实用肝脏病杂志 ›› 2021, Vol. 24 ›› Issue (3): 407-410.doi: 10.3969/j.issn.1672-5069.2021.03.026

• 肝硬化 • 上一篇    下一篇

应用DCE-MRI技术评估乙型肝炎肝硬化患者食管胃底静脉曲张严重程度的效能分析

南东, 洪金玲, 姜海宇   

  1. 150001 哈尔滨市 哈尔滨医科大学附属第一医院磁共振室(南东);
    超声科(洪金玲,姜海宇)
  • 收稿日期:2020-10-09 出版日期:2021-05-30 发布日期:2021-04-30
  • 作者简介:南东,男,33岁,硕士研究生,主治医师。研究方向:磁共振临床应用研究。E-mail:nd_hmu1@163.com
  • 基金资助:
    黑龙江省自然科学基金资助项目(编号:2019763)

Efficacyof DCE-MRI in evaluating severity of gastroesophageal varices in patients with hepatitis B cirrhosis

Nan Dong, Hong Jinling, Jiang Haiyu   

  1. Department of Radiology, First Affiliated Hospital, Harbin Medical University,Harbin 150001,Heilongjiang Province,China
  • Received:2020-10-09 Online:2021-05-30 Published:2021-04-30

摘要: 目的 探讨应用动态增强磁共振成像(DCE-MRI)技术评估乙型肝炎肝硬化患者并发食管胃底静脉曲张(GOV)严重程度的效能。方法 2014年6月~2020年6月我院收治的88例乙型肝炎肝硬化并发GOV患者,接受胃镜检查诊断并行GOV分级,使用彩色多普勒超声检测肝脏门静脉直径(PVD)、脾静脉直径(SVD)、脾脏长径(SD)和脾脏厚径(ST),使用DCE-MRI技术评估GOV程度,分析DCE-MRI技术诊断GOV程度的效能。结果 在本组88例肝硬化患者中,经胃镜检查诊断并发轻度GOV者60例,并发中重度GOV者28例;并发中重度GOV的乙型肝炎肝硬化患者血清白蛋白水平为(36.0±3.8)g/L,显著低于并发轻度GOV患者【(40.1±3.7)g/L,P<0.05】;外周血白细胞计数为(3.4±0.5)×109/L,血小板计数为(69.5±7.3)×109/L,均显著低于轻度GOV患者【分别为(4.2±0.3)×109/L和(103.3±16.4)×109/L,P<0.05】;PVD为(15.4±2.0)mm,SVD为(11.2±2.1)mm,SD为(155.9±29.8)mm,ST为(53.2±9.8)mm,均显著大于轻度GOV组【分别为(14.3±2.1)mm、(10.0±2.6)mm、(140.6±30.6)mm和(47.6±10.1)mm,P<0.05】;在28例中重度GOV患者中,DCE-MRI检查发现2级和3级GOV占比分别为42.9%和50.0%,显著高于轻度组的11.7%和0.0%(P<0.05);DCE-MRI技术评估乙型肝炎肝硬化并发GOV严重程度的灵敏度、特异度和准确度分别为88.3%、92.9%和89.8%,阳性预测值和阴性预测值分别为96.4%和78.8%。结论 使用DCE-MRI检查判断乙型肝炎肝硬化患者并发GOV有一定的应用价值,值得进一步研究。

关键词: 肝硬化, 食管胃底静脉曲张, 动态增强磁共振成像, 诊断

Abstract: Objective The aim of this study was to explore the efficacy of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in evaluating the severity of gastroesophageal varices (GOV) in patients with chronic B cirrhosis. Methods A total of 88 patients with hepatitis B cirrhosis complicated with GOV were admitted to our hospital between June 2014 and June 2020, and all patients underwent gastroscopy for the GOV severity and color Doppler ultrasonography for the measurement of portal vein diameter (PVD), splenic vein diameter (SVD), spleen diameter (SD), and spleen thickness (ST). The severity of GOV in patients with hepatitis B cirrhosis was evaluated by DCE-MRI.Results We found 28 cases of moderate and severe, and 60 cases of mild GOV by gastroscopy in our series; serum albumin level in patients with moderate/severe GOV was (36.0±3.8)g/L, much lower than [(40.1±3.7)g/L, P<0.05] in those with mild GOV; the white blood cell count was (3.4±0.5)×109/L, and the platelet count was (69.5±7.3)×109/L, both significantly lower than [(4.2±0.3)×109/L and (103.3±16.4)×109/L, respectively, P<0.05] in patients with mild GOV; the PVD was (15.4±2.0)mm, the SVD was (11.2±2.1)mm, the SD was (155.9±29.8)mm, and the ST was (53.2±9.8)mm, all significantly greater than those in patients with mild GOV [(14.3±2.1)mm, (10.0±2.6)mm, (140.6±30.6)mm, and(47.6±10.1)mm, respectively, P<0.05]; the percentages of grade 2 and grade 3 GOV determined by DCE-MRI in 28 moderate/severe GOV by gastroscopy were 42.9% and 50.0%, significantly higher than 11.7% and 0.0%(P<0.05) in those with mild GOV; the sensitivity, specificity and accuracy, positive predicting value and negative predicting value in evaluating the severity of GOV by DCE-MRI were 88.3% (53/60), 92.9% (26/28), 89.8% (79/88), 96.4% and 78.8%, respectively.Conclusion The application of DCE-MRI in diagnosing GOV in patients with liver cirrhosis is feasible and promising, which needs further investigation.

Key words: Liver cirrhosis, Gastroesophageal varices, Dynamic contrast enhanced magnetic resonance imaging, Diagnosis