3.0t磁共振定量評估hbv相關(guān)慢加急性肝衰竭

1、1 3.0T 磁共振定量評估 HBV 相關(guān)慢加急性肝衰竭 摘 要 目的： 探討肝臟磁共振成像對慢性乙型病毒性肝炎所致慢加急性肝衰竭的評估價值。方法：收集我院2015年1月至2016年1月符合標準的病例39例，包括慢加急性肝衰竭患者28例、慢性肝炎患者11例，同時收集正常對照組14例。分別對其進行3.0T肝臟磁共振檢查， 檢查序列包括Dual FFE、 TSE/T2WI/SPAIR、 THRIVE、 DWI、m-GRASE和VEN-

2、BOLD序列， 并分別計算出相應(yīng)的影像指標 （rSI、 rSII、 SIIT2WI、SIITHRIVE、ADC值、T2值或R2值、SIISWI）。同時收集病例組磁共振檢查前后2天內(nèi)血液生化指標。 采用單因素方差分析或非參數(shù)秩和檢驗分析三組間各影像指標的組間差異，采用Spearman秩相關(guān)分析各影像指標與三組肝功能等級的相關(guān)性，采用接受者工作特性（ROC）曲線評價部分影像指標對慢加急性肝衰竭的診斷效能。結(jié)果：三組間rSI、SIIT2WI、

3、ADC值、T2/R2值及SIISWI的差異有統(tǒng)計學(xué)意義。rSI、SIIT2WI及T2值隨著肝功能損害的加重而升高，其秩相關(guān)系數(shù)分別為0.410、0.370和0.637，ADC值、R2及SIISWI隨著肝功能損害的加重而降低，其秩相關(guān)系數(shù)分別為-0.505、-0.637和-0.455，余rSII及SIITHRIVE與三組肝功能等級無相關(guān)性。兩兩比較顯示： R2值及ADC值能同時區(qū)別正常對照組與慢加急性肝衰竭組及肝炎組與慢加急性肝衰竭組；r

4、SI、SIIT2WI及SIISWI僅能區(qū)別正常對照組與慢加急性肝衰竭組。ROC曲線示T2診斷慢加急性肝衰竭曲線下面積= 0.863，P =0.000，最佳診斷界點 57.73ms（R2 =0.0173）。ADC值診斷慢加急性肝衰竭曲線下面積=0.794，P =0.001，最佳診斷界點ADC=1.1261× 10-3mm2/s，但該診斷截值與慢性肝炎組ADC值平均值明顯重疊。刪除慢性肝炎組后ROC曲線顯示，rSI、SIIT2WI

5、及SIISWI診斷慢加急性肝衰竭的曲線下面積分別為0.799、0.737、0.798，P值分別為0.002、3 The Quantitatively Evaluating of HBV-related Acute-on-chronic Liver Failure with 3.0T MRI Abstract Objective: To investigate the value of MRI for evaluation of chro

6、nic HBV-related acute-on-chronic liver failure. Method: A total of 39 patients who satisfied the inclusion criteria were enrolled in our study between January, 2015 and January, 2016 in our hospital. This study consisted

7、 of 28 patients with acute-on-chronic liver failure, 11 patients with chronic hepatitis (case groups) and 14 healthy volunteers as a control group. Both the case groups and control group undergone a 3.0T MRI scan of uppe

8、r abdomen and the MRI scan sequences included Dual FFE, TSE/T2WI/SPAIR, THRIVE, DWI, m-GRASE and VEN-BOLD. The corresponding imaging indexes including rSI, rSII, SIIT2WI, SIITHRIVE, ADC value, T2 relaxation time or R2 va

9、lue, and SIISWI were calculated respectively. Simultaneously, blood biochemical indexes from case groups were collected in 2 days pre- or post-scan was calculated. The differences of imaging index among 3 groups were com

10、pared using an One-way ANOVA analysis or nonparametric test. The correlation were analysed using Spearman rank correlation analysis among imaging index and liver function staging.Receiving-operator characteristics(ROC) c

11、urve analysis was performed to assess the diagnostic efficiency of some imaging indexes for diagnosing acute-on-chronic liver failure. Results: rSI, SIIT2WI,ADC, T2/R2 and SIISWI value had statistical differences among t

12、he three groups. In our study, the patients with poorer liver function demonstrated statistically significant higher rSI, SIIT2WI and T2 values. The corresponding spearman rank correlation coefficient was 0.410(P=0.003),