磁共振IDEAL-IQ成像技术在乙型病毒性肝炎肝纤维化和 早期肝硬化诊断中的应用价值

doi:10.19871/j.cnki.xfcrbzz.2021.04.005

摘要/Abstract

摘要： 目的探究磁共振IDEAL-IQ成像技术在乙型病毒性肝炎肝纤维化和早期肝硬化诊断中的应用价值,探索一种新的、简单的影像方法评估肝纤维化和早期肝硬化。方法选取深圳市第三人民医院2019年10月至2021年5月行肝穿刺组织学检查确诊为乙型病毒性肝炎肝纤维化患者229例,根据慢性肝炎分级分期标准分为四组：S1（105例）、S2（51例）、S3（41例）、S4（32例）,分别采集四组患者的影像学资料（IDAEL-IQ R2*弛豫率值、超声弹性成像STE值）和实验室检查资料（血清学检查：透明质酸、Ⅲ前胶原、Ⅳ胶原、层粘连蛋白）。对四组患者的影像学和实验室计量资料进行对比;对IDAEL-IQ R2*值与超声弹性成像STE值、血清学指标进行相关性分析;采用ROC曲线评价IDAEL-IQ R2*值的诊断效能。结果 ①S4组的R2*值与其他三组（S1、S2、S3）对比差异均有统计学意义（P=0.001,P<0.001,P=0.041）,而S1、S2、S3组的R2*值两两组间对比差异无统计学意义（P=1.000,P=1.000,P=0.720）。②R2*值与超声STE值、透明质酸呈正相关,（r=0.203,P=0.004;r=0.245,P<0.001）。③R2*值诊断早期肝硬化的ROC曲线下面积为0.747,敏感性和特异性分别为0.818、0.619,诊断界值为51.05sec^-1。结论 R2*值在乙型病毒性肝炎患者肝硬化早期（S4）和肝纤维化进展期（S1、S2、S3）中存在明显的差异性,可以作为诊断乙型病毒性肝炎患者早期肝硬化和肝纤维化的一种新技术。

关键词: 早期肝硬化, 肝纤维化, 磁共振成像

Abstract: Objective To investigate the application value of MRI IDEAL-IQ imaging technology in the diagnosis of hepatic fibrosis and early cirrhosis of hepatitis B virus and to explore a new and simple imaging method to evaluate hepatic fibrosis and early cirrhosis. Methods A total of 229 patients with hepatitis B and liver fibrosis diagnosed with hepatic puncture and histology from Shenzhen Third People's Hospital from October 2019 to May 2021 were selected and divided into four groups according to the classification and staging criteria of chronic hepatitis: S1 stage (105 cases), S2 stage (51 cases), S3 stage (41 cases), S4 stage (32 cases), the imaging data of four groups of patients (IDAEL-IQ R2* relaxation rate value, ultrasound elastography STE Value) and laboratory examination data (serological examination: hyaluronic acid, procollagen Ⅲ, collagen Ⅳ, laminin). Compare the imaging and laboratory measurement data of the four groups of patients; analyze the correlation between IDAEL-IQ R2* value and ultrasound elastography STE value and serological indicators; use ROC curve to evaluate the diagnostic efficacy of IDAEL-IQ R2* value . Results ①The R2* value of the S4 group was significantly different from the other three groups (S1, S2, S3) (P=0.001, P<0.001, P=0.041), while the S1, S2, and S3 groups There was no statistically significant difference in R2* value between the two groups (P=1.000, P=1.000, P=0.720). ②The R2* value was significantly positively correlated with the ultrasound STE value and hyaluronic acid (r=0.203, P=0.004; r=0.245, P<0.001). ③The area under the ROC curve for the diagnosis of early liver cirrhosis by R2* value is 0.747, the sensitivity and specificity are 0.818 and 0.619, respectively, and the diagnostic cut-off value is 51.05sec-1. Conclusion There were statisticallysignificant difference between the R2* value in the early stage of liver cirrhosis (S4) and the advanced stage of liver fibrosis (S1, S2, S3) in patients with hepatitis B, and can be used as a new technique for the diagnosis of early liver cirrhosis and liver fibrosis in patients with viral hepatitis B.

Key words: Brain parenchymal tuberculoma, Magnetic resonance imaging, Enhancement

罗杰棋, 沈菁, 郭昂, 郑广平, 李好东, 王立非, 云永兴. 磁共振IDEAL-IQ成像技术在乙型病毒性肝炎肝纤维化和早期肝硬化诊断中的应用价值[J]. 新发传染病电子杂志, 2021, 6(4): 289-293.

Luo Jieqi, Shen Jing, Guo Ang, Zheng Guangping, Li Haodong, Wang Lifei Yun Yongxing. Evaluation of IDEAL-IQ imaging in the diagnosis of hepatic fibrosis and early stage of liver cirrhosis associated with hepatitis B virus infection[J]. Electronic Journal of Emerging Infectious Diseases, 2021, 6(4): 289-293.

参考文献

[1] 蓝云翠,刘曦,丁立,等.611例CHB患者的临床指标与肝脏组织学关系研究[J/CD].新发传染病电子杂志,2017,2(2):72-75.
[2] 王国光,孟令平,胡明秀,等.磁共振灌注成像在鼠肝纤维化、肝硬化病理分级中的价值[J].放射学实践,2017,32(11):1117-1121.
[3] 张宝腾,郑悠,黎金葵,等.基于表观扩散系数图的影像组学模型评价肝纤维化分期的价值[J].中国医学影像学杂志,2021,29(4):362-366,371.
[4] 王泰龄,刘霞,高琳,等.对慢性肝炎分类、分级分期的探讨[J].肝脏病杂志,1995,3(3):130-133.
[5] 中华肝脏病学会肝纤维化学组.肝纤维化诊断和治疗共识(精简版,2019年)[J].中华消化杂志,2019,12:800-805.
[6] 张飞宇,阿迪拉•亚克普,赵金明,等.铁死亡的发生机制及在肝脏疾病中的作用[J].临床肝胆病杂志,2021,37(6):1454-1458.
[7] 沙治林,宋少华,丁国善.血清铁蛋白及其与肝脏疾病的关系研究进展[J].解放军医学杂志,2021,46(2):181-185.
[8] 周忠洋,向颜韩,廖锦元.钆塞酸二钠增强磁共振成像T1-MAPPING评估肝纤维化评分的研究[J/CD].新发传染病电子杂志,2020,5(3):178-182.
[9] 刘梦苓,黄小华,徐红霞,等.磁共振IDEAL-IQ序列对急性胰腺炎状态下胰腺脂肪沉积和铁沉积的评估[J].放射学实践,2018,33(12):1266-1271.
[10] 许桂晓,何浩强,彭康强,等.应用磁共振IDEAL-IQ技术评估肝脏铁沉积[J].临床放射学杂志,2019,38(11):2200-2204.
[11] 黄伟强,董常峰.弹性成像及血生化指标对肝纤维化的评价及研究进展[J/CD].新发传染病电子杂志,2017,2(2):117-121.
[12] 叶琪,赵艳.铁超载与非酒精性脂肪肝病的关系[J].卫生研究,2015,44(3):503-505,510.
[13] 朱乃懿,严福华,王鹤,等.MR IDEAL-QUANT及ESWAN成像技术评估肝纤维化铁质沉积的初步研究[J].诊断学理论与实践,2014,13(2):146-151.
[14] 李鹏,张振国.磁共振弥散加权成像对慢性乙型肝炎肝纤维化程度和炎症活动程度的判断价值分析[J].肝胆外科杂志,2017,25(4):265-268.
[15] JEAN-PIERRE CERCUEIL.一种诊断肝纤维化的有效方法——评WÁNG等IVIM诊断肝纤维化的论文[J/CD].新发传染病电子杂志,2017,2(4):196-197.
[16] 李若坤,严福华.MRI定量技术在肝纤维化诊断分期中的应用[J].中国医学计算机成像杂志,2018,24(2):181-184.
[17] 王毅翔. 不用B=0图像的活体组织体素内不相干运动分析:应用在肝脏纤维化评估的一个例子[J/CD].新发传染病电子杂志,2019,4(1):8-14.
[18] LABRANCHE ROXANNE ET AL. Liver iron quantification with mr imaging: a primer for radiologists.[J].Radiographics, 2018, 38(2): 392-412.