基于黄金角径向并行采集技术的MRI动态增强评估肝纤维化的研究

Dynamic contrast⁃enhanced MRI based on GRASP technique for the assessment of liver fibrosis

目的探讨基于黄金角径向并行采集技术(GRASP)技术的动态对比增强MRI(DCE⁃MRI)在评估肝纤维化程度分期的应用价值。方法前瞻性收集2022年9月至2023年12月就诊于中山大学孙逸仙纪念医院行肝脏局灶性病变切除的患者,并获得肿瘤周围肝组织的纤维化分期。所有患者术前均行基于GRASP的DCE⁃MRI检查,并测量其定量参数包括动脉血流量(Fa)、门静脉血流量(Fv)、总血流量(Ftotal)、动脉流量分数(AF)、细胞外平均通过时间(MTT)、细胞外容积(ECV)。不同肝纤维化分期参数对比采用t检验。Spearman秩相关检验方法用于评估DCE各参数与肝纤维化分期的相关性。受试者操作特征(ROC)曲线分析用于评估模型的效能。结果对76名参与者(男性64名)的DCE⁃MRI参数进行定量分析。与非晚期(S≤2)患者相比,晚期患者(S≥3)的Fv降低(125.1 vs.104.26 mL/100 mL/min,P=0.026),AF升高(45.24%vs.51.89%,P=0.025),ECV增加(35.46 vs 40.44 mL/100 mL,P<0.001)。各纤维化分期中,Fv随着分期的增加而降低(r=⁃0.326,P=0.004),AF(r=0.317,P=0.005)与ECV(r=0.569,P<0.001)随着分期的增加而增加。Fv鉴别晚期与非晚期肝纤维化的截断值为145.13 mL/100 mL/min,AUC为0.651(95%CI:0.524~0.778,P=0.013),AF的截断值为42.97%,AUC为0.652(95%CI:0.521~0.782,P=0.013),ECV的截断值为37.72 mL/100 mL,AUC为0.776(95%CI:0.664~0.888,P<0.001)。结论基于GRASP的DCE⁃MRI定量参数可用于肝纤维化的辅助诊断及分期。

Objective To investigate the value of dynamic contrast⁃enhanced MRI(DCE⁃MRI)based on golden⁃angle radial sparse parallel(GRASP)acquisition technique in assessing the degree of liver fibrosis staging.Methods This was a prospective enrollment of patients who underwent resection for localized liver lesions at Sun Yat⁃sen Memorial Hospital,Sun Yat⁃sen University,between September 2022 and December 2023,with subsequent assessment of fibrosis staging in the peritumoral liver tissue.All patients underwent preoperative DCE⁃MRI examination using the GRASP technique.Quantitative DCE⁃MRI parameters including arterial flow(Fa),portal venous flow(Fv),total blood flow(Ftotal),arterial flow fraction(AF),mean extracellular transit time(MTT),and extracellular volume(ECV)were mea⁃sured in all patients.Parameter comparisons for different liver fibrosis stages were performed using t⁃tests.Spearman′s rank correlation test method was used to assess the correlation between each DCE parameter and the liver fibrosis staging.The efficacy of the model was evaluated using Receiver Operating Character⁃istic(ROC)curve analysis.Results DCE⁃MRI parameters were analyzed in 76 participants(64 males).Compared to non⁃late(S≤2)patients,late patients(S≥3)showed a decrease in Fv(125.1 vs.104.26 ml/100 ml/min,P=0.013),an increase in AF(45.24%vs.51.89%,P=0.013),and an increase in ECV(35.46 vs.40.44 ml/100 ml,P<0.001).Across fibrosis stages,Fv(r=-0.326,P=0.004)decreased with increasing stages,and AF(r=0.317,P=0.005)and ECV(r=0.569,P<0.001)increased with increasing stages.The cut⁃off value for Fv was 145.13 mL/100 mL/min with an AUC of 0.651(95%CI:0.524~0.778,P=0.026),and the cut⁃off value for AF was 42.97%with an AUC of 0.652(95%CI:0.521~0.782,P=0.025),and a cut⁃off value of 37.72 mL/100 mL for ECV,with an AUC of 0.776(95%CI:0.664~0.888,P<0.001).Conclusion Quantitative GRASP⁃based DCE⁃MRI parameters can be employed to diagnose and stage the liver fibrosis.