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目的探讨磁共振扩散加权成像(diffusion-weighted imaging,DWI)对慢性病毒性肝炎患者肝纤维化和炎症程度的评价价值。方法选择2014年1月—2015年12月丽水市中心医院慢性病毒性肝炎患者93例作为研究对象,进行磁共振DWI检查,测量b=100、500和1 000 s/mm2时的ADC值。结果 b=100 s/mm2时,不同纤维化分期ADC值之间比较差异无统计学意义(P>0.05),b值=500和1 000 s/mm2时,不同纤维化分期ADC值之间比较差异有统计学意义(P<0.05),纤维化分期越高,ADC值越低。b=100、500、1 000 s/mm2时,纤维化分期和肝脏ADC之间均呈负相关(P<0.05)。b=100、500、1 000 s/mm2时DWI诊断肝纤维化≥3期(严重纤维化)的ROC曲线下面积分别为0.66±0.04、0.89±0.06、0.82±0.05,灵敏度分别为76.1%、87.7%、75.6%,特异度分别为58.4%、82.0%、83.6%。b=100 s/mm2时,不同炎症分级ADC值之间比较差异无统计学意义(P>0.05),b=500和1 000 s/mm2时,不同炎症分级ADC值之间比较差异有统计学意义(P<0.05),炎症分级越高,ADC值越低。b=500、1 000 s/mm2时,炎症分级和肝脏ADC之间均呈负相关(P<0.05)。结论磁共振DWI检查ADC值和慢性病毒性肝炎的肝纤维化和炎症程度呈负相关,在慢性病毒性肝炎肝纤维化和炎症程度的评价中具有一定价值。
Objective To investigate the value of diffusion-weighted imaging (DWI) in evaluating the degree of liver fibrosis and inflammation in patients with chronic viral hepatitis. Methods Ninety-three patients with chronic viral hepatitis from January 2014 to December 2015 in Lishui Central Hospital were enrolled in this study. Their DWI was examined by MRI. The ADC values at b = 100, 500 and 1000 s / mm2 were measured. Results When b = 100 s / mm2, there was no significant difference in ADC value between different fibrosis stages (P> 0.05). When b = 500 and 1 000 s / mm2, ADC values of different fibrosis stages were compared The difference was statistically significant (P <0.05), the higher the fibrosis stage, the lower the ADC value. At b = 100, 500 and 1 000 s / mm2, there was a negative correlation between fibrosis stage and liver ADC (P <0.05). The area under the ROC curve of DWI in diagnosing hepatic fibrosis≥3 (severe fibrosis) at b = 100, 500 and 1 000 s / mm2 were 0.66 ± 0.04, 0.89 ± 0.06 and 0.82 ± 0.05, respectively, with sensitivities of 76.1% 87.7% and 75.6% respectively, the specificity was 58.4%, 82.0% and 83.6% respectively. When b = 100 s / mm2, there was no significant difference between the different inflammatory grading ADC values (P> 0.05), b = 500 and 1000 s / mm2, Significance (P <0.05), the higher the grade of inflammation, the lower the ADC value. At b = 500,1 000 s / mm2, there was a negative correlation between inflammation grade and liver ADC (P <0.05). Conclusion MRI value of DWI is negatively correlated with the degree of liver fibrosis and inflammation in chronic viral hepatitis, and is of value in the evaluation of liver fibrosis and inflammation in chronic viral hepatitis.