剪切波速对比磁共振弥散成像评价慢性乙型肝炎肝纤维化程度

doi:10.3969/j.issn.1006-7795.2016.04.010

首都医科大学学报 ›› 2016, Vol. 37 ›› Issue (4): 465-471.doi: 10.3969/j.issn.1006-7795.2016.04.010

• 感染与炎性反应放射学 • 上一篇下一篇

剪切波速对比磁共振弥散成像评价慢性乙型肝炎肝纤维化程度

董常峰¹, 曾政², 刘映霞³, 李汉英¹, 陈昕⁴, 骆永芳¹, 单灵波¹, 黄华², 陆普选²

1. 深圳市第三人民医院超声科, 广东深圳 518112;
2. 深圳市第三人民医院放射科, 广东深圳 518112;
3. 深圳市第三人民医院感染科, 广东深圳 518112;
4. 深圳大学生物医学工程学院, 广东深圳 518112

收稿日期:2016-06-03 出版日期:2016-08-21 发布日期:2016-07-18
通讯作者: 陆普选 E-mail:lupuxuan@126.com
基金资助:
国家自然科学基金（61031003，81471735，81570552）。

Comparative study of shear wave velocity and diffusion MRI for hepatic fibrosis in patients with chronic hepatitis B.

Dong Changfeng¹, Zeng Zheng², Liu Yingxia³, Li Hanying¹, Chen Xin⁴, Luo Yongfang¹, Shan Lingbo¹, Huang Hua², Lu Puxuan²

1. Department of Ultrasound, The Third People's Hospital of Shenzhen, Shenzhen 518112, Guangdong Province, China;
2. Department of Radiology, The Third People's Hospital of Shenzhen, Shenzhen 518112, Guangdong Province, China;
3. Department of Infection, The Third People's Hospital of Shenzhen, Shenzhen 518112, Guangdong Province, China;
4. School of Biomedical Engineering, Shenzhen University, Shenzhen 518112, Guangdong Province, China

Received:2016-06-03 Online:2016-08-21 Published:2016-07-18
Supported by:
This study was supported by National Natural Science Foundation of China(61031003,81471735,81570552).

摘要/Abstract

摘要： 目的对比研究剪切波速与磁共振体素内不连贯运动弥散成像技术对慢性乙型肝炎（以下简称慢乙肝）肝纤维化程度进行无创性分期的价值。方法入选223例经病理证实肝纤维化程度的慢乙肝患者，将其分为轻微肝纤维化（F1）组、肝纤维化（F2）组、严重肝纤维化（F3）组、肝硬化（F4）组。80例健康体检者组成对照（F0）组，测量所有入选者肝右叶各段剪切波速及其均值。应用磁共振弥散成像技术获得其中不同病理分期的39例肝纤维化患者及19例健康体检者的弥散值（D）、弥漫分数（f）及灌注相关弥散值（D^*）。结果 5组间剪切波速结果两两比较，除对照组与F1组间s5肝段剪切波速差异无统计学意义（P>0.05），其余肝段剪切波速及其均值差异均有统计学意义（P<0.05），且随着肝纤维化程度的加重，剪切波速逐级递增。剪切波速诊断≥F1、≥F2、≥F3及F4的临界值分别为1.22 m/s、1.30 m/s、 1.45 m/s 及1.60 m/s，在非严重型肝纤维化（F1、F2）诊断方面，剪切波速有较高的敏感度，分别达到92.82%、90.12%，而对于严重的肝纤维化及肝硬化（F3、F4），剪切波速则具有极佳的特异度，分别达到92.27%、95.93%，其诊断各期（≥F1、≥F2、≥F3、F4）肝纤维化的受试者工作特征曲线下面积（area under the receiver operating characteristic curve，AUROC）分别达到0.887、0.920、0.952、0.954。磁共振弥散成像方面，与对照组比较，肝纤维化患者的D、f、D^* 均显著减低（P<0.05），且随着肝纤维化程度的加重，f值和D^*值持续减低，差异有统计学意义（P<0.05）。f值和D^*值具有区分肝纤维化F2期与F1期的能力，最佳诊断分界点分别是0.135、9.928×10^-3mm²/s。结论对比剪切波速可细分F2以上级慢乙肝肝纤维化程度，磁共振体素内不连贯运动弥散成像则能将F1期与其他期肝纤维化精确区分，二者联合应用值得临床推广。

关键词: 剪切波速, 磁共振体素内不连贯运动弥散成像, 肝脏纤维化, 无创性诊断

Abstract: Objective To compare the value of shear wave velocity (SWV) and intravoxel incoherent motion diffusion MRI (IVIM) in evaluating the stage of hepatic fibrosis in patients with chronic Hepatitis B. Methods Totally 223 patients with HBV infection who underwent liver biopsy were selected into this research, they were divided into four groups:mild hepatic fibrosis (F1), obvious hepatic fibrosis (F2), serious hepatic fibrosis (F3), cirrhosis (F4). Eighty normal subjects were chosen as control group. The SWV of all hepatic segments s5, s6, s7, s8 and their average value were measured; 39 patients of different degrees hepatic fibrosis and 19 normal subjects accepted IVIM, the diffusion parameters (D, f, D^*) were measured. Results Among these 5 groups, the SWV of all hepatic segments had significant difference (P<0.05) except for the segment s5 between control and F1 group (P>0.05), with the development of hepatic fibrosis, SWV increase gradually. The cut-off value of ≥ F1, ≥ F2, ≥ F3 and F4 was separately 1.22 m/s, 1.30 m/s, 1.45 m/s and 1.60m/s, SWV had fine sensitivity of 92.82% and 90.12% for liver fibrosis F1 and F2, as it comes to F3 and F4, SWV get fantastic specificity of 92.27% and 95.93%. The diagnostic accuracy of SWV expressed as area under receiver operating characteristic curve (AUROC) was 0.887, 0.920, 0.952 and 0.954 for the diagnosis of hepatic fibrosis ≥ F1, ≥ F2, ≥ F3 and F4. The mean D, f and D^* values of IVIM measured in patients with hepatic fibrosis were obviously smaller than healthy subjects. As the fibrosis severity progressed, f and D^* values decreased, a trend towards lower f and D^* with the increase of fibrosis stages was statistically significant (P<0.05). f and D^* values had the ability to distinguish different fibrosis stages of F2 between F1, the best cut-off points were 0.135, 9.928×10^-3 mm²/s, respectively. Conclusion SWV could accurately evaluate the stage of obvious hepatic fibrosis in patients suffering from chronic hepatitis B; IVIM could distinguish mild liver fibrosis from obvious hepatic fibrosis, the combination of them were suitable for clinical use.

Key words: shear wave velocity, intravoxel incoherent motion diffusion MRI, hepatic fibrosis, noninvasive diagnosis

中图分类号:

董常峰, 曾政, 刘映霞, 李汉英, 陈昕, 骆永芳, 单灵波, 黄华, 陆普选. 剪切波速对比磁共振弥散成像评价慢性乙型肝炎肝纤维化程度[J]. 首都医科大学学报, 2016, 37(4): 465-471.

Dong Changfeng, Zeng Zheng, Liu Yingxia, Li Hanying, Chen Xin, Luo Yongfang, Shan Lingbo, Huang Hua, Lu Puxuan. Comparative study of shear wave velocity and diffusion MRI for hepatic fibrosis in patients with chronic hepatitis B.[J]. Journal of Capital Medical University, 2016, 37(4): 465-471.

参考文献

[1] 梁扩寰,李绍白. 肝脏病学[M]. 2版. 北京:人民卫生出版社,2003: 796.
[2] Kaminuma C, Tsushima Y, Matsumoto N, et al. Reliable measurement procedure of virtual touch tissue quantification with acoustic radiation force impulse imaging[J]. J Ultrasound Med, 2011, 30(6):745-751.
[3] Gallotti A, D’Onofrio M, Pozzi Mucelli R. Acoustic Radiation Force Impulse (ARFI) technique in ultrasound with Virtual Touch tissue quantification of the upper abdomen[J]. Radiol Med, 2010, 115(6):889-897.
[4] Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups[J]. Lancet,1997, 349(9055): 825-832.
[5] Myers R P, Tainturier M H, Ratziu V, et al. Prediction of liver histological lesions with biochemical markers in patients with chronic hepatitis B. Prediction of liver histological lesions with biochemical markers in patients with chronic hepatitis B[J]. J Hepatol,2003, 39(2): 222-230.
[6] Poynard T, Zoulim F, Ratziu V, et al. Longitudinal assessment of histology surrogate markers (FibroTest-ActiTest) during lamivudine therapy in patients with chronic hepatitis B infection[J]. Am J Gastroenterol, 2005, 100(9): 1970-1980.
[7] Chen X, Shen Y, Zheng Y, et al. Quantification of liver viscoelasticity with acoustic radiation force: a study of hepatic fibrosis in a rat model[J]. Ultrasound Med Biol, 2013, 39(11): 2091-2102.
[8] Liu Y X, Dong C F, Yang G L, et al. Optimal linear combination of ARFI, transient elastography, and APRI for the assessment of fibrosis in chronic hepatitis B[J]. Liver Int, 2015,35(3):816-825.
[9] Le Bihan D. Intravoxel incoherent motion perfusion MR imaging: a wake-up call[J]. Radiology, 2008, 249(3):748-752.
[10] Zhu Y, Dong C F, Yin Y, et al. The role of viscosity estimation for oil-in-gelatin phantom in shear wave based ultrasound elastography[J]. Ultrasound Med Boil, 2015, 41(2):601-609.
[11] 董常峰, 刘映霞, 杨桂林,等. 声辐射力脉冲成像技术评价肝脏纤维化及早期肝硬化的初步研究[J]. 中华实验和临床病毒学杂志,2012,26(2):145-147.
[12] Huwart L, Sempoux C, Vicaut E, et al. Magnetic resonance elastography for the noninvasive staging of liver fibrosis[J]. Gastroenterology,2008, 135(1): 32-40.
[13] Poynard T, Munteanu M, Imbert-Bismut F,et al. Prospective analysis of discordant results between biochemical markers and biopsy in patients with chronic hepatitis C[J]. Clin Chem,2004, 50(8): 1344-1355.
[14] Poynard T, Halfon P, Castera L, et al. Variability of the area under the receiver operating characteristic curves in the diagnostic evaluation of liver fibrosis markers: impact of biopsy length and fragmentation[J]. Aliment Pharmacol Ther,2007, 25(6): 733-739.
[15] Poynard T, Halfon P, Castera L, et al. Standardization of ROC curve areas for diagnostic evaluation of liver fibrosis markers based on prevalences of fibrosis stages[J]. Clin Chem, 2007, 53(9): 1615-1622.
[16] 马春,张树华,马琳,等. 背向散射积分技术在肝纤维化及早期肝硬化诊断中的应用价值[J]. 中国煤炭工业医学杂志,2015,18(6):962-965.
[17] 吴永胜,赵夏夏,苗英,等. 实时组织弹性成像技术在评价脂肪肝肝纤维化程度中的应用价值[J]. 解放军医药杂志,2014,26(1):89-91,94.
[18] 王丽旻,张鸿飞,董漪,等. 先天性肝纤维化47例临床特点及误诊分析[J]. 临床误诊误治,2013,26(7):15-16.
[19] Lu P X, Huang H, Yuan J, et al. Decreases in molecular diffusion, perfusion fraction and perfusion-related diffusion in fibrotic livers: a prospective clinical intravoxel incoherent motion MR imaging study[J]. PLoS One, 2014, 9(12):e113846.
[20] Guiu B, Petit J M, Capitan V, et al. Intravoxel incoherent motion diffusion-weighted imaging in nonalcoholic fatty liver disease: a 3.0-T MR study[J]. Radiology, 2012, 265(1):96-103.
[21] Yoon J H, Lee J M, Baek J H, et al. Evaluation of hepatic fibrosis using intravoxel incoherent motion in diffusion-weighted liver MRI[J]. J Comput Assist Tomogr, 2014, 38(1):110-116

剪切波速对比磁共振弥散成像评价慢性乙型肝炎肝纤维化程度

Comparative study of shear wave velocity and diffusion MRI for hepatic fibrosis in patients with chronic hepatitis B.

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