动态对比增强磁共振在肝炎后肝硬化中的定量研究

摘要

Purpose:To investigate the value of dynamic contrast-enhanced MRI (DCE-MRI) in post-hepatitic liver cirrhosis.Methods:Twenty subjects with liver cirrhosis (10 compensatory liver cirrhosis and 10 decompensatory liver cirrhosis) and 10 healthy volunteers were prospectively enrolled and performed liver DCE-MRI.Quantitative parameters of these three groups were obtained by extended Tofts model with permeability parameters including Ktrans,Kep,Ve,Vp and perfusion parameters including HPI,BV,BF,MTT.The parameters of these three groups were analyzed.The diagnostic efficacy of the quantitative parameters was analyzed by ROC analysis.Results:The Ktrans of liver cirrhosis groups was lower than that of normal group,the difference was with statistical significant (P＜0.05),and Ktrans of decompensatory liver cirrhosis group was lower than that of normal group with statistical significant (P＜0.05).The Ve of liver cirrhosis groups was higher than that of normal group (P＜0.05),and Ve of decompensatory liver cirrhosis group was higher than that of normal group with statistical significant (P＜0.05).There were statistical significant differences of HPI and MTT among these three groups (P＜0.05),as well as between every two groups (P＜0.05).The BF of liver cirrhosis groups was higher than that of normal group (P＜0.05).There was no statistical significant difference of BV,Kep and Vp among these three groups (P＞0.05).According to the result of ROC analysis,the optimal HPI was set as 0.54 and MTT as 0.29,the sensitivity and specificity for diagnosis of compensatory liver cirrhosis were 85％,85％ and 75％,75％,respectively.When optimal HPI was set as 0.695 and MTT as 0.528,the sensitivity and specificity for diagnosis of decompensatory liver cirrhosis were 95％,90％ and 80％,80％,respectively.When optimal Ktrans was set as 0.415 and Ve as 0.283,the sensitivity and specificity of diagnosis for decompensatory liver cirrhosis were 90％,100％ and 100％,80％,respectively.Conclusions:Quantitative DCE-MRI analysis could reflect hemodynamic changes and variation of vascular microenvironment for liver cirrhosis,and could be used to evaluate the severity of liver cirrhosis.%目的:探讨动态对比增强MRI (DCE-MRI)定量分析技术对肝炎后肝硬化的评估价值.方法:符合入组标准的肝硬化代偿期和失代偿期患者各10例,正常对照组10例,行肝脏DCE-MRI扫描,通过Extended Toffs血流动力学模型测得各组渗透参数(Ktrans、Kep、Ve、Vp)和灌注参数(HPI、BV、BF、MTT).对各组定量参数行统计学分析并绘制受试者工作曲线(ROC)分析各参数的诊断效能.结果:肝硬化组Ktrans值低于正常组(P＜0.05),其中失代偿期肝硬化组较正常组Ktrans降低(P＜0.05).肝硬化组Ve高于正常组(P＜0.05),其中失代偿期肝硬化组Ve较正常组升高具有统计学意义(P＜0.05).肝硬化组HPI和MTT均高于正常组(P＜0.05),且三组间两两比较差异均有统计学意义(P＜0.05).肝硬化组BF低于正常组且差异具有统计学差异(P＜0.05).三组间BV值、Kep值及Vp值均无统计学差异(P＞0.05).根据各参数ROC,当HPI为0.54,MTT为0.29时,诊断代偿期肝硬化的敏感性(85％、85％)和特异性(75％、75％)之和最大.当HPI为0.695,MTT为0.528时,诊断失代偿期肝硬化敏感性(95％、90％)及特异性(80％、80％)之和最大.当Ktrans为0.415,Ve为0.283时,诊断失代偿期肝硬化敏感性(90％、100％)及特异性(100％、80％)之和最大.结论:DCE-MRI定量分析技术能够反映肝硬化的血流动力学改变及血管微环境变化,可用于评估肝硬化的严重程度并对其进行分级.