应用DCE-MRI技术评估乙型肝炎肝硬化患者食管胃底静脉曲张严重程度的效能分析

Efficacyof DCE-MRI in evaluating severity of gastroesophageal varices in patients with hepatitis B cirrhosis

目的探讨应用动态增强磁共振成像(DCE-MRI)技术评估乙型肝炎肝硬化患者并发食管胃底静脉曲张(GOV)严重程度的效能。方法2014年6月~2020年6月我院收治的88例乙型肝炎肝硬化并发GOV患者,接受胃镜检查诊断并行GOV分级,使用彩色多普勒超声检测肝脏门静脉直径(PVD)、脾静脉直径(SVD)、脾脏长径(SD)和脾脏厚径(ST),使用DCE-MRI技术评估GOV程度,分析DCE-MRI技术诊断GOV程度的效能。结果在本组88例肝硬化患者中,经胃镜检查诊断并发轻度GOV者60例,并发中重度GOV者28例;并发中重度GOV的乙型肝炎肝硬化患者血清白蛋白水平为(36.0±3.8)g/L,显著低于并发轻度GOV患者【(40.1±3.7)g/L,P<0.05】;外周血白细胞计数为(3.4±0.5)×10^(9)/L,血小板计数为(69.5±7.3)×10^(9)/L,均显著低于轻度GOV患者【分别为(4.2±0.3)×10^(9)/L和(103.3±16.4)×10^(9)/L,P<0.05】;PVD为(15.4±2.0)mm,SVD为(11.2±2.1)mm,SD为(155.9±29.8)mm,ST为(53.2±9.8)mm,均显著大于轻度GOV组【分别为(14.3±2.1)mm、(10.0±2.6)mm、(140.6±30.6)mm和(47.6±10.1)mm,P<0.05】;在28例中重度GOV患者中,DCE-MRI检查发现2级和3级GOV占比分别为42.9%和50.0%,显著高于轻度组的11.7%和0.0%(P<0.05);DCE-MRI技术评估乙型肝炎肝硬化并发GOV严重程度的灵敏度、特异度和准确度分别为88.3%、92.9%和89.8%,阳性预测值和阴性预测值分别为96.4%和78.8%。结论使用DCE-MRI检查判断乙型肝炎肝硬化患者并发GOV有一定的应用价值,值得进一步研究。

Objective The aim of this study was to explore the efficacy of dynamic contrast enhanced magnetic resonance imaging(DCE-MRI)in evaluating the severity of gastroesophageal varices(GOV)in patients with chronic B cirrhosis.Methods A total of 88 patients with hepatitis B cirrhosis complicated with GOV were admitted to our hospital between June 2014 and June 2020,and all patients underwent gastroscopy for the GOV severity and color Doppler ultrasonography for the measurement of portal vein diameter(PVD),splenic vein diameter(SVD),spleen diameter(SD),and spleen thickness(ST).The severity of GOV in patients with hepatitis B cirrhosis was evaluated by DCE-MRI.Results We found 28 cases of moderate and severe,and 60 cases of mild GOV by gastroscopy in our series;serum albumin level in patients with moderate/severe GOV was(36.0±3.8)g/L,much lower than[(40.1±3.7)g/L,P<0.05]in those with mild GOV;the white blood cell count was(3.4±0.5)×10^(9)/L,and the platelet count was(69.5±7.3)×10^(9)/L,both significantly lower than[(4.2±0.3)×10^(9)/L and(103.3±16.4)×10^(9)/L,respectively,P<0.05]in patients with mild GOV;the PVD was(15.4±2.0)mm,the SVD was(11.2±2.1)mm,the SD was(155.9±29.8)mm,and the ST was(53.2±9.8)mm,all significantly greater than those in patients with mild GOV[(14.3±2.1)mm,(10.0±2.6)mm,(140.6±30.6)mm,and(47.6±10.1)mm,respectively,P<0.05];the percentages of grade 2 and grade 3 GOV determined by DCE-MRI in 28 moderate/severe GOV by gastroscopy were 42.9%and 50.0%,significantly higher than 11.7%and 0.0%(P<0.05)in those with mild GOV;the sensitivity,specificity and accuracy,positive predicting value and negative predicting value in evaluating the severity of GOV by DCE-MRI were 88.3%(53/60),92.9%(26/28),89.8%(79/88),96.4%and 78.8%,respectively.Conclusion The application of DCE-MRI in diagnosing GOV in patients with liver cirrhosis is feasible and promising,which needs further investigation.