中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2010年
12期
1263-1267
,共5页
肝炎,慢性%肝硬化%磁共振成像
肝炎,慢性%肝硬化%磁共振成像
간염,만성%간경화%자공진성상
Hepatitis,chronic%Liver cirrhosis%Magnetic resonance imaging
目的 探讨MR DWI在慢性肝病及其肝功能储备评价中的临床应用价值.方法 搜集正常志愿者30名作为对照组,病例组共60例,包括慢性乙型肝炎和肝硬化各30例,均行肝脏DWI,病例组中15例进行了治疗前后的随访复查.病例组抽取静脉血行肝功能测定,根据终末期肝病模型(model for end-stage liver disease,MELD)评分不同分为3组,其中MELD评分＜30分组27例、30～36分组17例、＞36分组16例.测量肝实质的ADC值并与同层面椎管内脑脊液ADC值进行标准化处理.采用单因素方差分析比较组间ADC值,治疗前后ADC值比较采用配对组间t检验.结果 正常对照组肝实质在DWI上信号均匀,ADC伪彩图上表现为均匀的绿色区域;慢性乙型肝炎DWI示散在不规则斑片状稍高信号扩散受限区,25例分布于左右叶,5例局限在右叶,ADC图上扩散受限区表现为蓝色区域;30例肝硬化肝实质呈斑片状扩散受限区更为明显,同时显示肝边缘不规则.正常组ADC值为(0.47±0.02)× 10-3mm2/s,慢性乙型肝炎组为(0.37±0.03)×10-3mm2/s,肝硬化组为(0.36±0.04)×10-3mm2/s,差异有统计学意义(F=97.05,P＜0.05),正常组与病例组ADC值差异有统计学意义(P＜0.05),但慢性乙型肝炎组与肝硬化组间的差异无统计学意义(P＞0.05).MELD评分＜30分组、30～36分组、＞36分组的ADC值分别为(0.38±0.02)×10-3mm2/s、(0.35±0.02)×10-3mm2/s、(0.32±0.03)×10-3mm2/s,正常组与这3组间差异均有统计学意义(P＜0.05).治疗后,15例慢性肝病患者DWI显示扩散受限区减少,治疗后ADC值由治疗前的(0.33±0.03)×10-3mm2/s提高到(0.38±0.03)×10-3mm2/s(t=7.73,P＜0.01);MELD评分由治疗前的36.01±6.00降低到27.83±4.86(t=9.01,P＜0.01).结论 慢性肝病的DWI表现为斑片状扩散受限区,肝细胞损害越严重,肝功能越差,ADC值越低;治疗好转后,肝功能恢复,肝实质的扩散受限减少,ADC值升高.
目的 探討MR DWI在慢性肝病及其肝功能儲備評價中的臨床應用價值.方法 搜集正常誌願者30名作為對照組,病例組共60例,包括慢性乙型肝炎和肝硬化各30例,均行肝髒DWI,病例組中15例進行瞭治療前後的隨訪複查.病例組抽取靜脈血行肝功能測定,根據終末期肝病模型(model for end-stage liver disease,MELD)評分不同分為3組,其中MELD評分＜30分組27例、30～36分組17例、＞36分組16例.測量肝實質的ADC值併與同層麵椎管內腦脊液ADC值進行標準化處理.採用單因素方差分析比較組間ADC值,治療前後ADC值比較採用配對組間t檢驗.結果 正常對照組肝實質在DWI上信號均勻,ADC偽綵圖上錶現為均勻的綠色區域;慢性乙型肝炎DWI示散在不規則斑片狀稍高信號擴散受限區,25例分佈于左右葉,5例跼限在右葉,ADC圖上擴散受限區錶現為藍色區域;30例肝硬化肝實質呈斑片狀擴散受限區更為明顯,同時顯示肝邊緣不規則.正常組ADC值為(0.47±0.02)× 10-3mm2/s,慢性乙型肝炎組為(0.37±0.03)×10-3mm2/s,肝硬化組為(0.36±0.04)×10-3mm2/s,差異有統計學意義(F=97.05,P＜0.05),正常組與病例組ADC值差異有統計學意義(P＜0.05),但慢性乙型肝炎組與肝硬化組間的差異無統計學意義(P＞0.05).MELD評分＜30分組、30～36分組、＞36分組的ADC值分彆為(0.38±0.02)×10-3mm2/s、(0.35±0.02)×10-3mm2/s、(0.32±0.03)×10-3mm2/s,正常組與這3組間差異均有統計學意義(P＜0.05).治療後,15例慢性肝病患者DWI顯示擴散受限區減少,治療後ADC值由治療前的(0.33±0.03)×10-3mm2/s提高到(0.38±0.03)×10-3mm2/s(t=7.73,P＜0.01);MELD評分由治療前的36.01±6.00降低到27.83±4.86(t=9.01,P＜0.01).結論 慢性肝病的DWI錶現為斑片狀擴散受限區,肝細胞損害越嚴重,肝功能越差,ADC值越低;治療好轉後,肝功能恢複,肝實質的擴散受限減少,ADC值升高.
목적 탐토MR DWI재만성간병급기간공능저비평개중적림상응용개치.방법 수집정상지원자30명작위대조조,병례조공60례,포괄만성을형간염화간경화각30례,균행간장DWI,병례조중15례진행료치료전후적수방복사.병례조추취정맥혈행간공능측정,근거종말기간병모형(model for end-stage liver disease,MELD)평분불동분위3조,기중MELD평분＜30분조27례、30～36분조17례、＞36분조16례.측량간실질적ADC치병여동층면추관내뇌척액ADC치진행표준화처리.채용단인소방차분석비교조간ADC치,치료전후ADC치비교채용배대조간t검험.결과 정상대조조간실질재DWI상신호균균,ADC위채도상표현위균균적록색구역;만성을형간염DWI시산재불규칙반편상초고신호확산수한구,25례분포우좌우협,5례국한재우협,ADC도상확산수한구표현위람색구역;30례간경화간실질정반편상확산수한구경위명현,동시현시간변연불규칙.정상조ADC치위(0.47±0.02)× 10-3mm2/s,만성을형간염조위(0.37±0.03)×10-3mm2/s,간경화조위(0.36±0.04)×10-3mm2/s,차이유통계학의의(F=97.05,P＜0.05),정상조여병례조ADC치차이유통계학의의(P＜0.05),단만성을형간염조여간경화조간적차이무통계학의의(P＞0.05).MELD평분＜30분조、30～36분조、＞36분조적ADC치분별위(0.38±0.02)×10-3mm2/s、(0.35±0.02)×10-3mm2/s、(0.32±0.03)×10-3mm2/s,정상조여저3조간차이균유통계학의의(P＜0.05).치료후,15례만성간병환자DWI현시확산수한구감소,치료후ADC치유치료전적(0.33±0.03)×10-3mm2/s제고도(0.38±0.03)×10-3mm2/s(t=7.73,P＜0.01);MELD평분유치료전적36.01±6.00강저도27.83±4.86(t=9.01,P＜0.01).결론 만성간병적DWI표현위반편상확산수한구,간세포손해월엄중,간공능월차,ADC치월저;치료호전후,간공능회복,간실질적확산수한감소,ADC치승고.
Objective To evaluate clinical application value of DWI and reservation of liver function in patients with chronic liver disease. Methods Thirty cases of healthy control group, and 60 case group with chronic liver disease,including both 30 chronic hepatitis B and 30 cirrhosis. liver function in case group was analysed by venous blood samples. Case groups were divided into three groups according to MELD score: ＜30 group in 27 cases, 30 to 36 group in 17 cases, ＞36 group in 16 cases. All cases underwent liver magnetic resonance DWI. Among the case group, 15 cases were followed-up twice of pre- and aftertreatment. DWI images were read, ADC values of liver parenchyma were measured and standardized with the cephalospinal fluid (CSF) at the same slice. Used SPSS 13.0 for windows to treat the data, group comparison of ADC values were treated by one-factor analysis of variance, interclass comparison each other by SNK method, comparison between pretherapy and post-treatment by paired-samples t test. Results Healthy liver parenchyma of the control group is homogeneous signal on DWI. ADC pseudo-color pictures showed green on the homogeneous areas. Slightly restricted area of chronic hepatitis B showed irregular scattered patchy in DWI images, 25 cases in right and left lobes, 5 cases only in right lobe of the liver. ADC pseudo-color pictures reaveled blue region in proliferation-constrained areas. Restricted areas of the liver parenchymal become more evident, also showed an irregular liver edge in 30 cases of cirrhosis. The standarized ADC average values were: the healthy group (0. 47 ±0. 02) × 10-3 mm2/s, chronic hepatitis B group (0. 37 ±0. 03) × 10-3 mm2/s, cirrhosis group (0. 36 ±0. 04) × 10-3 mm2/s( F =97.05,P ＜0. 05).The difference between healthy group and patients group was statistically significant (P ＜ 0. 05 ). No statistically significant difference between groups of chronic hepatitis B and liver cirrhosis ( P ＞ 0. 05 ).Average ADC values of MELD score among groups of ＜ 30, 30 to 36, ＞ 36 were ( 0. 38 ± 0. 02 ) ×10-3 mm2/s,(0.35 ±0.02) × 10-3 mm2/s, (0.32 ± 0.03) × 10-3 mm2/s respectively. There is a significant difference among the three groups (P ＜0. 05). After treatment, DWI of 15 patients with chronic liver disease showed reduction in restricted areas, and the average ADC value from pre-treatment (0. 33 ±0. 03) × 10-3 mm2/s increased to(0. 38 ±0. 03) × 10-3 mm2/s, MELD score from pre-treatment 36. 01 ±6. 00 reduced to 27. 83 ± 4. 86. Conclusion DWI of chronic liver disease showed patchy diffuse restricted areas; more severe of the liver cell damage was, more worse the liver function was and lower ADC values was. ADC values increased after effective treatment, liver function recoved and diffuse restricted areas of liver parenchyma reduced.
