Gd-EOB-DTPA增强磁共振成像对乙型肝炎肝纤维化程度的评估

Evaluation of hepatic fibrosis by Gd-EOB-DTPA enhanced magnetic resonance imaging

目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI评估乙型肝炎肝纤维化程度的价值。方法回顾性选取2019年2月—2022年1月于资阳市雁江区人民医院行Gd-EOB-DTPA增强MRI检查的慢性乙型肝炎患者102例,按穿刺病理结果评价慢性乙型肝炎患者的肝纤维化程度。测量T1WI及增强扫描肝胆期图像肝右前叶、右后叶、左叶、尾状叶及右侧竖脊肌的平均信号值,计算肝实质在肝胆期的相对强化程度。分析肝实质相对强化程度(RE)在不同肝纤维化程度中的差异。结果共纳入102例慢性乙型肝炎患者,男55例,女47例,平均年龄35岁。根据乙型肝炎肝纤维化程度,S0期21例,S1期18例,S2期29例,S3期20例,S4期14例。乙型肝炎患者S0、S1、S2、S3及S4期肝纤维化肝胆期RE分别为(86.2±9.7)%、(74.1±12.6)%、(70.9±10.7)%、(62.5±13.4)%及(45.6±15.1)%,差异具有统计学意义(P<0.05)。肝胆期RE评估乙型肝炎肝纤维化程度的ROC曲线的结果显示AUC为86%,最佳截断值为55.4%,敏感性为67.8%,特异性为91.1%。在明显肝纤维化患者中,肝胆期RE为(52.7±6.1)%,低于不明显肝纤维化患者的RE(78.2±5.3)%,差异具有统计学意义(P<0.05)。结论乙型肝炎肝纤维化程度越严重,Gd-EOB-DTPA增强MRI上肝实质在肝胆期的相对强化程度越低。因此,Gd-EOB-DTPA增强MRI有助于评估慢性乙型肝炎患者的肝纤维化程度。

Objective To evaluate the value of gadolinium-ethoxybenzyl-diethylenetriaminepentaaceticacid(Gd-EOB-DTPA)enhanced magnetic resonance imaging(MRI)in the evaluation of liver fibrosis degrees of hepatitis B.Methods A retrospective study was performed on chronic hepatitis B patients who underwent Gd-EOB-DTPA enhanced MRI examination enrolled from February 2019 to January 2022.The degree of liver fibrosis in these patients was evaluated according to the pathological results of liver biopsies.The mean signal values of right anterior lobe,right posterior lobe,left lobe,caudate lobe and right erector ridge muscle were measured in T1W1 and enhanced hepatobiliary phase images,and the relative enhancement of liver parenchyma in hepatobiliary phase was calculated.The difference of relative enhancement(RE)ratio of liver parenchyma in different hepatic fibrosis degree was analyzed.Results A total of 102 patients with chronic hepatitis B were enrolled,including 55 males and 47 females,with an average age of 35 years.According to the degree of hepatitis B fibrosis,21 cases were S0 stage,18 cases were S1 stage,29 cases were S2 stage,20 cases were S3 stage,and 14 cases were S4 stage.The RE ratio of patients with liver fibrosis in S0,S1,S2,S3 and S4 stages were(86.2±9.7)%,(74.1±12.6)%,(70.9±10.7)%,(62.5±13.4)%and(45.6±15.1)%,respectively,the difference was statistically significant(P<0.05).The receiver operating characteristic(ROC)curve of Gd-EOB-DTPA enhanced MRI for evaluating the degree of liver fibrosis in hepatitis B showed an Area Under Curve(AUC)of 86%,an optimal cut-off value of 55%,a sensitivity of 67%,and a specificity of 91%.In patients with obvious liver fibrosis,the RE ratio of hepatobiliary phase was(52.7±6.1)%,which was lower than that of patients without obvious liver fibrosis(78.2±5.3)%,and the difference was statistically significant(P<0.05).Conclusion The more severe the degree of liver fibrosis in patients with chronic hepatitis B,the lower the degree of RE ratio of liver parenchyma in hepatobiliary phase on Gd-EOB-DTPA enhanced MRI.Therefore,Gd-EOB-DTPA enhanced MRI is helpful to evaluate the degree of liver fibrosis in patients with chronic hepatitis B.