Value of diffusion imaging of magnetic resonancefunction in pathological grading and liver fibrosis in patients with liver cirrhosis
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摘要:目的 探讨磁共振功能弥散成像技术(DWI)在原发性胆汁淤积性肝硬化(PBC)患者肝纤维化进程及肝硬化分级评价中的应用价值。方法 对129例原发性胆汁淤积患者和23例健康志愿者进行常规磁共振扫描及DWI检查。依据肝穿刺病理诊断结果对其进行肝纤维化分期, 按照Child-Pugh分级标准对S4期患者进行肝硬化分级。选择单因素重复测量分析法比较不同肝纤维化进程及肝硬化分级在弥散敏感系数(b值)为100~1 000 s/mm2时表观弥散系数(ADC)值变化，采用Spearman相关分析法探究肝纤维化进程、肝硬化分级与ADC值的相关性，采用受试者工作曲线(AUC)评估ADC值在S2~S3肝纤维化及S4肝硬化中的诊断效能。结果 b值为600、800、1 000 s/mm2时, S3组、S4组肝纤维化患者ADC值显著低于正常组、S0组、S1组、S2组(P < 0.05)。肝纤维化组不同b值下ADC值显著低于正常组, 不同肝硬化分级组ADC值均显著低于正常组和肝纤维化组(P < 0.05);随肝硬化分级增高和程度加深, ADC值均呈现递减趋势, 3组间差异存在统计学意义(P < 0.05)。b值为600、800、1 000 s/mm2时，ADC值与肝纤维化进程存在显著负相关(P < 0.01); b值为100~1 000 s/mm2时, ADC值与肝硬化分级存在显著负相关(P < 0.01)。b值为600 s/mm2时, ADC≤1.65×10-3 mm2/s和ADC≤1.23×10-3 mm2/s分别为显著纤维化和肝硬化的诊断标准, 敏感性为85.8%和91.5%, 特异性为75.9%和84.4%。结论 DWI在原发性胆汁淤积患者肝纤维化进程及肝硬化分级诊断中具有极高的临床价值，b值为600 s/mm2时，其诊断效能最高。Abstract:Objective To explore the value of magnetic resonance functional diffusion imaging (DWI) in the evaluation of liver fibrosis and pathological grading of cirrhosis in patients with primary cholestasis cirrhosis (PBC).Methods Routine magnetic resonance imaging and DWI were performed in 129 patients with primary cholestasis and 23 healthy volunteers. Hepatic fibrosis stagings was classified according to the pathological diagnosis of liver puncture, and hepatic fibrosis in S4 patients were classified according to Child-Pugh classification criteria. Single factor repeated measures analysis was used to compare the changes in Apparent dispersion coefficient (ADC) values during liver fibrosis progression and cirrhosis grade at b values of 100~1 000 s/mm2. Spearman correlation analysis was used to investigate the correlation between liver fibrosis progression, cirrhosis grading and ADC values. The receiver operating curve (AUC) was used to assess the diagnostic efficacy of ADC values in S2 to S3 liver fibrosis and S4 cirrhosis.Results When the b value was 600 s/mm2, 800 s/mm2, 1000 s/mm2, the ADC values of patients with liver fibrosis in S3 and S4 groups were significantly lower than those in normal group, S0, S1 and S2 groups (P < 0.05). The ADC values were significantly lower with the worse of cirrhosis grading, and the difference was statistically significant (P < 0.05). When the b value was 600, 800, 1 000 s/mm2, the ADC value was negatively correlated with the liver fibrosis process(P < 0.01). When the b value was from100 s/mm2 to 1000 s/mm2, there was a negative correlation betweenADC value and cirrhosis grade (P < 0.01). When the b value was 600 s/mm2, ADC≤1.65×10-3 mm2/s and ADC≤1.23×10-3 mm2/s were the diagnostic criteria for significant fibrosis and cirrhosis, sensitivity were 85.8%and 91.5%, respectively, and specificity were 75.9 % and 84.4%, respectively.Conclusion DWI is of high clinical value in the diagnosis of liver fibrosis and grading diagnosis of cirrhosis in patients with primary cholestasis. The diagnostic performance is highest when the b value is 600 s/mm2.
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表 1 不同b值状态下肝纤维化进程及肝硬化分级患者ADC值比较(x±s)
×10-3 mm2/s 病理分级 n b值/(s/mm2) 100 300 600 800 1 000 正常组 23 3.17±0.35 2.41±0.32 1.82±0.26*# 1.64±0.23*# 1.43±0.22*# S0组 30 3.11±0.33 2.39±0.30 1.79±0.27*# 1.65±0.21*# 1.41±0.18*# S1组 17 3.07±0.28 2.31±0.24 1.73±0.22*# 1.57±0.19*# 1.37±0.15*# S2组 19 3.02±0.31 2.22±0.15 1.65±0.17*# 1.52±0.16*# 1.32±0.18*# S3组 25 2.35±0.17 2.15±0.21 1.42±0.12 1.25±0.10 1.06±0.11 S4组 38 2.26±0.21 2.11±0.14 1.38±0.13 1.23±0.11 1.02±0.09 ADC:表观弥散系数; b值:弥散敏感系数。与S3组比较, *P < 0.05;与S4组比较, #P < 0.05。 
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表 2 不同b值状态下肝硬化Child-Pugh不同分级患者ADC值比较(x±s)
×10-3 mm2/s 组别 n b值/(s/mm2) 100 300 600 800 1 000 正常组 23 3.17±0.35 2.41±0.32 1.82±0.26 1.64±0.23 1.43±0.22 肝纤维化组 61 3.01±0.31* 2.03±0.31* 1.69±0.22* 1.50±0.17* 1.31±0.15* A分级 12 2.41±0.28*# 2.22±0.28*# 1.44±0.15*# 1.31±0.13*# 1.15±0.10*# B分级 15 2.23±0.22*#△ 1.88±0.22*#△ 1.21±0.11*#△ 1.12±0.10*#△ 0.94±0.08*#△ C分级 11 2.04±0.18*#△▲ 1.52±0.15*#△▲ 1.03±0.08*#△▲ 0.91±0.06*#△▲ 0.72±0.05*#△▲ ADC:表观弥散系数; b值:弥散敏感系数。与正常组比较, *P < 0.05;与肝纤维化组比较, #P < 0.05;
与A分级组比较, △P < 0.05;与B分级组比较, ▲P < 0.05。
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表 3 ADC值与肝纤维化进程和肝硬化分级的相关性分析
b值/(s/mm2) 肝纤维化进程 肝硬化分级 r P r P 100 -0.911 0.115 -0.528 < 0.001 300 -0.746 0.091 -0.493 < 0.001 600 -0.569 0.003 -0.461 < 0.001 800 -0.414 < 0.001 -0.342 < 0.001 1 000 -0.395 < 0.001 -0.267 < 0.001 ADC:表观弥散系数; b值:弥散敏感系数。
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表 4 DWI在肝纤维化进程及肝硬化分级诊断中的敏感度和特异性
b值/(s/mm2) S2~S3(显著纤维化) S4(肝硬化) AUC ADC/(×10-3 mm2/s) 敏感性/% 特异性/% AUC ADC/(×10-3 mm2/s) 敏感性/% 特异性/% 100 0.641±0.072 ≤2.86 63.6 71.8 0.611±0.061 ≤2.11 72.2 55.8 300 0.735±0.068 ≤2.01 71.5 51.7 0.759±0.059 ≤1.65 86.3 51.5 600 0.893±0.046 ≤1.65 85.8 75.9 0.896±0.042 ≤1.23 91.5 84.4 800 0.924±0.033 ≤1.41 79.1 89.6 0.933±0.037 ≤1.15 83.1 92.5 1 000 0.905±0.031 ≤1.22 61.3 95.9 0.862±0.053 ≤0.88 73.6 88.1 ADC:表观弥散系数; b值:弥散敏感系数。
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