增强MRI T1 mapping定量评估慢性乙型肝炎患者肝纤维化程度效能分析

doi:10.3969/j.issn.1672-5069.2021.05.020

摘要/Abstract

摘要： 目的应用钆塞酸二钠增强MRI T1 mapping技术定量评估慢性乙型肝炎(CHB)患者肝纤维化程度。方法 2018年1月～2020年6月我院诊治的CHB患者74例,接受肝活检和钆塞酸二钠增强MR扫描,测量肝胆期信号强度(SI)、肝胆期T1值、相对增强(RE)和T1值变化率,绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),采用Z检验,分析MRI指标评估CHB患者显著性肝纤维化的效能。结果在74例CHB患者中,组织病理学诊断肝纤维化F0期22例,F1期12例,F2期15例,F3期9例,F4期16例;40例显著性肝纤维化患者肝胆期SI、肝胆期T1值、RE和T1值变化率分别为(362.5±29.8)、(418.5±41.2)、(0.52±0.07)和(50.8±4.8)%,与34例非显著性肝纤维化组比,差异显著【分别为(472.6±50.6)、(284.0±35.9)、(0.80±0.09)和(76.2±5.4)%,P<0.05】;在评估显著性肝纤维化的效能方面,T1值变化率诊断的敏感度和特异度分别达到77.6%和93.2%,显著高于其他指标(P<0.05)。结论应用钆塞酸二钠增强MRI T1 mapping技术定量评价CHB患者显著性肝纤维化有一定的价值,值得进一步验证。

关键词: 慢性乙型肝炎, 肝纤维化, 钆塞酸二钠, 磁共振成像, 磁共振T1成像, 诊断

Abstract: Objective The purpose of this study was to evaluate the hepatic fibrosis in patients with chronic Hepatitis B (CHB) by gadolinium-ethoxybenzyl- diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI T1 mapping. Methods A total of 74 patients with CHB were recruited between January 2018 and June 2020, and underwent Gd-EOB-DTPA enhanced MRI and liver biopsies. The hepatobiliary phase signal intensity (SI), hepatobiliary phase T1, relative enhancement (RE) and T1 changing rate of MRI were obtained. The ROC curve was drawn by MedCalc 15.1 statistical software, and the area under the curve (AUC) was calculated by Z test. The cut-off-value of each parameters were analyzed to evaluate the diagnostic efficacy. Results Out the 74 patients with CHB, the histopathological examination showed F0 liver fibrosis stage in 22 cases, F1 stage in 12, F2 stage in 15, F3 stage in 9 and F4 stage in 16; the SI of hepatobiliary phase, the T1 in hepatobiliary phase, the RE, and the T1 changing rate in 40 patients with significant liver fibrosis were(362.5±29.8), (418.5±41.2), (0.52±0.07) and (50.8±4.8)%, all significantly different compared to in 34 patents without significant liver fibrosis; the sensitivity and specificity of T1 changing rate in diagnosis of significant liver fibrosis were 77.6% and 93.2%, both significantly higher than by other three parameters. Conclusion The application of MRI T1 mapping technique in diagnosing liver fibrosis in patients with CHB is to some extent efficacious, which warrants further investigation.

Key words: Hepatitis B, Hepatic fibrosis, Gadolinium-ethoxybenzyl- diethylenetriamine-pentaacetic acid, MRI T1 mapping, Diagnosis

杨永汉, 路萍, 孟庆宁, 张枫婕. 增强MRI T1 mapping定量评估慢性乙型肝炎患者肝纤维化程度效能分析[J]. 实用肝脏病杂志, 2021, 24(5): 685-688.

Yang Yonghan, Lu Ping, Meng Qingning, et al. Quantitative evaluation of hepatic fibrosis in patients with chronic hepatitis B by enhanced MRI T1 mapping[J]. Journal of Practical Hepatology, 2021, 24(5): 685-688.

参考文献

[1]Wang K, Lu X, Zhou H, et al. Deep learning radiomics of shear wave elastography significantly improved diagnostic performance for assessing liver fibrosis in chronic hepatitis B: a prospective multicentre study. Gut, 2019, 68 (4):729-741.
[2]Qu J, Yu Z, Li Q, et al. Blocking and reversing hepatic fibrosis in patients with chronic hepatitis B treated by traditional Chinese medicine (tablets of biejia ruangan or RGT): study protocol for a randomized controlled trial. Trials, 2014, 15:438.
[3]Huang C, Shen D, Sun S,et al. Effect of fufang biejia ruangan tablet on lowering biochemical and virological parameters of hepatic fibrosis in patients with chronic hepatitis B: protocol for a systematic review and meta-analysis of randomized controlled trials and cohort studies. Medicine (Baltimore), 2019, 98 (17):e15297.
[4]Li Q, Song J, Huang Y, et al. The gamma-glutamyl-transpeptidase to platelet ratio does not show advantages than APRI and Fib-4 in diagnosing significant fibrosis and cirrhosis in patients with chronic hepatitis B: a retrospective cohort study in China. Medicine (Baltimore), 2016, 95 (16):e3372.
[5]Yang L, Ding Y, Rao S, et al. Staging liver fibrosis in chronic hepatitis B with T₁ relaxation time index on gadoxetic acid-enhanced MRI: comparison with aspartate aminotransferase-to-platelet ratio index and FIB-4. J Magn Reson Imaging, 2017, 45 (4):1186-1194.
[6]左中宝, 崔怀中, 黄从想, 等. FibroTouch与6种肝纤维化血清学模型评估慢性乙型肝炎患者肝纤维化程度的临床研究. 中华肝脏病杂志, 2019, 27 (6):430-435.
[7]丁荣蓉, 陆伟, 王雁冰, 等. 采用瞬时弹性成像技术和血清标志物预测丙氨酸转氨酶轻度升高的慢性乙型肝炎患者肝纤维化程度. 中华传染病杂志, 2019, 37 (2):72-76.
[8]Zhu YF, Tan YF, Xu X, et al. Gamma-glutamyl transpeptidase-to-platelet ratio and the fibrosis-4 index in predicting hepatitis B virus-related hepatocellular carcinoma development in elderly chronic hepatitis B patients in China: a single-center retrospective study. Medicine (Baltimore), 2019, 98 (50):e18319.
[9]Vanhooymissen IJSML, Thomeer MG, Braun LMM, et al. Intrapatient comparison of the hepatobiliary phase of Gd-BOPTA and Gd-EOB-DTPA in the differentiation of hepatocellular adenoma from focal nodular hyperplasia. J Magn Reson Imaging, 2019, 49 (3):700-710.
[10] 张瑶, 张林启, 陈景标, 等. 钆贝葡胺与钆塞酸二钠增强MRI诊断HBV相关肝癌包膜的效能比较. 中华肝脏外科手术学电子杂志, 2020, 9 (1):72-76.
[11] Leonhardt M, Keiser M, Oswald S, et al. Hepatic uptake of the magnetic resonance imaging contrast agent Gd-EOB-DTPA: role of human organic anion transporters. Drug Metab Dispos, 2010, 38(7):1024-1028.
[12] Juluru K, Talal AH, Yantiss RK, et al. Diagnostic accuracy of intracellular uptake rates calculated using dynamic Gd-EOB-DTPA-enhanced MRI for hepatic fibrosis stage. J Magn Reson Imaging, 2017, 45(4):1177-1185.
[13] 覃夏丽, 黄仲奎, 龙莉玲, 等. 钆塞酸二钠增强MRI T₁ mapping鉴别诊断不典型增生结节及不同分化程度肝细胞癌的价值. 中华放射学杂志, 2018, 52(8):603-607.
[14] Jin K, Wang H, Zeng M, et al. A comparative study of MR extracellular volume fraction measurement and two-dimensional shear-wave elastography in assessment of liver fibrosis with chronic hepatitis B. Abdom Radiol (NY), 2019, 44(4):1407-1414.
[15] Banerjee R, Pavlides M, Tunnicliffe EM, et al. Multiparametric magnetic resonance for the non-invasive diagnosis of liver disease. J Hepatol, 2014, 60(1):69-77.
[16] Pan S, Wang XQ, Guo QY. Quantitative assessment of hepatic fibrosis in chronic hepatitis B and C: T₁ mapping on Gd-EOB-DTPA-enhanced liver magnetic resonance imaging. World J Gastroenterol, 2018, 24(18):2024-2035.
[17] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南 (2015 年版). 实用肝脏病杂志, 2016, 19 (3):389-400.
[18] Li X, Li C, Wang R, et al. Combined application of gadoxetic aciddisodium-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in the diagnosis of chronic liver disease-induced hepatocellular carcinoma: a meta-analysis. PLoS One, 2015, 10(12):e0144247.
[19] Xiao H, Shi M, Xie Y, et al. Comparison of diagnostic accuracy of magnetic resonance elastography and Fibroscan for detecting liver fibrosis in chronic hepatitis B patients: a systematic review and meta-analysis. PLoS One, 2017, 12 (11):e0186660.
[20] Wu LM, Hu J, Gu HY, et al. Can diffusion-weighted magnetic resonance imaging (DW-MRI) alone be used as a reliable sequence for the preoperative detection and characterisation of hepatic metastases? a meta-analysis. Eur J Cancer, 2013, 49 (3):572-584.
[21] Li J, Li X, Weng J, et al. Gd-EOB-DTPA dynamic contrast-enhanced magnetic resonance imaging is more effective than enhanced 64-slice CT for the detection of small lesions in patients with hepatocellular carcinoma. Medicine (Baltimore), 2018, 97(52):e13964.
[22] Peng Z, Li C, Chan T, et al. Quantitative evaluation of Gd-EOB-DTPA uptake in focal liver lesions by using T₁ mapping: differences between hepatocellular carcinoma, hepatic focal nodular hyperplasia and cavernous hemangioma. Oncotarget, 2017, 8(39):65435-65444.
[23] Katsube T, Okada M, Kumano S, et al. Estimation of liver function using T₂ mapping on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging. Eur J Radiol, 2012, 81(7):1460-1464.
[24] Yoneyama T, Fukukura Y, Kamimura K, et al. Efficacy of liver parenchymal enhancement and liver volume to standard liver volume ratio on Gd-EOB-DTPA-enhanced MRI for estimation of liver function. Eur Radiol, 2014, 24(4):857-865.
[25] Haimerl M, Utpatel K, Verloh N, et al. Gd-EOB-DTPA-enhanced MR relaxometry for the detection and staging of liver fibrosis. Sci Rep, 2017, 7:41429.