Fibrosis in nonalcoholic fatty liver disease: Noninvasive assessment using computed tomography volumetry

AIM To evaluate the diagnostic performance of computed tomography(CT) volumetry for discriminating the fibrosis stage in patients with nonalcoholic fatty liver disease(NAFLD).METHODS A total of 38 NAFLD patients were enrolled. On the basis of CT imaging, the volumes of total, left lateral segment(LLS), left medial segment, caudate lobe, and right lobe(RL) of the liver were calculated with a dedicated liver application. The relationship between the volume percentage of each area and fibrosis stage was analyzed using Spearman's rank correlation coefficient. A receiver operating characteristic(ROC) curve analysis was performed to determine the accuracy of CT volumetry for discriminating fibrosis stage.RESULTS The volume percentages of the caudate lobe and the LLS significantly increased with the fibrosis stage(r = 0.815, P < 0.001; and r = 0.465, P = 0.003, respectively). Contrarily, the volume percentage of the RL significantly decreased with fibrosis stage(r =-0.563, P < 0.001). The volume percentage of the caudate lobe had the best diagnostic accuracy for staging fibrosis, and the area under the ROC curve values for discriminating fibrosis stage were as follows: ≥ F1, 0.896; ≥ F2, 0.929; ≥ F3, 0.955; and ≥ F4, 0.923. The best cut-off for advanced fibrosis(F3-F4) was 4.789%, 85.7% sensitivity and 94.1% specificity.CONCLUSION The volume percentage of the caudate lobe calculated by CT volumetry is a useful diagnostic parameter for staging fibrosis in NAFLD patients.

Hepatic focal nodular hyperplasia in children:Imaging features on multi-slice computed tomography

AIM:To retrospectively analyze the imaging features of hepatic focal nodular hyperplasia(FNH) in children on dynamic contrast-enhanced multi-slice computed tomography(MSCT) and computed tomography angiography(CTA) images.METHODS:From September 1999 to April 2012,a total of 218 cases of hepatic FNH were confirmed by either surgical resection or biopsy in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and the Cancer center of Sun Yat-sen University,including 12 cases(5.5%) of FNH in children(age ≤ 18 years old).All the 12 pediatric patients underwent MSCT.We retrospectively analyzed the imaging features of FNH lesions,including the number,location,size,margin,density of FNH demonstrated on pre-contrast and contrastenhanced computed tomography(CT) scanning,central scar,fibrous septa,pseudocapsule,the morphology of the feeding arteries and the presence of draining vessels(portal vein or hepatic vein).RESULTS:All the 12 pediatric cases of FNH had solitary lesion.The maximum diameter of the lesions was 4.0-12.9 cm,with an average diameter of 5.5 ± 2.5 cm.The majority of the FNH lesions(10/12,83.3%) had well-defined margins.Central scar(10/12,83.3%) and fibrous septa(11/12,91.7%) were commonly found in children with FNH.Central scar was either isodense(n = 7) or hypodense(n = 3) on pre-contrast CT images and showed progressive enhancement in 8 cases in the equilibrium phase.Fibrous septa were linear hypodense areas in the arterial phase and isodense in the portal and equilibrium phases.Pseudocapsule was very rare(1/12,8.3%) in pediatric FNH.With the exception of central scars and fibrous septa within the lesions,all 12 cases of pediatric FNH were homogenously enhanced on the contrast-enhanced CT images,significantly hyperdense in the arterial phase(12/12,100.0%),and isodense in the portal venous phase(7/12,58.3%) and equilibrium phase(11/12,91.7%).Central feeding arteries inside the tumors were observed on CTA images for all 12 cases of FNH,whereas no neovascularization of malignant tumors was noted.In 9 cases(75.0%),there was a spoke-wheel shaped centrifugal blood supply inside the tumors.The draining hepatic vein was detected in 8 cases of pediatric FNH.However,the draining vessels in the other 4 cases could not be detected.No associated hepatic adenoma or hemangioma was observed in the livers of the 12 pediatric cases.CONCLUSION:The characteristic imaging appearances of MSCT and CTA may reflect the pathological and hemodynamic features of pediatric FNH.Dynamic multi-phase MSCT and CTA imaging is an effective method for diagnosing FNH in children.

Radiologic evaluation of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD)is a frequent cause of chronic liver diseases,ranging from simple steatosis to nonalcoholic steatohepatitis(NASH)-related liver cirrhosis.Although liver biopsy is still the gold standard for the diagnosis of NAFLD,especially for the diagnosis of NASH,imaging methods have been increasingly accepted as noninvasive alternatives to liver biopsy.Ultrasonography is a well-established and costeffective imaging technique for the diagnosis of hepatic steatosis,especially for screening a large population at risk of NAFLD.Ultrasonography has a reasonable accuracy in detecting moderate-to-severe hepatic steatosis although it is less accurate for detecting mild hepatic steatosis,operator-dependent,and rather qualitative.Computed tomography is not appropriate for general population assessment of hepatic steatosis given its inaccuracy in detecting mild hepatic steatosis and potential radiation hazard.However,computed tomography may be effective in specific clinical situations,such as evaluation of donor candidates for hepatic transplantation.Magnetic resonance spectroscopy and magnetic resonance imaging are now regarded as the most accurate practical methods of measuring liver fat in clinical practice,especially for longitudinal followup of patients with NAFLD.Ultrasound elastography and magnetic resonance elastography are increasingly used to evaluate the degree of liver fibrosis in patients with NAFLD and to differentiate NASH from simple steatosis.This article will review current imaging methods used to evaluate hepatic steatosis,including the diagnostic accuracy,limitations,and practical applicability of each method.It will also briefly describe the potential role of elastography techniques in the evaluation of patients with NAFLD.

Current status of imaging in nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD) is the most common diffuse liver disease, with a worldwide prevalence of 20% to 46%. NAFLD can be subdivided into simple steatosis and nonalcoholic steatohepatitis. Most cases of simple steatosis are non-progressive, whereas nonalcoholic steatohepatitis may result in chronic liver injury and progressive fibrosis in a significant minority. Effective risk stratification and management of NAFLD requires evaluation of hepatic parenchymal fat, fibrosis, and inflammation. Liver biopsy remains the current gold standard; however, non-invasive imaging methods are rapidly evolving and may replace biopsy in some circumstances. These methods include well-established techniques, such as conventional ultrasonography, computed tomography, and magnetic resonance imaging and newer imaging technologies, such as ultrasound elastography, quantitative ultrasound techniques, magnetic resonance elastography, and magnetic resonancebased fat quantitation techniques. The aim of this article is to review the current status of imaging methods for NAFLD risk stratification and management, including their diagnostic accuracy, limitations, and practical applicability.

Prevalence of nonalcoholic fatty liver disease and its association with age in patients with type 2 diabetes mellitus

BACKGROUND Type 2 diabetes mellitus(T2DM)is a risk factor for nonalcoholic fatty liver disease(NAFLD).AIM To determine the prevalence and clinical correlates of NAFLD in a large cohort of patients with T2DM.METHODS Four hundred thirty-seven participants with T2DM who consulted at Meijo Hospital from April 2019 to September 2020 and underwent computed tomography(CT)were assessed.The mean age was 74±13 years,and 269 were men.Hepatic attenuation minus splenic attenuation(CTL−S)less than 1 Hounsfield unit was considered fatty liver.NAFLD was defined as fatty liver in the absence of significant alcohol consumption and hepatitis virus infection.A multiple logistic regression was used to assess the independent factors associated with NAFLD.RESULTS NAFLD was identified in 25.2%of the participants.Young age(odds ratio[OR]=−0.945;95%confidence interval[CI]:0.922–0.969),higher hemoglobin levels(OR=1.501,95%CI:1.278–1.764),lower high-density lipoprotein(HDL)cholesterol levels(OR=0.971,95%CI:0.953–0.989),and the absence of dialysis(OR=0.109,95%CI:0.014–0.856)were independent predictors of NAFLD.CONCLUSION NAFLD was detected with CT in 25.2%of the participants.NAFLD was associated with younger age,higher hemoglobin levels,lower HDL cholesterol levels,and an absence of dialysis.

Liver involvement in patients with COVID-19 infection:A comprehensive overview of diagnostic imaging features

During the first wave of the pandemic,coronavirus disease 2019(COVID-19)infection has been considered mainly as a pulmonary infection.However,different clinical and radiological manifestations were observed over time,including involvement of abdominal organs.Nowadays,the liver is considered one of the main affected abdominal organs.Hepatic involvement may be caused by either a direct damage by the virus or an indirect damage related to COVID-19 induced thrombosis or to the use of different drugs.After clinical assessment,radiology plays a key role in the evaluation of liver involvement.Ultrasonography(US),computed tomography(CT)and magnetic resonance imaging(MRI)may be used to evaluate liver involvement.US is widely available and it is considered the first-line technique to assess liver involvement in COVID-19 infection,in particular liver steatosis and portal-vein thrombosis.CT and MRI are used as second-and third-line techniques,respectively,considering their higher sensitivity and specificity compared to US for assessment of both parenchyma and vascularization.This review aims to the spectrum of COVID-19 liver involvement and the most common imaging features of COVID-19 liver damage.

基于MR Q-Dixon序列和QCT测量小鼠肝脏脂肪含量的可行性研究

目的探讨定量CT(QCT,quantitative CT)与MR Q-Dixon序列测量小鼠肝脏脂肪含量的可行性研究。方法本研究采用高脂饮食诱导的肥胖(Dietinduced obesity,DIO)的小鼠动物模型,6周龄C57BL/6小鼠30只,随机分成三组,每组10只,第一组给予普通饲料饲养40周,第二组给予高脂饮食20周,第三组给予高脂饮食40周,2名医师利用QCT和MR Q-Dixon序列对小鼠肝脏脂肪含量进行测量,对QCT测得的肝脏脂肪含量(Fat%Q)和MR Q-Dixon序列测得的肝脏脂肪含量(Fat%M)进行一致性检验和相关性分析。结果本实验QCT肝脏脂肪含量测量值为17.6(6.00,28.95)%,MR Q-Dixon序列肝脏脂肪含量测量值为19.6(5.70,29.55)%。两种方法评估脂肪肝严重程度比较,无显著差异(χ^(2)=4.000,P=0.216),且一致性较高(Kappa=0.816,P<0.001);两种方法的测量结果呈正相关(r=0.978,P<0.01)。结论在定量测量小鼠肝脏脂肪含量方面,定量CT与MR Q-Dixon序列具有较好的一致性和相关性,即可在体定量研究小鼠脂肪肝动物实验。

CT影像组学识别非酒精性脂肪性肝炎的应用研究

目的构建并验证基于CT的全肝影像组学模型用于识别非酒精性脂肪性肝炎(non-alcoholic steatohepatitis,NASH)。方法回顾性选取2018年6月至2022年12月浙江省人民医院收治的122例非酒精性脂肪性肝病患者,其中NASH患者52例。将纳入患者按7:3比例随机分为训练组(n=85)和测试组(n=37),选取每例患者的肝脏平扫图像提取影像组学特征,对训练组提取的特征进行降维并建立影像组学标签,之后联合相关临床特征构建联合预测模型用于识别NASH患者,使用受试者操作特征曲线及测试组数据评估模型的诊断效能。结果联合预测模型基于年龄和影像组学标签构建,该模型在训练组和测试组中识别NASH患者的诊断效能分别为0.899和0.880,特异性分别为91.2%和88.1%,敏感度分别为86.7%和88.2%。校准曲线在训练组和测试组中也显示出良好的校准性能。结论基于肝脏CT的影像组学模型可定量评估NASH,有望为临床提供一种无创性评价工具。

Epithelioid angiomyolipoma of the liver:Cross-sectional imaging findings of 10 immunohistochemically-verified cases

AIM： To retrospectively evaluate the computed tomography （CT）/magnetic resonance imaging （MRI） imaging features of epithelioid angiomyolipoma of the liver （Epi-HAML）, with pathology as a reference. METHODS： The CT/MRI findings （number, diameter, lobar location, and appearance of lesions） in a series of 10 patients with 12 pathologically proven epithelioid angiomyolipomas of the liver were retrospectively analyzed. The imaging features, including attenuation/ signal intensity characteristics, presence of fat, hypervascular, outer rim, and vessels within lesion, were evaluated and compared with that of non-Epi- HAML in 11 patients （13 lesions）. The Fisher exact test was used to compare difference in probability of imaging features between the two types. RESULTS： For 21 patients, CT images of 15 patients and MR images of six patients were available. No patient underwent two examinations. For the 15 patients with a CT scan, all HAML lesions in the two groups （10 Epi-HAML and seven non-Epi-HAML） manifested as hypoattenuation. For the six patients with MRI, all lesions （two Epi-HAML and six non-Epi- HAML） were hypointense on TlWI （fat suppression） and hyperintense on T2WI. There were 10 non-Epi-HAML, but only two Epi-HAML lesions showed the presence of fat, which significantly different between the two types （P = 0.005）. On the dynamic contrast enhancement （DCE） imaging, eight Epi-HAML, and 13 non-Epi lesions manifested as hypervascular. Punctate or curved vessels were displayed in 10 Epi-HAML as well as in nine non- Epi lesions and outer rim enhancement could be found with eight Epi-HAML as well as six non-Epi lesions. CONCLUSION： Little or no presence of adipose tissue was found to be an imaging feature of Epi- HAML, compared with the non-Epi type. In addition, hypervascularity with opacification of central punctiform or filiform vessels on DCE would be a characteristic enhancement pattern for Epi-HAML.

Perivascular epithelioid cell tumor of the liver:A report of two cases and review of the literature

Perivascular epithelioid cell tumor (PEComa) is a rare tumor which arises from mesenchymal tissues. It is predominant in the uterus,but very rare in the liver. To the best of our knowledge,less than 5 cases of PEComa of the liver have been reported. Herein we present two pathologically proven cases of PEComa of the liver,retrospectively analyze their clinical and imaging features,and review the literature.

Perfusion CT findings in liver of patients with tumor during chemotherapy

AIM: To investigate the microcirculation changes in liver of patients with tumor during chemotherapy by perfusion computed tomography (CT). METHODS: Sixty patients with tumor and 20 controls were enrolled in this study. Perfusion CT parameters of patients and controls were compared, including hepatic perfusion index (HPI), mean transit time (MTT), and permeability-surface area product (PS). Correlation between perfusion CT parameters, treatment cycle and alanine aminotransferase (ALT) level was studied. RESULTS: No difference was found in HPI (25.68% ± 7.38% vs 26.82% ± 5.13%), MTT (19.67 ± 5.68 s vs21.70 ± 5.43 s) and PS (17.00 ± 4.56 mL/100 mL per min vs 19.92 ± 6.35 mL/100 mL per min) between pa- tients and controls. The HPI and MTT were significantly higher in patients undergoing 2 cycles of chemotherapy than in controls and those undergoing 1 cycle of che- motherapy (29.76% ± 5.87% vs 25.68% ± 7.38% and 25.35% ± 4.05%, and 25.61 ± 5.01 s vs 19.67 ± 5.68 s and 19.74 ± 4.54 s, respectively, P < 0.05). The HPI was higher in patients with hepatic steatosis than in controls and those without hepatic steatosis (30.85% ± 6.17% vs 25.68% ± 7.38% and 25.70% ± 4.24%, P < 0.05). Treatment cycle was well correlated with HPI and MTT (r = 0.40, r = 0.50, P < 0.01). ALT level was not correlated with perfusion CT parameters. CONCLUSION: HPI and MTT are significantly increased in patients with tumor during chemotherapy and well correlated with treatment cycle. Chemotherapy affects hepatic microcirculation in patients with tumor. Changes in hepatic microcirculation can be quantitatively assessed by perfusion CT.

Correlation between Calcified Liver Metastases and Histopathology of Primary Colorectal Carcinoma in Chinese

The study examined the association between calcified liver metastases and the histopathology of the primary colorectal carcinoma in Chinese.The clinical,pathological and CT data were retrospectively analyzed in 210 patients (mean age:54.2 years) with liver metastases from colorectal carcinoma.Plain CT scanning and contrast-enhanced scanning were performed in all the patients.For the contrast-enhanced examination,iohexol was injected by using a high pressure syringe at a flow rate of 2.5-3.0 mL/s.The arterial phase lasted approximately 25 s and the portal venous phase about 60 s.All patients had no history of chronic liver diseases and had never received interventional treatments.χ 2-test was used to analyze the rate of calcification in the liver metastasis from colorectal cancer of different differentiation degrees.Among the 210 cases of liver metastases,22 patients (10.5%) were found to have calcified liver metastases on CT scan.Two patients with calcified liver metastasis received lumpectomy and developed calcification in recurrent tumors.Another two patients had calcification in newly developed tumor masses.And the calcification in the newly developed masses was similar to that of their primary counterparts in terms of morphology and distribution.On the enhanced CT scan,the tumors exhibited no enhancement during hepatic arterial phase and showed slight rim enhancement during portal venous scan in the 22 cases.The calcification became obscure on contrast-enhanced scans.Histopathologically,the primary tumors were well-differentiated adenocarcinoma in 6 cases,moderately-differentiated adenocarcinoma in 10,poorly-differentiated adenocarcinoma in 4 and mucinous adenocarcinoma in 2 among the 22 cases.No statistical correlation was noted between the incidence of calcified liver metastasis and the pathological subtypes and differentiation degrees of the primary colorectal carcinoma.It was concluded that calcified liver metastases may result from colorectal adenocarcinomata of different differentiation degrees or mucinous adenocarcinomata in Chinese population.There is no correlation between calcification of liver metastases and the pathological subtype of the primary colorectal carcinoma in Chinese,which is different from the findings that calcified metastases were associated with colorectal mucinous adenocarcinoma in other ethnic groups.

A case of leptospirosis simulating colon cancer with liver metastases

We report a case of a 61-year-old man who presented with fatigue,abdominal pain and hepatomegaly.Computed tomography (CT) of the abdomen showed hepatomegaly and multiple hepatic lesions highly suggestive of metastatic diseases.Due to the endoscopic finding of colon ulcer,colon cancer with liver metastases was suspected.Biochemically a slight increase of transaminases,alkaline phosphatase and gammaglutamyl transpeptidase were present;α- fetoprotein,carcinoembryogenic antigen and carbohydrate 19-9 antigen serum levels were normal.Laboratory and instrumental investigations,including colon and liver biopsies revealed no signs of malignancy.In the light of spontaneous improvement of symptoms and CT findings,his personal history was revaluated revealing direct contact with pigs and their tissues.Diagnosis of leptospirosis was considered and confirmed by detection of an elevated titer of antibodies to leptospira.After two mo,biochemical data,CT and colonoscopy were totally normal.

Multislice spiral CT angiography in evaluation of liver transplantation candidates

BACKGROUND: Orthotopic liver transplantation has be- come the treatment of choice for patients with end-stage liver disease. This study was designed to study whether multislice spiral CT angiography (MSCTA) could be used for preoperative evaluation for orthotopic liver transplanta- tion candidates. METHODS: Eighty consecutive potential candidates for liver transplantation were evaluated with dual-phase three-di- mensional CT angiography (3DCTA). The arterial-phase was used to create vascular maps of the celiac axis (inclu- ding the origin of the hepatic common artery, left gastric artery and splenic artery) and origin of the superior mesen- teric artery. The portal venous-phase was used to analyze portal vein thrombosis and collateral vascularization of the portal vein. Statistical analyses were made using the chi- square test for differences between hepatic arterial anatomy of 80 patients and Michel's anatomy of 200 patients. Appearance of MSCTA and operative results of 16 patients were analyzed. RESULTS; Sixty-two patients (77.5%) showed conven- tional and 18 (22.5%) nonconventional hepatic arterial anatomy. A significant difference was found between the two groups in anatomy of the hepatic artery (P <0.05). Celiac axis stenosis was observed in 6 patients, SA aneu- rysm in 2, small-caliber hepatic arterial vessels in 2, and portal vein thrombosis in 15. Vascular structures of 16 ope- rative patients were well defined. CONCLUSION: As a noninvasive examination, MSCTA can provide a comprehensive preoperative vascular evalua- tion for liver transplantation candidates.

Functional transition:Inconsistently parallel to the increase in future liver remnant volume after preoperative portal vein embolization

BACKGROUND Preoperative portal vein embolization(PVE)is a widely used strategy to enable major hepatectomy in patients with insufficient liver remnant.PVE induces hypertrophy of the future liver remnant(FLR)and a shift of the functional reserve to the FLR.However,whether the increase of the FLR volume(FLRV)corresponds to the functional transition after PVE remains unclear.AIM To investigate the sequential relationship between the increase in FLRV and functional transition after preoperative PVE using 3-dimensional(3D)computed tomography(CT)and 99mTc-galactosyl-human serum albumin(99mTc-GSA)singlephoton emission computed tomography(SPECT)fusion images.METHODS Thirty-three patients who underwent major hepatectomy following PVE at the Department of Gastroenterological Surgery I,Hokkaido University Hospital between October 2013 and March 2018 were enrolled.Three-phase dynamic multidetector CT and 99mTc-GSA SPECT scintigraphy were performed at pre-PVE,and at 1 and 2 wk after PVE;3D 99mTc-GSA SPECT CT-fused images were constructed from the Digital Imaging and Communications in Medicine data using 3D image analysis system.Functional FLRV(FFLRV)was defined as the total liver volume×(FLR volume counts/total liver volume counts)on the 3D 99m Tc-GSA SPECT CT-fused images.The calculated FFLRV was compared with FLRV.RESULTS FFLRV increased by a significantly larger extent than FLRV at 1 and 2 wk after PVE(P<0.01).The increase in FFLRV and FLRV was 55.1%±41.6%and 26.7%±17.8%(P<0.001),respectively,at 1 wk after PVE,and 64.2%±33.3%and 36.8%±18.9%(P<0.001),respectively,at 2 wk after PVE.In 3 of the 33 patients,FFLRV levels decreased below FLRV at 2 wk.One of the three patients showed rapidly progressive fatty changes in FLR.The biopsy at 4 wk after PVE showed macroand micro-vesicular steatosis of more than 40%,which improved to 10%.Radical resection was performed at 13 wk after PVE.The patient recovered uneventfully without any symptoms of pos-toperative liver failure.CONCLUSION The functional transition lagged behind the increase in FLRV after PVE in some cases.Evaluating both volume and function is needed to determine the optimal timing of hepatectomy after PVE.

能谱CT虚拟平扫技术在化疗相关性脂肪肝中的应用

目的探讨能谱CT虚拟平扫(VNC)技术在诊断化疗相关性脂肪肝(CRFLD)中替代真实平扫(TNC)的可行性。资料与方法回顾性收集2020年6月—2021年6月于兰州大学第二医院行能谱CT、MRI及超声检查的155例患者,根据化疗后MRI及超声检查结果分为CRFLD组131例和非CRFLD组24例。基于能谱CT多物质分解算法获得三期VNC图像,于TNC与三期VNC图像上分别测量肝脏和脾脏CT值及肝/脾CT值比(LSR),比较不同成像类型之间LSR对CRFLD的诊断效能。结果CRFLD组在TNC和三期VNC图像上测量的肝脏平均CT值[53.90(49.48,56.75)~55.50(49.50,61.25)Hu]和LSR[(0.91±0.14)~1.00(0.90,1.03)]均明显低于无CRFLD组[61.80(58.40,66.65)~65.00(59.00,73.00)Hu,1.12(1.05,1.20)~(1.16±0.19);Z/t=6.102~7.921,均P<0.001]。肝脏和脾脏平均CT值在三期VNC图像上均显著低于TNC图像[(61.90±8.46)~(62.98±7.92)Hu比(64.32±9.68)Hu,55.00(52.70,58.70)~56.00(53.60,60.45)Hu比58.00(52.00,64.00)Hu;Z/t=2.616~7.606,均P<0.05]。LSR在TNC和三期VNC图像之间具有良好的一致性[1.10(1.02,1.19)~1.11(1.03,1.18)比1.10(0.97,1.24);Z/t=0.362~0.183,均P>0.05]。在TNC和VNC三期图像上用于诊断CRFLD的LSR曲线下面积均>0.80。应用VNC后,辐射剂量减少约24.10%。结论在三期VNC图像上测量的LSR与TNC图像上测量的LSR具有良好的一致性,可成为临床诊断CRFLD的可靠替代。

影像学检查方法在非酒精性脂肪性肝病定量分析中的应用

目的:就超声、电子计算机断层扫描与磁共振成像在非酒精性脂肪性肝病定量分析中的应用进行概述。方法:检索中国知网、中华医学期刊全文数据库和PubMed数据库中,超声、电子计算机断层扫描与磁共振成像及其相关新技术在非酒精性脂肪性肝病定量分析中的应用和最新进展。结果:超声被较多应用于非酒精性脂肪性肝病的分级、病变范围初步评估和随诊观察;电子计算机断层扫描被广泛应用于非酒精性脂肪性肝病的定性、分级及半定量分析;磁共振成像是临床上最具价值的无创性影像学非酒精性脂肪性肝病定量分析方法。结论:超声、电子计算机断层扫描与磁共振成像均能对非酒精性脂肪性肝病的诊断、定级及定量分析起到积极作用,而以三种无创性影像学技术为基础发展的新技术将对未来非酒精性脂肪性肝病的定量分析起到至关重要的作用,并具有极大的应用价值和良好的医学前景。

能量CT定量检查对新西兰兔脂肪肝的诊断价值分析

目的探讨能量CT定量检查对新西兰兔脂肪肝的诊断价值。方法选择39只新西兰兔中的30只作为实验组,9只作为对照组。实验组新西兰兔给予高脂饲料喂养,对照组给予普通饲料喂养。使用双源双能量128层CT对新西兰兔进行单能量及双能量扫描,实验组与对照组分别在喂养12、16、20周时分别取两组新西兰兔检测血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、甘油三酯、总胆固醇水平,完成抽血及CT扫描后进行HE染色病理检查。分析实验动物的脂肪肝成模结果、病理检查结果、肝脏脂肪含量及血清ALT、甘油三酯、AST、总胆固醇水平,对比不同程度脂肪肝在单能量、双能量CT扫描下不同管电压扫描下的CT值,分析单能量、双能量CT扫描下CT值与脂肪含量及血清ALT、AST、甘油三酯、总胆固醇的相关性。结果30只实验新西兰兔中,25只成模并顺利完成,成模率为83.33%,9只对照组均存活。病理检查结果,正常9只,轻度8只,中度8只,重度9只。轻度、中度、重度脂肪肝组的肝脏脂肪含量、血清ALT、AST、甘油三酯、总胆固醇水平明显较正常组高,中度、重度脂肪肝组明显较轻度脂肪肝组高,重度脂肪肝组明显较中度脂肪肝组高,差异均有统计学意义(P<0.05)。单能量CT扫描下,80、100、120、140 kV时,轻度、中度、重度脂肪肝组的CT值明显较正常组低,中度、重度脂肪肝组明显较轻度脂肪肝组低,重度脂肪肝组明显较中度脂肪肝组低,差异均有统计学意义(P<0.05)。双能量CT扫描下,40、60、80、100、120、140 kV时,轻度、中度、重度脂肪肝组的CT值明显较正常组低,中度、重度脂肪肝组明显较轻度脂肪肝组低,重度脂肪肝组明显较中度脂肪肝组低,差异均有统计学意义(P<0.05)。单能量CT扫描下,80、100、120、140 kV时的CT值与脂肪含量、血清ALT、AST、甘油三酯、总胆固醇均呈负相关(P<0.05)。双能量CT扫描下,40、60、80、100、120、140 kV时的CT值与脂肪含量、血清ALT、AST、甘油三酯、总胆固醇均呈负相关(P<0.05)。结论能量CT定量检查对新西兰兔脂肪肝的诊断效果较好,单能量CT扫描下100 kV CT值与脂肪含量及血清ALT、AST、甘油三酯、总胆固醇相关性最好。

TG/HDL-C比值与revolution CT肝脏脂肪含量测定的相关性

目的探讨TG/HDL-C比值与revolution CT肝脏脂肪含量测定的相关性。方法选取非酒精性脂肪肝(NAFLD)患者108例为NAFLD组,按TG/HDL-C比值将NAFLD组分为低分位组(<1)、中分位组(1-1.5)及高分位组(>1.5);另选取非NAFLD的健康者80例为对照组,均行Revolution CT能谱成像检查,分析TG/HDL-C比值与CT指标的相关性,对NAFLD相关影响因素进行分析,并分析各指标对NAFLD的诊断效能。结果合并基础疾病(糖尿病、高脂血症)占比、BMI、TC指标,高分位组、中分位组>低分位组、对照组(P<0.05);LDL-C指标:高分位组>中分位组、低分组位>对照组(P<0.05);TG指标:高分位组>中分位组>低分位组、对照组(P<0.05);HDL-C、70Kev CT值、CT能谱曲线:高分位组<中分位组<低分位组<对照组(P<0.05);肝脏脂肪含量(FF):高分位组>中分位组>低分位组>对照组(P<0.05);相关分析显示,TG/HDL-C比值与FF、能谱曲线斜率呈正相关(r=0.735、0.467,均P<0.001),与70Kev CT值呈负相关(r=—0.687、r=-0.664,均P<0.01)。logistic回归分析显示,TG/HDL-C(OR=3.159)、FF(OR=3.832)是NAFLD的独立危险因素(P<0.05);ROC分析显示,TG/HDL-C、FF诊断NAFLD的AUC值为0.844、0.953,截断值为2.17、5.109%(P<0.05)。结论TG/HDL-C比值与revolution CT指标密切相关,TG/HDL-C比值、FF作为评估NAFLD的参考指标具有较佳效能。

能谱CT脂肪浓度、肝脾CT比值与MRQD脂肪含量在非酒精性脂肪肝定量中的相关性研究

目的探讨能谱电子计算机断层扫描(CT)脂肪浓度、肝脾CT比值与磁共振Q-dixon(MRQD)脂肪含量(FF)在非酒精性脂肪肝定量中的相关性。方法回顾性选取2019年12月至2021年4月于我院1周内行肝脏MRQD和能谱CT检查的80例疑似非酒精性脂肪肝患者为研究对象,根据MRQD检查结果,将研究对象分为健康组20例(FF<5%),非酒精性脂肪肝组60例[轻度组(n=26,FF=5%~10%)、中度组(n=20,FF=11%~25%)、重度组(n=14,FF>25%)]。分析2位观察者关于能谱CT脂肪浓度检测的一致性,MRQD FF与能谱CT脂肪浓度、肝脾CT比值的相关性。结果同一观察者3次能谱CT脂肪浓度测量可重复性高[组内相关系数(ICC)>0.900],肝脾CT比值测量可重复性高(ICC>0.900);观察者同一测量次数一致性高,能谱CT脂肪浓度ICC为0.896~0.957、肝脾CT比值ICC为0.780~0.840。四组的能谱CT脂肪浓度比较,差异具有统计学意义(P<0.05),脂肪浓度越大,MRQD FF越高;中度组、重度组的肝脾CT比值低于健康组及轻度组,重度组的肝脾CT比值低于中度组(P<0.05),肝脾CT比值越小,MRQD FF越高。能谱CT脂肪浓度和MRQD FF呈正相关(r=0.959,P<0.001),肝脾CT比值和MRQD FF呈负相关(r=-0.848,P<0.001);r绝对值显示能谱CT脂肪浓度与MRQD FF的相关性优于肝脾CT比值。结论能谱CT测量的疑似非酒精性脂肪肝患者脂肪浓度与MRQD FF的相关性优于肝脾CT比值。