CAJ | 학술논문

目的：探讨磁共振扩散加权成像（DWI）对肝纤维化的诊断价值。方法采用四氯化碳注射法建立家兔肝纤维化模型，每次实验抽取模型组家兔7~8只和对照组家兔2~3只进行DWI检查，共对30只肝纤维化成模组和10只对照组家兔进行了DWI检查，测算不同b值（分别为300、500和1000 s/mm2）时DWI的表观扩散系数（ADC）值；行DWI后12h内处死家兔，行肝组织病理学检查，按肝纤维化病理分期结果进行分组，比较不同分期动物ADC值的差异，采用Spearman相关分析探讨ADC值变化和纤维化分期之间的相关性，运用受试者工作特性（ROC）曲线评估ADC值预测S2及以上肝纤维化和S3及以上肝纤维化的诊断效能。结果 ADC值与纤维化分期之间呈负相关性，取b值=500 s/mm2时，相关性最高（r=-0.795,P=0.000）；在不同b值情况下，肝纤维化≤S1与≥S2之间、纤维化≤S2与≥S3之间肝脏ADC值差异均有统计学意义（均P<0.05）；当b值=500 s/mm2时，ADC值诊断≥S2肝纤维化的ROC曲线下面积（AUC）为0.912，以ADC值=1.58×10-3mm2/s为截断点，其诊断肝纤维化的敏感性为90.2%，特异性为75.0%；ADC值诊断≥S3肝纤维化的AUC为0.920，以ADC值=1.43×10-3mm2/s为截断点，其敏感性为93.0%，特异性为80.0%。结论 ADC值可以用于诊断肝纤维化分期，值得进一步研究。
목적：탐토자공진확산가권성상（DWI）대간섬유화적진단개치。방법채용사록화탄주사법건립가토간섬유화모형，매차실험추취모형조가토7~8지화대조조가토2~3지진행DWI검사，공대30지간섬유화성모조화10지대조조가토진행료DWI검사，측산불동b치（분별위300、500화1000 s/mm2）시DWI적표관확산계수（ADC）치；행DWI후12h내처사가토，행간조직병이학검사，안간섬유화병리분기결과진행분조，비교불동분기동물ADC치적차이，채용Spearman상관분석탐토ADC치변화화섬유화분기지간적상관성，운용수시자공작특성（ROC）곡선평고ADC치예측S2급이상간섬유화화S3급이상간섬유화적진단효능。결과 ADC치여섬유화분기지간정부상관성，취b치=500 s/mm2시，상관성최고（r=-0.795,P=0.000）；재불동b치정황하，간섬유화≤S1여≥S2지간、섬유화≤S2여≥S3지간간장ADC치차이균유통계학의의（균P<0.05）；당b치=500 s/mm2시，ADC치진단≥S2간섬유화적ROC곡선하면적（AUC）위0.912，이ADC치=1.58×10-3mm2/s위절단점，기진단간섬유화적민감성위90.2%，특이성위75.0%；ADC치진단≥S3간섬유화적AUC위0.920，이ADC치=1.43×10-3mm2/s위절단점，기민감성위93.0%，특이성위80.0%。결론 ADC치가이용우진단간섬유화분기，치득진일보연구。
Objective To investigate MR diffusion-weighted imaging (DWI) in the diagnosis of hepatic fibrosis in rabbits. Methods Rabbits with CCl4-induced liver fibrosis was established. 7 or 8 rabbits in model group and 2 or 3 rabbits in control group were sacrificed at each attempt,and a total of 30 rabbits in model and 10 rabbits in control group had DWI checked-up. Apparent diffusion coefficient (ADC) values of liver with different b values (b=300,500 and 1000 s/mm2,respectively) were calculated. The rabbits were sacrificed 12h after DWI scanning and the liver tissues were examined pathologically. Spearman correlation analysis was conducted to reveal the correlation between ADC values and fibrosis staging,and receiver operating characteristic (ROC) curve was used to assess the performance of ADC values in predicting the presence of ≥2 stage and ≥3 stage of hepatic fibrosis. Results There was a negative correlation between hepatic ADC values and fibrosis stage,and the optimal correlation was obtained with a b value of 500 s/mm2 (r=-0.697,P=0.000);There was a significant difference in hepatic ADC values between rabbits with ≤1 stage and ≥2 stage of fibrosis,as well as between ≤2 stage and ≥3 stage of fibrosis (P<0.05 for both) no matter at b=300,500 and 1000 s/mm2;When b value=500 s/mm2,the areas under the receiver operating characteristic curves(AUC) in discriminating ≥2 stage of fibrosis by ADC values were 0.912,given ADC value=1.58í10-3mm2/s as cut-off value,and the sensitivity and the specificity were 90.2% and 75.0%,respectively;while in discriminating ≥3 stage of fibrosis,the AUC were 0.920 with ADC of 1.43í10-3mm2/s as cut-off value,and the sensitivity and the specificity were 93.0% and 80.0%, respectively. Conclusion The hepatic ADC values can be employed tentatively in determining fibrosis staging and is expected to be a new approach for the diagnosis of hepatic fibrosis.