磁共振增强T1 mapping和IVIM-DWI技术评估乙型肝炎肝硬化患者肝脏储备功能价值研究*

doi:10.3969/j.issn.1672-5069.2024.01.018

摘要/Abstract

摘要： 目的分析应用磁共振(MR)体素内不相干运动扩散加权成像(IVIM-DWI)和钆塞酸二钠增强T1 mapping参数评估乙型肝炎肝硬化患者肝脏储备功能的价值。方法 2020年3月～2022年3月我院诊治的乙型肝炎肝硬化患者60例,接受吲哚菁绿15 min滞留率检测和MR增强扫描,测量增强前20 min和增强后20 min T1弛豫时间,计算肝细胞增强分数,并应用Mltalytics 1.0.1软件自动测算表观扩散系数(ADC)和真性水分子扩散系数(D)。应用受试者工作特征(ROC)曲线分析参数评估肝储备的效能。结果在60例肝硬化患者中,吲哚菁绿15 min滞留率<10%者30例(A组),≥10%但<30%者16例(B组),≥30%者14例(C组);C组增强前T1弛豫时间和增强后T1弛豫时间分别为(700.5±71.2)ms和(324.1±99.6)ms,显著长于A组【分别为(612.2±28.3)ms和(148.3±51.9)ms,P＜0.05】或B组【分别为(682.5±73.1)ms和(256.2±88.1)ms,P＜0.05】,而ADC、D和肝细胞增强分数分别为(0.5±0.1)×10³、(0.5±0.1)×10³和(50.2±11.6)%,均显著低于A组【分别为(1.2±0.1)×10³、(1.0±0.4)×10³和(80.8±10.9)%,P＜0.05】或B组【分别为(0.8±0.2)×10³、(0.7±0.2)×10³和(59.4±19.7)%,P＜0.05】;ROC曲线分析显示,增强前和增强后20 min T1弛豫时间、ADC、D和肝细胞增强分数评估乙型肝炎肝硬化患者肝脏储备功能均具有较高的价值(灵敏度均在70.0%以上,特异度均在76.7%以上)。结论应用MR IVIM-DWI和T1 mapping参数评估乙型肝炎肝硬化患者肝脏储备功能具有很大的临床价值,可为临床决策提供影像学依据。

关键词: 肝硬化, 磁共振成像, 体素内不相干运动扩散加权成像, T1弛豫时间, 肝脏储备功能, 诊断

Abstract: Objective This study was conducted to investigate the assessment of liver reserve functions by intra-voxel incoherent motion-diffusion weighted imaging (IVIM-DWI) and T1 mapping of Gd-EOB-DTPA enhanced MR scan in patients with hepatitis B-induced liver cirrhosis (LC). Methods Sixty patients with hepatitis B-induced LC were encountered in our hospital between March 2020 and March 2022, and all underwent indocyanine green 15 min retention detection and Gd-EOB-DTPA enhanced MR scan. The T1 relaxation times 20 minutes before and after enhancement were measured, and the hepatocyte enhancement fraction was calculated. The apparent diffusion coefficient (ADC) and the true water molecule diffusion coefficient (D) was automatically obtained by software Mltalytics 1.0.1. The diagnostic performance was evaluated by the receiver operating characteristic curve (ROC) analysis. Results Out of the 60 patient with hepatitis B-induced LC, the indocyanine green 15 min retention rates was found <10% in 30 case(group A), ≥10% but <30% in 16 case(group B) and ≥30% in 14 case (group C); the T1 relaxation times 20 minutes before and after enhancement in group C were (700.5±71.2) ms and (324.1±99.6)ms, much longer than [(612.2±28.3)ms and (148.3±51.9)ms, respectively, P＜0.05] in group A or [(682.5±73.1)ms and (256.2±88.1)ms, respectively, P＜0.05] in group B, while the ADC, the D and the hepatocyte enhancement fraction were (0.5±0.1)×10³, (0.5±0.1)×10³ and (50.2±11.6)%, all significantly lower than [(1.2±0.1)×10³, (1.0±0.4)×10³ and (80.8±10.9)%, P＜0.05] in group A or [(0.8±0.2)×10³, (0.7±0.2)×10³ and (59.4±19.7)%, P＜0.05] in group B; the ROC analysis showed that the T1 relaxation times 20 minutes before and after enhancement, ADC, D and hepatocyte enhancement fraction all had a promising diagnostic efficacy in assessing the liver reserve functions of patients with LC, with the sensitivities greater than 70.0% and the specificities greater than 76.7%. Conclusion The IVIM-DWI and T1 mapping parameters of MR is helpful in assessment of liver reserve functions in patients with LC, which might provide evidences for clinical decision-making.

Key words: Liver cirrhosis, MR scan, Intra-voxel incoherent motion-diffusion weighted imaging, Quantitative high-resolution longitudinal relaxation time imaging, Liver reserve functions, Diagnosis

穆玉娟, 吴斐斐, 陈莹. 磁共振增强T1 mapping和IVIM-DWI技术评估乙型肝炎肝硬化患者肝脏储备功能价值研究^*[J]. 实用肝脏病杂志, 2024, 27(1): 68-71.

Mu Yujuan, Wu Feifei, Chen Ying. Assessment of liver reserve functions by IVIM-DWI and T1 mapping of Gd-EOB-DTPA enhanced MR scan in patients with hepatitis B-induced liver cirrhosis[J]. Journal of Practical Hepatology, 2024, 27(1): 68-71.

参考文献

[1] 刘丽改, 骆长玲, 王琦, 等. 乙型肝炎肝硬化患者血脂水平与终末期肝病模型评分的相关性分析. 中国临床医生杂志, 2020, 48(10): 1193-1196.
[2] 王冰琼, 吴晓宁, 周家玲, 等. 乙型肝炎肝硬化抗病毒治疗后食管静脉曲张转归及其临床特征分析.中华肝脏病杂志, 2022, 30(6): 591-597.
[3] O'Shea RS, Davitkov P, Ko CW, et al. Aga clinical practice guideline on the management of coagulation disorders in patients with cirrhosis. Gastroenterology, 2021, 161(5): 1615-1627.
[4] D'Avola D, Granito A, Torre-Aláez M, et al. The importance of liver functional reserve in the non-surgical treatment of hepatocellular carcinoma. J Hepatol, 2022, 76(5): 1185-1198.
[5] Ibáñez-Samaniego L, Rapado-Castro M, Cabrero L, et al. Hepatitis C eradication improves cognitive function in patients with or without cirrhosis: a prospective real-life study. Eur J Neurol, 2022, 29(2): 400-412.
[6] Hiramatsu A, Aikata H, Uchikawa S, et al. Levocarnitine use is associated with improvement in sarcopenia in patients with Liver cirrhosis. Hepatol Commun, 2019, 3(3): 348-355.
[7] Tang XL, Miao YD, Mi DH. Comment on "outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis". World J Gastrointest Oncol, 2022, 14(1): 366-368.
[8] 中华医学会肝病学分会. 肝硬化诊治指南.实用肝脏病杂志,2019, 22(6): 770-786.
[9] Liu B, Zeng Q, Huang J, et al. Ivim using convolutional neural networks predicts microvascular invasion in HCC. Eur Radiol, 2022, 32(10): 7185-7195.
[10] Vasylechko SD, Warfield SK, Afacan O, et al. Self-supervised ivim DWI parameter estimation with a physics based forward model. Magn Reson Med, 2022, 87(2): 904-914.
[11] Gao P, Liu Y, Shi C, et al. Performing ivim-dwi using the multifunctional nanosystem for the evaluation of the antitumor microcirculation changes. MAGMA, 2020, 33(4): 517-526.
[12] Jia H, Jiang X, Zhang K, et al. A nomogram of combining ivim-dwi and mri radiomics from the primary lesion of rectal adenocarcinoma to assess nonenlarged lymph node metastasis preoperatively. J Magn Reson Imaging, 2022, 56(3): 658-667.
[13] Yang C, Wei XQ, Zheng J, et al. A correlative study between ivim-dwi parameters and vegf and mmps expression in hepatocellular carcinoma. Quant Imaging Med Surg, 2023, 13(3): 1887-1898.
[14] Abdel Razek AAK. Editorial for "preliminary assessment of intravoxel incoherent motion diffusion-weighted mri (ivim-dwi) metrics in alzheimer's disease". J Magn Reson Imaging, 2020, 52(6): 1827-1828.
[15] Hu H, Jiang H, Wang S, et al. 3.0 t mri ivim-dwi for predicting the efficacy of neoadjuvant chemoradiation for locally advanced rectal cancer. Abdom Radiol (NY), 2021, 6(1): 134-143.
[16] Wen X, Feng X, Kang Y, et al. Application progress of gd-eob-dtpa-enhanced mri t1 mapping in hepatic diffuse diseases. Curr Med Imaging, 2022, 18(12): 1276-1281.
[17] Xu J, Wang X, Jin ZY, et al. Assessing liver function by t1 maps on gd-eob-dtpa-enhanced mri for up to 50 min in rat models of liver fibrosis: a longer hepatobiliary time period may help. Chin Med Sci J, 2021, 36(2): 110-119.
[18] Dhar D, Baglieri J, Kisseleva T, et al. Mechanisms of liver fibrosis and its role in liver cancer. Exp Biol Med (Maywood), 2020, 245(2): 96-108.
[19] Li Q, Chen T, Shi N, et al. Quantitative evaluation of hepatic fibrosis by fibro scan and gd-eob-dtpa-enhanced t1 mapping magnetic resonance imaging in chronic hepatitis B. Abdom Radiol (NY), 2022, 47(2): 684-692.
[20] 周玮, 胡红杰, 沈博, 等. 基于钆塞酸二钠增强磁共振成像影像组学定量评估肝硬化患者肝脏储备功能的应用价值. 中国医学科学院学报, 2020, 42(4): 459-467.

磁共振增强T1 mapping和IVIM-DWI技术评估乙型肝炎肝硬化患者肝脏储备功能价值研究^*

Assessment of liver reserve functions by IVIM-DWI and T1 mapping of Gd-EOB-DTPA enhanced MR scan in patients with hepatitis B-induced liver cirrhosis

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