/s,P<0.05]in those with S 4;there were significant differences in regional velocity index among four groups of different stages of liver fibrosis(P<0.05);the ADC value in patients with S 1 was(1.3±0.2)×10^-3 mm^2/s,which was significantly higher than[(1.2±0.2)×10^-3 mm^2/s,P<0.05]in patients with S 2,or[(1.1±0.1)×10^-3 mm^2/s,P<0.05)]in patients with S 3 or[(0.9±0.1)×10^-3 mm^2/s,P<0.05]in patients with S 4;there were significant difference in ADC among the four groups of different stages of liver fibrosis(P<0.05);the ROC analysis showed that the area under the curve(AUC)of regional velocity index in judging>S 2 stage of liver fibrosis was 0.724(95%CI=0.597-0.851),with the sensitivity and specificity of 0.750 and 0.532,respectively,and the AUC of ADC in judging>S 2 stage of liver fibrosis was 0.715(95%CI=0.569-0.861),with the sensitivity of 0.758 and the specificity of 0.625,whereas the AUC of the two combination in judging>S 2 stage of liver fibrosis was 0.809(95%CI=0.678-0.910),with the sensitivity of 0.813 and the specificity of 0.710;the AUC of the combination of the two parameters in judging>S 2 stage of liver fibrosis in patients with chronic hepatitis B was significantly higher than those by any of the two examination alone(P<0.05).Conclusion It is practical to evaluate the liver fibrosis staging or the early screening of liver cirrhosis by ultrasonic velocity matching and MR diffusion imaging,and the dynamic monitoring of liver fibrosis by the regional velocity index and ADC value even helpful.