磁共振弥散加权成像表观弥散系数联合肝脾体积比值对非酒精性脂肪肝合并肝纤维化的诊断价值研究

Study on the diagnostic value of the ADC of MR DWI combined with the volume ratio of liver-spleen in the diagnosis of NAFLD with hepatic fibrosis

目的:探讨磁共振(MR)弥散加权成像(DWI)序列表观弥散系数(ADC)值联合肝脾体积比值诊断非酒精性脂肪肝(NAFLD)合并肝纤维化的临床价值。方法:选择医院收治的72例NAFLD患者,依据诊断结果将其分为无肝纤维化表现的NAFLD组(25例)、NAFLD轻度肝纤维化组(26例,S1~S2期)和NAFLD重度肝纤维化组(21例,S3~S4期)3组。所有患者均接受MR DWI序列检查,并计算和比较各组肝脏ADC值及肝脾体积比值,采用Spearman法分析肝脏ADC值与肝脾体积比值的相关性关系,绘制受试者工作特征(ROC)曲线,计算分析肝脏ADC值和肝脾体积比值单一及联合诊断NAFLD合并纤维化的ROC曲线下面积(AUC)。结果:NAFLD组、NAFLD轻度肝纤维化组和NAFLD重度肝纤维化组肝脏ADC值及肝脾体积比值比较,差异均有统计学意义(F=15.936,F=14.827;P<0.05),NAFLD轻度肝纤维化组和NAFLD重度肝纤维化组肝脏ADC值及肝脾体积比值均明显低于NAFLD组(t_(轻度肝纤维化组)=6.202,t=6.328;t_(重度肝纤维化组)=10.570,t=11.740;P<0.05),而NAFLD重度肝纤维化组肝脏ADC值及肝脾体积比值明显低于NAFLD轻度肝纤维化组(t=4.978,t=6.268;P<0.05);肝脏ADC值与肝脾体积比值呈正相关性关系(r=0.621,P<0.05);肝脏ADC值联合肝脾体积比值诊断NAFLD合并肝纤维化的AUC、灵敏度及特异度均优于单一指标检测。结论:MR DWI序列ADC值联合肝脾体积比值诊断NAFLD合并肝纤维化具有较高的临床价值。

Objective:To investigate the clinical value of the apparent diffusion coefficient(ADC)value of MR diffusion weighted imaging(DWI)sequence combined with the volume ratio of liver-spleen in the diagnosis of nonalcoholic fatty liver(NAFLD)with hepatic fibrosis.Methods:A total of 72 patients with NAFLD admitted to the hospital were selected,and they were divided into three groups:NAFLD group(25 cases),NAFLD with mild hepatic fibrosis group(26 cases,stage S1-S2)and NAFLD with severe hepatic fibrosis group(21 cases,stage S3-S4).All patients underwent MRI DWI sequence examination,and the hepatic ADC values and the volume ratio of liverspleen among three groups were calculated and compared.The correlation relationship between hepatic ADC values and volume ratio of liver-spleen was analyzed by Spearman method.Receiver operating characteristic(ROC)curve was drawn,and the areas under curve(AUC)of the ROC curve of the single diagnosis and combined diagnosis of hepatic ADC value and the volume ratio of liver-spleen for NAFLD with hepatic fibrosis were calculated and analyzed.Results:The differences of hepatic ADC value and the ratio of liver-spleen among NAFLD group,NAFLD with mild hepatic fibrosis group and NAFLD with severe hepatic fibrosis group were significant(F=15.936,F=14.827,P<0.05).The hepatic ADC value and the volume ratio of liver-spleen in NAFLD with mild hepatic fibrosis group and NAFLD with severe hepatic fibrosis group were significantly lower than those in NAFLD group(t_(mild hepatic fibrosis group)=6.202,t=6.328,t_(severe hepatic fibrosis group)=10.570,t=11.740,P<0.05),while the hepatic ADC value and volume ratio of liver-spleen in NAFLD with severe hepatic fibrosis group were significantly lower than those in NAFLD with mild hepatic fibrosis group(t=4.978,t=6.268,P<0.05).There was a positive correlation between the hepatic ADC value and the volume ratio of liver-spleen(r=0.621,P<0.05).The AUC,sensitivity and specificity of hepatic ADC value combined with volume ratio of liver-spleen in the diagnosis of NAFLD with hepatic fibrosis were better than those of each single examination of them.Conclusion:The examination of the ADC value of MR DWI sequence combines with the volume ratio of liver-spleen has a higher clinical value in the diagnosis of NAFLD with hepatic fibrosis.