CAJ | 학술논문

目的：探讨磁共振扩散加权成像(MR-DWI)在家兔肝纤维化(HF)分期中的价值。材料与方法将60只健康新西兰大白兔随机分为HF组(32只)、对照组(16只)和补充组(12只)。HF组和补充组兔经颈背部皮下注射50%的CCl4油溶液建立肝纤维化模型。在造模过程中，如HF组兔出现死亡，由补充组兔随机补充。HF组按预实验结果在注射CCl4后第4、5、6、10周末分别选HF组兔8只、对照组兔4只进行肝脏MRI常规轴位T1WI、T2WI序列及轴位DWI序列扫描，扫描完成后立即处死，进行病理学分期。DWI采用SE-EPI序列(b=50 s/mm2、400 s/mm2、800 s/mm2)，在ADC图上测量表观扩散系数(ADC值)。以组织病理学分期为标准，评价第4、5、6、10周ADC值与HF病理分期的相关性，并采用ROC曲线分析ADC值的诊断准确性。结果不同HF病理分期之间ADC值存在明显差异(F=5.344，P＜0.005)。随着肝纤维化的进展，肝脏实质平均ADC值相应降低；S0组和S1～S2组的ADC值均高于S3～S4组(P＜0.05)，S0组与S1～S2组的ADC值之间均无显著差异(P＞0.05)。ADC值与HF分期存在明显的相关性(r=－0.630，P＜0.001)但是S0、S1和S2三者之间以及S3和S4之间ADC值无明显差异(P＞0.1)。但相邻各组间ADC值重叠较大。结论 MR-DWI序列作为一种安全、可靠的无创性扫描技术，可为临床随访和疗效观察提供一种重要的补充手段。
목적：탐토자공진확산가권성상(MR-DWI)재가토간섬유화(HF)분기중적개치。재료여방법장60지건강신서란대백토수궤분위HF조(32지)、대조조(16지)화보충조(12지)。HF조화보충조토경경배부피하주사50%적CCl4유용액건립간섬유화모형。재조모과정중，여HF조토출현사망，유보충조토수궤보충。HF조안예실험결과재주사CCl4후제4、5、6、10주말분별선HF조토8지、대조조토4지진행간장MRI상규축위T1WI、T2WI서렬급축위DWI서렬소묘，소묘완성후립즉처사，진행병이학분기。DWI채용SE-EPI서렬(b=50 s/mm2、400 s/mm2、800 s/mm2)，재ADC도상측량표관확산계수(ADC치)。이조직병이학분기위표준，평개제4、5、6、10주ADC치여HF병리분기적상관성，병채용ROC곡선분석ADC치적진단준학성。결과불동HF병리분기지간ADC치존재명현차이(F=5.344，P＜0.005)。수착간섬유화적진전，간장실질평균ADC치상응강저；S0조화S1～S2조적ADC치균고우S3～S4조(P＜0.05)，S0조여S1～S2조적ADC치지간균무현저차이(P＞0.05)。ADC치여HF분기존재명현적상관성(r=－0.630，P＜0.001)단시S0、S1화S2삼자지간이급S3화S4지간ADC치무명현차이(P＞0.1)。단상린각조간ADC치중첩교대。결론 MR-DWI서렬작위일충안전、가고적무창성소묘기술，가위림상수방화료효관찰제공일충중요적보충수단。
Objective: To evaluate the accuracy of apparent diffusion coefifcient(ADC) correlates on staging liver ifbrosis.Materials and Methods:The study consisted of three groups: HF group (n=32), control group (n=15) and supplemental group (n=12). Rabbits from control and HF group underwent conventional MRI and DWI scan and the liver ADC values were measured. In HF group, eight rabbits randomly underwent MRI examinations at 4, 5, 6, 10 weeks after CCl4 administration. The correlation between ADC values and HF stages was assessed. The diagnostic performance of DWI for staging HF was compared using the receiver operating characteristic curve analysis on the basis of the histopathologic analysis of HF.Results:Signiifcant differences of ADC values were present among HF stages (F=5.344,P<0.005). The ADC values were correlated with the HF stages (r=-0.630,P<0.001). Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were for≥S1: 75.00%, 55.56%, 85.70%, 38.50%, respectively; for≥S2: 79.2%, 58.8%, 73.1%, 66.7%; for≥S3: 87.5%, 80.0%, 73.70%, 90.9%; for S4: 87.50%, 66.67%, 38.90%, 95.7%.Conclusion:DWI can offer important assistance in staging HF as a non-invasive technique.