DCE-MRI功能参数诊断代偿期和失代偿期乙型肝炎肝硬化价值研究*

doi:10.3969/j.issn.1672-5069.2025.01.024

摘要/Abstract

摘要： 目的探讨动态增强磁共振成像(DCE-MRI)功能成像参数诊断失代偿期乙型肝炎肝硬化的价值。方法 2020年2月～2022年2月我院收治的乙型肝炎肝硬化患者143例,按照指南肝功能分级诊断代偿期76例和失代偿期67例,另选择同期健康人60例,接受肝脏DCE-MRI扫描,应用Extended Tofts血流动力学模型获取MRI功能成像参数。以临床诊断结果为金标准,采用kappa检验两种诊断方法的一致性。结果失代偿期肝硬化患者肝动脉灌注量(HAP)、肝动脉灌注指数(HPI)、对比剂平均通过时间(MTT)和达峰时间(TTP)分别为(38.6±14.7)ml·min^-1·100 g^-1、(0.8±0.2)、(57.5±16.6)s和(13.7±3.4)s,均显著高于代偿期肝硬化患者【分别为(28.8±15.3)ml·min^-1·100 g^-1、(0.5±0.1)、(34.3±11.4)s和(8.4±1.3)s,P＜0.05】或健康人【分别为(23.6±12.6)ml·min^-1·100 g^-1、(0.3±0.1)、(17.4±14.2)s和(5.6±1.2)s,P＜0.05】,而门静脉灌注量(PVP)和肝脏总灌注量(FP)分别为(45.6±17.5)ml·min^-1·100 g^-1和(63.5±23.4)ml·min^-1·100 g^-1,显著低于代偿期肝硬化患者【分别为(72.4±21.8)ml·min^-1·100 g^-1和(109.7±18.8)ml·min^-1·100 g^-1,P＜0.05】或健康人【分别为(101.5±24.6)ml·min^-1·100 g^-1和(128.5±21.9)ml·min^-1·100 g^-1,P＜0.05】;DCE-MRI功能成像参数诊断失代偿期肝硬化与根据指南诊断结果具有较好的一致性(kappa=0.790),其敏感度为89.5%,特异度为89.6%,准确率为89.5%,阳性预测值为90.7%,阴性预测值为88.2%。结论应用DCE-MRI功能成像参数可以帮助早期判断乙型肝炎肝硬化患者肝功能失代偿,具有很大的临床意义。

关键词: 肝硬化, 动态增强磁共振成像, 肝功能失代偿, 诊断

Abstract: Objective The aim of this study was to investigate the diagnostic efficacy of dynamic enhanced magnetic resonance imaging (DCE-MRI) functional parameters in the diagnosis of decompensated liver functions in patients with hepatitis B-induced liver cirrhosis (LC). Methods 143 consecutive patients with hepatitis B-induced LC were encountered in our hospital between February 2020 and February 2022, including compensated in 76 cases and decompensated LC in 67 cases based on guideline criteria diagnosis. 60 healthy individuals during the same period were included, and all subjects underwent liver DCE-MRI scanning, and the functional imaging parameters were obtained by using Extended Tofts hemodynamic model. The kappa test was used to verify diagnostic consistency. Results Hepatic artery perfusion(HAP), hepatic perfusion index(HPI), mean transit time (MTT)and time to peak (TTP) in patients with decompensated LC were(38.6±14.7)ml·min^-1·100 g^-1, (0.8±0.2), (57.5±16.6)s and (13.7±3.4)s, all significantly higher than [(28.8±15.3)ml·min^-1·100 g^-1, (0.5±0.1), (34.3±11.4)s and (8.4±1.3)s, respectively, P＜0.05] in patients with compensated LC or [(23.6±12.6)ml·min^-1·100 g^-1, (0.3±0.1), (17.4±14.2)s and (5.6±1.2)s, respectively, P＜0.05] in control, while portal vein perfusion(PVP) and full perfusion (FP) were (45.6±17.5)ml·min^-1·100 g^-1 and (63.5±23.4)ml·min^-1·100 g^-1, significantly lower than [(72.4±21.8)ml·min^-1·100 g^-1 and (109.7±18.8)ml·min^-1·100 g^-1, P＜0.05] in compensated LC or [(101.5±24.6)ml·min^-1·100 g^-1 and (128.5±21.9)ml·min^-1·100 g^-1, P＜0.05] in healthy individuals; the diagnosis of decompensated LC by MRI functional parameters was well consistent to that based on guideline (kappa=0.790), with the sensitivity of89.5%, specificity of 89.6%, accuracy of 89.5%, positive predictive value of 90.7% and negative predictive value of 88.2%. Conclusion The DCE-MRI functional parameters could help early diagnosis of decompensated liver functions in patients with hepatitis B-induced LC, which might guide clinical decision-making.

Key words: Liver cirrhosis, Dynamic contrast-enhanced magnetic resonance imaging, Decompensated liver functions, Diagnosis

杨慧玲, 赵文哲, 杨柳青, 杨健, 刘小静. DCE-MRI功能参数诊断代偿期和失代偿期乙型肝炎肝硬化价值研究^*[J]. 实用肝脏病杂志, 2025, 28(1): 92-95.

Yang Huiling, Zhao Wenzhe, Yang Liuqing, et al. DCE-MRI functional imaging parameters in the diagnosis of decompensated liver functions in patients with hepatitis B-related liver cirrhosis[J]. Journal of Practical Hepatology, 2025, 28(1): 92-95.

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DCE-MRI功能参数诊断代偿期和失代偿期乙型肝炎肝硬化价值研究^*

DCE-MRI functional imaging parameters in the diagnosis of decompensated liver functions in patients with hepatitis B-related liver cirrhosis

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