CAJ | 학술논문

目的：探讨磁敏感加权成像（SWI）诊断兔肝纤维化（HF）分期的价值。方法将60只健康新西兰大白兔按照随机区组法随机分为HF组（44只）和对照组（16只）。HF组兔经颈背部皮下注射50%CCl4油溶液建立HF模型，对照组兔注射等剂量生理盐水。分别于注射50%CCl4油后4、5、6、10周任意选取HF组8只、对照组4只行肝脏常规MRI、SWI和DWI检查，在SWI图像上测量肝脏及背部肌肉信号强度（SI肝脏），计算肝脏与肌肉信号强度比（SIR肝/肌），并在DWI上测量ADC值。MRI扫描完成对兔肝组织进行病理检查，根据病理结果将实验兔分为F0组（无肝纤维化）、F1～2组（轻、中度肝纤维化）、F3～4组（重度肝纤维化）。采用单因素方差分析比较F0组、F1～2组、F3～4组间SI肝脏、SIR肝/肌及ADC值的差异，采用Spearman相关性检验分析SI肝脏、SIR肝/肌及ADC值与HF病理分期间的相关性；采用ROC曲线分析SIR肝/肌、SI肝脏和ADC值鉴别HF分期的效能。结果16只对照组兔中，1只出现肝纤维化剔除。47只兔顺利完成MRI检查。F0组15只、F1～2组16只、、F3～4组16只。F0、F1～2和F3～4组SIR肝/肌分别为0.973±0.020、0.880±0.090和0.649±0.140，SI肝脏分别为378±45、374±19和317±34，ADC值分别为（1.473±0.320）×10-3、（1.311±0.310）×10-3和（0.942±0.180）×10-3mm2/s，差异均有统计学意义（F值分别为46.571、15.803和15.317，P均<0.01）。SIR肝/肌与HF分期为高度负相关（r=－0.818，P<0.01），SI肝脏和ADC值与HF分期均为中度负相关性（r=-0.565、-0.630，P<0.01）。SIR肝/肌、SI肝脏和ADC值鉴别F0期和F1～4期HF的ROC曲线下面积（AUC）分别为0.916、0.695和0.768，鉴别F0～2期和F3～4期HF的AUC分别为0.951、0.904和0.900。结论 SWI成像SIR肝/肌在诊断HF分期中具有较高价值，可作为评价HF程度的有效手段。
목적：탐토자민감가권성상（SWI）진단토간섬유화（HF）분기적개치。방법장60지건강신서란대백토안조수궤구조법수궤분위HF조（44지）화대조조（16지）。HF조토경경배부피하주사50%CCl4유용액건립HF모형，대조조토주사등제량생리염수。분별우주사50%CCl4유후4、5、6、10주임의선취HF조8지、대조조4지행간장상규MRI、SWI화DWI검사，재SWI도상상측량간장급배부기육신호강도（SI간장），계산간장여기육신호강도비（SIR간/기），병재DWI상측량ADC치。MRI소묘완성대토간조직진행병리검사，근거병리결과장실험토분위F0조（무간섬유화）、F1～2조（경、중도간섬유화）、F3～4조（중도간섬유화）。채용단인소방차분석비교F0조、F1～2조、F3～4조간SI간장、SIR간/기급ADC치적차이，채용Spearman상관성검험분석SI간장、SIR간/기급ADC치여HF병리분기간적상관성；채용ROC곡선분석SIR간/기、SI간장화ADC치감별HF분기적효능。결과16지대조조토중，1지출현간섬유화척제。47지토순리완성MRI검사。F0조15지、F1～2조16지、、F3～4조16지。F0、F1～2화F3～4조SIR간/기분별위0.973±0.020、0.880±0.090화0.649±0.140，SI간장분별위378±45、374±19화317±34，ADC치분별위（1.473±0.320）×10-3、（1.311±0.310）×10-3화（0.942±0.180）×10-3mm2/s，차이균유통계학의의（F치분별위46.571、15.803화15.317，P균<0.01）。SIR간/기여HF분기위고도부상관（r=－0.818，P<0.01），SI간장화ADC치여HF분기균위중도부상관성（r=-0.565、-0.630，P<0.01）。SIR간/기、SI간장화ADC치감별F0기화F1～4기HF적ROC곡선하면적（AUC）분별위0.916、0.695화0.768，감별F0～2기화F3～4기HF적AUC분별위0.951、0.904화0.900。결론 SWI성상SIR간/기재진단HF분기중구유교고개치，가작위평개HF정도적유효수단。
Objective To assess the value of susceptibility-weighted imaging (SWI) in staging hepatic fibrosis (HF) in rabbits. Methods Sixty healthy rabbits were randomly divided into HF group (n=44), control group (n=16). Rabbits in the HF group and supplementary group were injected subcutaneously with 50%CCl4 oily solution to establish hepatic fibrosis model. On the basis of preliminary test, 8 rabbits in the HF group and 4 rabbits in the control group were selected randomly at the 4th, 5th, 6th, 10th week after CCL4 injection ,respectively , to undergo liver MR scan,including conventional axial T1WI, T2WI and axial SWI, DWI scan. All rabbits were sacrificed after MR scan and the tissue of liver were sampled for pathological test and hepatic fibrosis staging. Rabbits were classified into group F0, F1-2 and F3-4 based on pathological results. Liver signal intensity (SI), and liver-to-muscle SI ratio were measured on SWI images and ADC values were measured on DWI images correspondently. One-way ANOVA analysis was performed to compare difference in liver SI, liver-to-muscle SI ratio and ADC values among group F0 (no fibrosis), F1-2 (mild-moderate fibrosis) and F3-4 (severe fibrosis) . Spearman correlation analysis was performed to correlate pathological staging and liver SI, liver-to-muscle SI ratio and ADC values. Receiver operating characteristic (ROC) curve analysis was performed to compare the diagnostic performance of SWI and DWI for staging HF. Results Two and 5 rabbits in the HF group died at the 5th and the 6th week after CCL4 injection , respectively due to acute hepatic necrosis, hepatorrhexis and systemic failure. Seven rabbits in supplementary group were used as supplement. Of the 16 rabbits in the control group, 1 was excluded from the study due to liver fibrosis. Fifteen rabbits in group F0, sixteen rabbits in group F1-2 and sixteen rabbits in group F3-4 underwent MRI and were included into this study. Liver-to-muscle SI ratio in group F0, F1-2 and F3-4 were 0.973 ± 0.020, 0.880 ± 0.090 and 0.649 ± 0.140, respectively. Liver SI were 378 ± 45, 374 ± 19 and 317 ± 34. ADC values were (1.473 ± 0.320) × 10-3, (1.311 ± 0.310) × 10-3 and (0.942 ± 0.180) × 10-3mm2/s. There were statistically significant differences in liver SI, liver-to-muscle SI ratio and ADC values among group F0, F1-2 and F3-4 (F=46.571,15.803 and 15.317, P< 0.01). Liver-to-muscle SI ratio was highly negatively correlated with HF staging (r=-0.818,P<0.01), while liver SI and ADC values were moderately correlated with HF staging (r=-0.565,-0.630;P<0.01). Area under ROC curve (AUC) of liver-to-muscle SI ratio, liver SI and ADC value for differentiating hepatic fibrosis stage F0 and stage F1-4 were 0.916, 0.695 and 0.768, while the AUC for differentiating hepatic fibrosis stage F0-2 and stage F3-4 were 0.951, 0.904 and 0.900. Conclusion Liver-to-muscle SI ratio on SWI provide added diagnostic value and could be an useful parameter for staging hepatic fibrosis.