中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2011年
9期
874-878
,共5页
郭成伟%梁长虹%张水兴%沈三弟%刘再毅%贾乾君
郭成偉%樑長虹%張水興%瀋三弟%劉再毅%賈乾君
곽성위%량장홍%장수흥%침삼제%류재의%가건군
缺血再灌注损伤%磁共振成像%对比研究
缺血再灌註損傷%磁共振成像%對比研究
결혈재관주손상%자공진성상%대비연구
Ischemic reperfusion injury%MR imaging%Comparative study
目的 探讨DWI及ADC值对兔肝缺血再灌注损伤(IRI)的诊断价值及通过与肝酶、病理对照研究探讨其病理生理机制。方法 新西兰大白兔42只,用数字表法随机分成7组,每组6只。按照IRI后行MR扫描时间分为0.5、2.0、6.0、12.0、24.0和48.0 h IRI组及假手术(Sham)组。IRI组阻断肝左叶血供60 min后,恢复血供。Sham组未作缺血处理。采用3.0 T DWI,梯度因子(b)=20、50、100、200、300、400、500、600 s/mm2,同时行T2WI、T1WI和T1WI增强扫描,并行组织病理学和肝酶学丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)检查。不同b值下多组ADC值、各IRI与Sham组的AST、ALT值的比较采用单因素方差分析,组间均数差异的比较采用LSD-t法。结果 ADC值的总体变化趋势是在复氧后0.5h明显下降,然后在2.0h组急剧上升,经过6.0~12.0h缓慢上升后,24.0h组再次下降,于48.0 h组ADC明显升高。B值分别为20、50、100、200、300 s/mm2时,Sham组ADC值分别为(3.47±0.53)×10-3、(3.11±0.39) ×10-3、(2.87±0.19)×10-3、(2.56±0.37)×10-3和(1.95±0.33)×10-3mm2/s,0.5 h IRI组ADC值分别为(2.63±0.31) ×10-3、(2.47±0.32)×10-3、(2.12±0.38)×10-3、(2.01±0.51) ×10-3和(1.61±0.17)×10-3mm2/s,24.0 h IRI 组ADC值分别为(2.72±0.09) ×10-3、(2.51±0.11) ×10-3、(2.28±0.30)×10-3、(1.96 ±0.14)×10-3和( 1.58 ±0.17)×10-3mm2/s。当b≤300 s/mm2时,0.5h与24.0 h IRI组ADC值均低于Sham组,差异均有统计学意义(P<0.05)。Sham组、0.5 h IRI组、2.0 h IRI组、6.0 h IRI组、12.0 h IRI组、24.0 h IRI组和48.0 h IRI组ALT分别为(80±8)、(181 ±34)、(413±62)、(474±83)、( 424±41)、(332±41)和(302±39) U/L,AST分别为(79±10)、(454±55)、(547±72)、(607±31)、(649±79)、(785±49)和(1526±167) U/L,各IRI组与Sham组比较差异均有统计学意义(P<0.01)。病理表现在IRI早期肝窦内、汇管区、中央静脉及小动脉内充血淤积,随着损伤加重,肝窦肿胀,肝细胞核同缩凋亡,肝窦解离,最后发展为凝同性坏死。结论 3.0T DWI能够动态监测肝IRI的病理发展过程,为临床诊断和治疗提供了一种可行性的评价方法。
目的 探討DWI及ADC值對兔肝缺血再灌註損傷(IRI)的診斷價值及通過與肝酶、病理對照研究探討其病理生理機製。方法 新西蘭大白兔42隻,用數字錶法隨機分成7組,每組6隻。按照IRI後行MR掃描時間分為0.5、2.0、6.0、12.0、24.0和48.0 h IRI組及假手術(Sham)組。IRI組阻斷肝左葉血供60 min後,恢複血供。Sham組未作缺血處理。採用3.0 T DWI,梯度因子(b)=20、50、100、200、300、400、500、600 s/mm2,同時行T2WI、T1WI和T1WI增彊掃描,併行組織病理學和肝酶學丙氨痠轉氨酶(ALT)和天鼕氨痠轉氨酶(AST)檢查。不同b值下多組ADC值、各IRI與Sham組的AST、ALT值的比較採用單因素方差分析,組間均數差異的比較採用LSD-t法。結果 ADC值的總體變化趨勢是在複氧後0.5h明顯下降,然後在2.0h組急劇上升,經過6.0~12.0h緩慢上升後,24.0h組再次下降,于48.0 h組ADC明顯升高。B值分彆為20、50、100、200、300 s/mm2時,Sham組ADC值分彆為(3.47±0.53)×10-3、(3.11±0.39) ×10-3、(2.87±0.19)×10-3、(2.56±0.37)×10-3和(1.95±0.33)×10-3mm2/s,0.5 h IRI組ADC值分彆為(2.63±0.31) ×10-3、(2.47±0.32)×10-3、(2.12±0.38)×10-3、(2.01±0.51) ×10-3和(1.61±0.17)×10-3mm2/s,24.0 h IRI 組ADC值分彆為(2.72±0.09) ×10-3、(2.51±0.11) ×10-3、(2.28±0.30)×10-3、(1.96 ±0.14)×10-3和( 1.58 ±0.17)×10-3mm2/s。噹b≤300 s/mm2時,0.5h與24.0 h IRI組ADC值均低于Sham組,差異均有統計學意義(P<0.05)。Sham組、0.5 h IRI組、2.0 h IRI組、6.0 h IRI組、12.0 h IRI組、24.0 h IRI組和48.0 h IRI組ALT分彆為(80±8)、(181 ±34)、(413±62)、(474±83)、( 424±41)、(332±41)和(302±39) U/L,AST分彆為(79±10)、(454±55)、(547±72)、(607±31)、(649±79)、(785±49)和(1526±167) U/L,各IRI組與Sham組比較差異均有統計學意義(P<0.01)。病理錶現在IRI早期肝竇內、彙管區、中央靜脈及小動脈內充血淤積,隨著損傷加重,肝竇腫脹,肝細胞覈同縮凋亡,肝竇解離,最後髮展為凝同性壞死。結論 3.0T DWI能夠動態鑑測肝IRI的病理髮展過程,為臨床診斷和治療提供瞭一種可行性的評價方法。
목적 탐토DWI급ADC치대토간결혈재관주손상(IRI)적진단개치급통과여간매、병리대조연구탐토기병리생리궤제。방법 신서란대백토42지,용수자표법수궤분성7조,매조6지。안조IRI후행MR소묘시간분위0.5、2.0、6.0、12.0、24.0화48.0 h IRI조급가수술(Sham)조。IRI조조단간좌협혈공60 min후,회복혈공。Sham조미작결혈처리。채용3.0 T DWI,제도인자(b)=20、50、100、200、300、400、500、600 s/mm2,동시행T2WI、T1WI화T1WI증강소묘,병행조직병이학화간매학병안산전안매(ALT)화천동안산전안매(AST)검사。불동b치하다조ADC치、각IRI여Sham조적AST、ALT치적비교채용단인소방차분석,조간균수차이적비교채용LSD-t법。결과 ADC치적총체변화추세시재복양후0.5h명현하강,연후재2.0h조급극상승,경과6.0~12.0h완만상승후,24.0h조재차하강,우48.0 h조ADC명현승고。B치분별위20、50、100、200、300 s/mm2시,Sham조ADC치분별위(3.47±0.53)×10-3、(3.11±0.39) ×10-3、(2.87±0.19)×10-3、(2.56±0.37)×10-3화(1.95±0.33)×10-3mm2/s,0.5 h IRI조ADC치분별위(2.63±0.31) ×10-3、(2.47±0.32)×10-3、(2.12±0.38)×10-3、(2.01±0.51) ×10-3화(1.61±0.17)×10-3mm2/s,24.0 h IRI 조ADC치분별위(2.72±0.09) ×10-3、(2.51±0.11) ×10-3、(2.28±0.30)×10-3、(1.96 ±0.14)×10-3화( 1.58 ±0.17)×10-3mm2/s。당b≤300 s/mm2시,0.5h여24.0 h IRI조ADC치균저우Sham조,차이균유통계학의의(P<0.05)。Sham조、0.5 h IRI조、2.0 h IRI조、6.0 h IRI조、12.0 h IRI조、24.0 h IRI조화48.0 h IRI조ALT분별위(80±8)、(181 ±34)、(413±62)、(474±83)、( 424±41)、(332±41)화(302±39) U/L,AST분별위(79±10)、(454±55)、(547±72)、(607±31)、(649±79)、(785±49)화(1526±167) U/L,각IRI조여Sham조비교차이균유통계학의의(P<0.01)。병리표현재IRI조기간두내、회관구、중앙정맥급소동맥내충혈어적,수착손상가중,간두종창,간세포핵동축조망,간두해리,최후발전위응동성배사。결론 3.0T DWI능구동태감측간IRI적병리발전과정,위림상진단화치료제공료일충가행성적평개방법。
Objective To explore the value of DWI ADC in the diagnosis of hepatic ischemia reperfusion injury (IRI) at 3.0 T and investigate the mechanism by comparison with liver enzyme and pathological findings. Methods Forty-two New Zealand white rabbits were divided randomly into ( n = 6,each) six IRI groups by rank sum test. The IRI animals underwent left lobar ischemia for 60 min and were reperfused 0. 5 h, 2. 0 h, 6. 0 h, 12. 0 h, 24. 0 h and 48. 0 h later. One Sham operative group underwent laparotomy without liver ischemia. T2 WI, T1 WI, DWI and contrast-enhanced T, WI were performed with 3.0 T magnetic resonance imaging scanner in each group respectively. For DWI, b-values of 20, 50, 100,200,300,400,500 and 600 s/mm2 were used respectively. Blood samples were taken to detect the levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) at different time points. Liver samples were examined histologically after MRI scanning. One-way analysis of variance (ANOVA) was used to determine differences, followed by LSD-t test for multiple comparisons. Results Overall, ADC decreased markedly at the early IRI phase ( 0. 5 h), drastically increased in the 2.0 h group, and then ascended slightly from 6. 0 h to 48.0 h after reperfusion, except for a transient decrease at the time point of 24. 0 h. When b values were 20, 50, 100,200 and 300 s/mm2, the ADC values in the Sham group were (3.47 ±0.53) × 10-3, (3.11 ±0.39) ×10-3, (2.87 ±0.19) ×10-3, (2.56 ±0.37) × 10-3 and (1.95 ±0.33) ×10-3mm2/s, (2.63±0.31)±10-3, (2.47±0.32) ×10-3, (2.12±0.38) ×10-3, (2.01±0.51) ×10-3and (1.61 ±0.17) ×10-3mm2/s in the 0.5 h group, (2.72 ±0.09) ×10-3, (2.51±0. 11) ×10-3, (2.28 ±0.30) ± 10-3, (1.96 ±0. 14) × 10-3 and (1.58 ±0. 17) × 10-3mm2/s in the 24.0 h group, respectively. ADC of 0. 5 h and 24. 0 h groups were significantly lower than that of Sham group (P<0.05) when b value was under 300 mm2/s. In the Sham, 0.5 h, 2.0 h, 6.0 h, 12.0 h,24.0 h and 48. 0 h IRI groups, they were (80±8), (181 ±34), (413 ±62), (474 ±83), (424 ±41 ),(332 ±41 )and(302 ±39) U/L for the levels of ALT,and (79 ± 10), (454 ±55), (547 ±72), (607±31 ), (649 ±79), (785 ±49) and ( 1526 ± 167) U/L for the AST respectively. The levels of AST and ALT in IRI groups were significantly higher than those in the Sham group ( P < 0. 01 ). Histological findings showed diffuse hepatocytes swelling and erythrocytes depositing in the hepatic sinusoids, portal area, central venous and arterials at the initial phase. With the injury aggravated, inflammatory cell infiltration,hepatocyte nuclear condensation of apoptosis, sinusoidal dissociation and coagulation necrosis developed eventually. Conclusion 3.0 T DWI can monitor the pathological process of rabbit liver ischemia reperfusion injury dynamically, and provides a feasible imaging modality for clinical diagnosis and treatment.