超声造影定量参数与肝纤维化程度的相关性研究

摘要

目的 探讨超声造影定量参数与肝穿刺病理纤维化程度的相关性.方法 对病理诊断明确的肝纤维化患者60例进行超声造影检查和脱机定量分析,分别在肝动脉、肝实质、门静脉及肝静脉选取感兴趣区绘制时间-强度曲线,获得定量参数到达时间、强度增量(ISI)、峰值强度(PI)和曲线下面积(AUC),计算肝动-静脉渡越时间(HA-HVTT)、门静脉-肝静脉渡越时间(PV-HVTT)和肝实质-肝静脉渡越时间(PA-HVTT).将以上参数与病理肝纤维化程度进行相关性分析,对相关性较好指标分别以肝纤维化程度S＞S1及S＞S3为不同研究终点分组进行受试者特征曲线(ROC)分析.结果 病理肝纤维化分期显示轻度(S0、S1)25例,中度(S2、S3)17例,重度(S4)18例.反映造影剂在肝内渡越时间的HA-HVTT、PV-HVTT和PA-HVTT与纤维化程度呈负相关(P＜0.05);反映造影剂灌注强度的门静脉ISI、PI和AUC与纤维化程度呈负相关(P＜0.05);对HA-HVTT、PV-HVTT和PA-HVTT进行ROC分析,肝纤维化分期S＞S1时曲线下面积分别为0.808、0.848和0.823;S＞S3时曲线下面积分别为0.856、0.903和0.806.结论 超声造影定量参数可间接反映肝纤维化程度,其中反映造影剂在肝内渡越时间的参数HA-HVTT、PV-HVTT和PA-HVTT为较好指标.%Objective To investigate the correlations between quantitative parameters of contrast-enhanced ultrasonography(CEUS) and histopathological stage of liver fibrosis.Methods Sixty cases of hepatic fibrosis diagnosed pathologically were examined with CEUS.The dynamic images of CEUS were analyzed off-line with a quantitative software.Region of interest (ROI) were drawn separately in hepatic artery(HA),liver parenchyma(PA),main portal vein(PV) and right hepatic vein(HV).The time intensity curve(TIC) and some quantitative parameters,including arrival time,increased signal intensity(ISI),peak intensity(PI) and area under curve(AUC) were acquired.Intrahepatic transit time of contrast agents were calculated as the arrival time difference between hepatic artery(HA) and HV(HA-HVTT),between PV and HV(PV-HVTT) and between PA and HV (PA-HVTT).All the parameters were compared with histopathologic stage.Results All cases were grouped into mild fibrosis (S0 and S1,25 cases),moderate fibrosis (S2 and S3,17 cases) and severe fibrosis (S4,18 cases) according pathologic stage.HA-HVTT,PV-HVTT and PA-HVTT decreased with the development of liver fibrosis.The parameters of ISI,PI and AUC obtained from TIC of portal vein reduced with the progression of fibrosis,too(P＜0.05).Receive operating characteristic(ROC) curve analysis showed that the area under curve of HA-HVTT,PV-HVTT and PA-HVTT were 0.808,0.848,and 0.823 (S＞S1),and 0.856,0.903,and 0.806 (S＞S3),respectively.Conclusions Quantitative parameters of CEUS reflect the stage of liver fibrosis mediately.The parameters of HA-HVTT,PV-HVTT and PA-HVTT are closely correlated with the stage of liver fibrosis.