Objective To compare the value of shear wave velocity ( SWV) and intravoxel incoherent motion diffusion MRI ( IVIM) in evaluating the stage of hepatic fibrosis in patients with chronic Hepatitis B. Methods Totally 223 patients with HBV infection who underwent liver biopsy were selected into this research, they were divided into four groups: mild hepatic fibrosis ( F1 ) , obvious hepatic fibrosis (F2), serious hepatic fibrosis (F3), cirrhosis (F4). Eighty normal subjects were chosen as control group. The SWV of all hepatic segments s5, s6, s7, s8 and their average value were measured;39 patients of different degrees hepatic fibrosis and 19 normal subjects accepted IVIM, the diffusion parameters ( D, f, D∗) were measured. Results Among these 5 groups, the SWV of all hepatic segments had significant difference (P<0. 05) except for the segment s5 between control and F1 group (P>0. 05), with the development of hepatic fibrosis, SWV increase gradually. The cut-off value of ≥F1,≥F2,≥F3 and F4 was separately 1. 22 m/s,1. 30 m/s, 1. 45 m/s and 1. 60m/s, SWV had fine sensitivity of 92. 82% and 90. 12% for liver fibrosis F1 and F2, as it comes to F3 and F4, SWV get fantastic specificity of 92. 27% and 95. 93%. The diagnostic accuracy of SWV expressed as area under receiver operating characteristic curve (AUROC) was 0. 887, 0. 920, 0. 952 and 0. 954 for the diagnosis of hepatic fibrosis≥F1,≥F2,≥F3 and F4. The mean D, f and D∗values of IVIM measured in patients with hepatic fibrosis were obviously smaller than healthy subjects. As the fibrosis severity progressed, f and D∗ values decreased, a trend towards lower f and D∗with the increase of fibrosis stages was statistically significant (P<0. 05). f and D∗ values had the ability to distinguish different fibrosis stages of F2 between F1, the best cut-off points were 0. 135, 9. 928 × 10-3 mm2/s, respectively. Conclusion SWV could accurately evaluate the stage of obvious hepatic fibrosis in patients suffering from chronic hepatitis B;IVIM could distinguish mild liver fibrosis from obvious hepatic fibrosis, the combination of them were suitable for clinical use.%目的：对比研究剪切波速与磁共振体素内不连贯运动弥散成像技术对慢性乙型肝炎(以下简称慢乙肝)肝纤维化程度进行无创性分期的价值。方法入选223例经病理证实肝纤维化程度的慢乙肝患者,将其分为轻微肝纤维化( F1)组、肝纤维化( F2)组、严重肝纤维化(F3)组、肝硬化(F4)组。80例健康体检者组成对照(F0)组,测量所有入选者肝右叶各段剪切波速及其均值。应用磁共振弥散成像技术获得其中不同病理分期的39例肝纤维化患者及19例健康体检者的弥散值( D)、弥漫分数( f)及灌注相关弥散值(D∗)。结果5组间剪切波速结果两两比较,除对照组与F1组间s5肝段剪切波速差异无统计学意义(P>0.05),其余肝段剪切波速及其均值差异均有统计学意义(P<0.05),且随着肝纤维化程度的加重,剪切波速逐级递增。剪切波速诊断≥F1、≥F2、≥F3及F4的临界值分别为1.22 m/s、1.30 m/s、1.45 m/s及1.60 m/s,在非严重型肝纤维化(F1、F2)诊断方面,剪切波速有较高的敏感度,分别达到92.82％、90.12％,而对于严重的肝纤维化及肝硬化( F3、F4),剪切波速则具有极佳的特异度,分别达到92.27％、95.93％,其诊断各期(≥F1、≥F2、≥F3、F4)肝纤维化的受试者工作特征曲线下面积( area under the receiver operating characteristic curve, AUROC)分别达到0.887、0.920、0.952、0.954。磁共振弥散成像方面,与对照组比较,肝纤维化患者的D、f、D∗均显著减低( P<0.05),且随着肝纤维化程度的加重,f值和D∗值持续减低,差异有统计学意义(P<0.05)。 f值和D∗值具有区分肝纤维化F2期与F1期的能力,最佳诊断分界点分别是0.135、9.928×10－3 mm2/s。结论对比剪切波速可细分F2以上级慢乙肝肝纤维化程度,磁共振体素内不连贯运动弥散成像则能将F1期与其他期肝纤维化精确区分,二者联合应用值得临床推广。
展开▼
