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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、9.928×10-3mm2/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。
Objective To comparatively study the value of noninvasive staging of hepatic fibrosis in chronic hepatitis B (hereinafter referred to as chronic hepatitis B) by comparing the shear wave velocity and intravascular magnetic resonance voxels with discrete motion diffusion imaging. Methods Totally 223 patients with chronic hepatitis B confirmed by histopathology were divided into four groups: mild liver fibrosis (F1), liver fibrosis (F2), severe liver fibrosis (F3), cirrhosis (F4 )group. Eighty healthy subjects were included in the control group (F0), and the shear wave velocity and its mean of each segment of the right lobe of liver were measured. Diffusion (D), diffuse fraction (f) and perfusion-associated diffusivity (D *) were obtained in 39 patients with liver fibrosis and 19 healthy controls in different pathological stages by using MR diffusion imaging. Results There was no significant difference in the shear wave velocity of s5 segment between control group and F1 group (P> 0.05). The shear wave velocity of the other segments and their mean difference were statistically significant (P <0.05), and with the aggravation of liver fibrosis, the shear wave velocity increased gradually. The critical values of shear wave velocity for diagnosing ≥F1, ≥F2, ≥F3 and F4 were 1.22 m / s, 1.30 m / s, 1.45 m / s and 1.60 m / s, respectively. In the non-severe liver fibrosis (F1, F2 ), The diagnostic sensitivity of shear wave velocity was 92.82% and 90.12%, respectively. For severe liver fibrosis and cirrhosis (F3 and F4), the shear wave velocity had excellent sensitivity The area under the receiver operating characteristic curve (AUROC) reached 92.27% and 95.93%, respectively. The areas under the curve of liver fibrosis (≥F1, ≥F2, ≥F3, F4) 0.920,0.952,0.954. Compared with the control group, the values of D, f and D * in patients with liver fibrosis were significantly decreased (P <0.05), and f value and D * value continued to decrease with the degree of liver fibrosis. The difference was statistically significant (P <0.05). The value of f and D * have the ability to distinguish between F2 and F1 of liver fibrosis. The best diagnostic cutoff points are 0.135 and 9.928 × 10-3mm2 / s, respectively. Conclusion Contrast shear wave velocity can be subdivided into F2 level of chronic hepatitis B liver fibrosis, intravascular magnetic resonance voxels within discrete motion diffusion imaging will be able to distinguish between F1 and other stages of liver fibrosis accurate distinction between the two is worthy of clinical promotion.