磁共振FRFSE联合多模态影像学技术评估脾脏Gamna-Gandy小体预测乙型肝炎肝硬化患者并发食管胃底静脉曲张价值研究*

doi:10.3969/j.issn.1672-5069.2025.02.022

摘要/Abstract

摘要： 目的探讨应用磁共振成像(MRI)快速恢复快速自旋回波脉冲(FRFSE)序列评估脾脏Gamna-Gandy小体预测乙型肝炎肝硬化并发食管胃底静脉曲张(EGV)的效能。方法 2020年1月～2022年12月我院诊治的乙型肝炎肝硬化患者80例,均接受MRI检查,应用不同,包括FRFSE序列测定门静脉直径、计算脾脏指数和Gamna-Gandy小体,行胃镜检查诊断EGV程度。应用ROC曲线分析指标预测EGV的效能。结果在本组80例乙型肝炎肝硬化患者中,胃镜检查发现轻度EGV者23例,中重度EGV者41例;MR FRFSE序列检查Gamna-Gandy小体阳性率和≥3mm的Gamna-Gandy小体数分别为61.2%和(4.8±1.4)个,显著高于或多于T1W1、T2W1或增强扫描检测(P＜0.05);中重度EGV患者门静脉直径、脾脏指数和Gamna-Gandy小体检出数分别为(17.6±2.1)mm、(158.9±32.6)mm³和(5.5±1.6)个,均显著高于轻度组【分别为(14.6±1.2)mm、(119.6±10.6)mm³和(3.2±1.0)个,P＜0.05】; ROC曲线分析显示,以FRFSE序列检出Gamna-Gandy小体大于4.7个为截断点,其预测中重度EGV的AUC为0.923,敏感度和特异度分别为93.9%和83.9%,显著优于门静脉直径或脾脏指数预测(P＜0.05)。结论应用MR FRFSE序列检查脾脏Gamna-Gandy小体能够作为筛查肝硬化患者EGV的无创手段,其价值值得进一步探讨。

关键词: 肝硬化, 食管胃底静脉曲张, 磁共振成像, 快速恢复快速自旋回波脉冲, 脾脏Gamna-Gandy小体, 诊断

Abstract: Objective This study was conducted to explore application of splenic Gamna-Gandy vesicles by fast recovery fast spin echo pulse (FRFSE) sequence of MRI in predicting esophageal and gastric varices (EGV) in patients with hepatitis B-induced liver cirrhosis (LC). Methods 80 patients with hepatitis B-induced LC were encountered in our hospital between January 2020 and December 2022, and all underwent gastroscopy and MR scan. The portal vain diameters, splenic index and Gamna-Gandy bodies were determined and calculated under different MR sequences. The diagnostic performance was evaluated byreceiver operating characteristic curve (ROC). Results Among the 80 patients with LC, the gastroscopy found mild EGV in 23 cases, and moderate to severe EGV in 41 cases; the splenic Gamna-Gandy body positive rate and the number of greater than 3mm Gamna-Gandy body revealed by MR FRFSE sequence were 61.2% and (4.8±1.4), both significantly higher or greater than by T1W1, T2W1 or enhanced MR scan (P＜0.05); the portal vain diameter, splenic index and numbers of Gamna-Gandy bodies in patients with moderate to severe EGV were (17.6±2.1)mm, (158.9±32.6)mm³and (5.5±1.6), all significantly higher than [(14.6±1.2)mm,(119.6±10.6)mm³ and (3.2±1.0), respectively, P＜0.05] in patients with mild EGV; the ROC analysis showed that the AUC was 0.923, with sensitivity of 93.9% and specificity of 83.9%, when splenic Gamna-Gandy body greater than 4.7 was set as the cut-off-value in predicting the existence of moderate to severe EGV in patients with LC, much superior to portal diameter or splenic index did(P<0.05). Conclusion Thesplenic Gamna-Gandy body showed by FRFSE sequence of MRI might be used as a noninvasive tool for screening EGV in patients with hepatitis B-induced LC.

Key words: Liver cirrhosis, Esophageal and gastric varices, MRI, Fast recovery fast spin echo sequence, Splenic Gamna-Gandy vesicles, Diagnosis

刘成环, 刘刚, 甘郑宁, 尹桂秀, 李伟霞. 磁共振FRFSE联合多模态影像学技术评估脾脏Gamna-Gandy小体预测乙型肝炎肝硬化患者并发食管胃底静脉曲张价值研究^*[J]. 实用肝脏病杂志, 2025, 28(2): 246-249.

Liu Chenghuan, Liu Gang, Gan Zhengning, et al. Splenic Gamna-Gandy vesicles by FRFSE sequence of MRI in predicting esophageal and gastric varices in patients with hepatitis B-induced liver cirrhosis[J]. Journal of Practical Hepatology, 2025, 28(2): 246-249.

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