双能量CT增强与磁共振弹性成像联合诊断慢性乙型肝炎肝纤维化的临床价值

The clinical value of dual-energy CT enhancement and magnetic resonance elastography in the diagnosis of hepatitis B liver fibrosis

目的探讨双能量CT(dual-energy CT,DECT)增强和磁共振弹性成像(magnetic resonance elastography,MRE)在慢性乙型肝炎肝纤维化诊断中的价值,为临床医师提供参考。方法对2022年7月至2023年7月于广东省深圳市罗湖区中医院诊治的85例慢性乙型肝炎患者临床资料开展回顾性研究。本组患者均先后行DECT扫描、MRE检查,以病理活检结果为金标准,根据肝纤维化严重度分为S0组、S1~S2组、S3~S4组,对比三组MRE弹性值、动脉期肝实质碘浓度(hepatic parenchymal iodine concentration atarterial stage,Ia)、门静脉期肝实质碘浓度(hepatic parenchymal iodine concentration inportal vein stage,Ip)及肝动脉碘分数(arterial iodine fraction,AIF);通过Spearman秩相关系数分析肝纤维化分级与上述指标的相关性,并分析临床诊断的效能。结果本组85例患者经病理活检证实,S0组28例,S1~S2组35例,S3~S4组22例,三组患者的临床基本资料无显著性差异(P>0.05)。S0组、S1~S2组、S3~S4组的MRE弹性值、Ia、Ip及AIF差异存在统计学意义(均P<0.05);Spearman秩相关分析表明,慢性乙型肝炎肝纤维化严重度与MRE弹性值、Ia及AIF呈正相关(r分别为0.705、0.543、0.685,均P<0.05),与Ip呈负相关(r为-0.607,P<0.05)。MRE与DECT增强联合诊断慢性乙型肝炎肝纤维化的敏感度、特异度、准确率均显著高于单一方法诊断(P<0.05)。通过受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析,DECT增强、MRE及联合诊断慢性乙型肝炎肝纤维化的曲线下面积分别是0.769、0.833、0.926。结论在慢性乙型肝炎肝纤维化诊断中,DECT增强、MRE检查均有较好效果,两者联合可提高诊断效能,有重要临床价值。

Objective To explore the value of dual energy CT(DECT)enhanced scanning and magnetic resonance elastography(MRE)in the diagnosis of hepatitis B liver fibrosis,and provide reference for clinical application.Method From July 2022 to July 2023,a retrospective study was carried out on the clinical diagnosis and treatment data of 85 patients with chronic hepatitis B diagnosed and treated in Department of Radiography of Luohu Hospital of Traditional Chinese Medicine,Guangdong Shenzhen.All patients in this group underwent DECT scans and MRE examinations.Based on the pathological biopsy results as the gold standard,they were divided into S0 group,S1-S2 group,and S3-S4 group according to the severity of liver fibrosis.The MRE elasticity values,arterial hepatic parenchymal iodine concentration(Ia),portal venous hepatic parenchymal iodine concentration(Ip),and hepatic arterial iodine fraction(AIF)were compared among the three groups;Analyze the correlation between liver fibrosis grading and the above indicators through Spearman correlation coefficient,and analyze the efficacy of clinical diagnosis.Result Pathological biopsies of 105 patients in this group showed that there were 28 cases in group S0,35 cases in group S1-S2,and 22 cases in group S3-S4.There was no significant difference in the basic clinical data of the three groups(P>0.05).The MRE elastic value,Ia,Ip and AIF of S0 group,S1-S2 group and S3-S4 group were significantly different(P<0.05).Spearman correlation analysis showed that the severity of hepatitis B fibrosis was positively correlated with MRE elasticity score,Ia and AIF(r=0.705,0.543,0.685,P<0.05),and negatively correlated with Ip(r=-0.607,P<0.05).The sensitivity,specificity and accuracy of MRE and DECT enhanced scanning in the diagnosis of hepatitis B fibrosis were significant(P<0.05).According to ROC curve analysis,the AUC of DECT enhanced scan,MRE and combined diagnosis of HBV fibrosis were 0.769、0.833、0.926,respectively.Conclusion In the diagnosis of hepatitis B liver fibrosis,DECT enhanced scanning and MRE examination have good results,and the combined diagnosis of both can improve the diagnostic efficiency and has important clinical value.