摘要
目的探寻多参数功能性MRI技术[体素内不相干运动(IVIM)、扩散峰度成像(DKI)及非对称回波的最小二乘估算法迭代水脂分离(IDEAL-IQ)]在肝纤维化(HF)分级诊断中的价值。方法选择经病理确诊43例HF患者作为HF组,其中男性23例,女性20例;年龄45~65岁,平均年龄57.0岁。选择同期无HF者25例作为对照组,其中男性12例,女性13例;年龄45~65岁,平均年龄54.0岁。按照肝组织纤维化分期评分(METAVIR评分)系统将HF组分为S1~S4级,对照组为S0级;所有受试者均行肝脏常规及功能性MRI检查。采用GE AW4.6工作站Functool软件进行图像后处理,并以受试者穿刺部位为感兴趣区测量相关参数,获得IVIM(standard-ADC、Dslow、Dfast、PF)、DKI(MK、MD、Ka、Kr、FA、FAk)及IDEAL-IQ(R2*、FF)参数值。利用单因素方差分析和组间多重比较进行组间各参数值的比较;采用Spearman相关性分析评价各组病理分级与各参数值的相关性,并利用受试者工作特性(ROC)曲线评价各参数值对HF病理分级的诊断效能。结果HF组不同病理分级间DKI、IVIM及IDEAL-IQ参数值差异均有统计学意义(P<0.05);而Kr、Dslow值组间差异无统计学意义(P>0.05)。除Ka值外,上述指标均与HF病理分级具有相关性;其中IVIM参数(standard-ADC、Dfast、PF)与HF病理分级呈较强负相关(r值分别为-0.819、-0.780、-0.824,P<0.05);IDEAL-IQ相关参数(FF、R2*)则呈明显正相关(r值分别为0.907、0.918,P<0.05)。PF值诊断≥S1级HF(ROC曲线下面积为0.882)、Dfast值诊断≥S2/S3级HF(ROC曲线下面积分别为0.869、0.854)、FF值诊断S4级HF(ROC曲线下面积为0.883)的诊断效能优于其他参数。结论IVIM、DKI及IDEAL-IQ功能性MRI技术能定量评估HF病理分级。PF值有助于≥S1级HF的早期诊断,其有潜力成为预测早期HF的量化指标;Dfast值有助于早、中期HF的诊断,FF值能够为评估末期HF的严重程度提供依据。
Objective To explore the value of multi-parameter functional magnetic resonance imaging(fMRI)[intravoxel incoherent motion(IVIM),diffusion kurtosis imaging(DKI)and iterative decomposition of water and fat with echo asymmetry and least-squares estimation-image quantification(IDEAL-IQ)]in grading diagnosis of hepatic fibrosis(HF).Methods A total of 43 HF patients were enrolled as HF group,which included 23 males and 20 females,aged 45-65 years old with mean age of 57.0 years old.Twenty-five patients without HF were set as control group,which included 12 males and 13 females,aged 45-65 years old with mean age of 54.0 years old.According to METAVIR score(liver tissue fibrosis staging score)system,the HF group was classified as S1-S4,and control group was classified as S0.All of them performed routine and functional MRI examinations of liver.The Functool software of GE AW4.6 workstation was used for image post-processing,and relevant parameters were measured with puncture site as region of interest to obtain parameter values of IVIM[standard apparent diffusion coefficient(standard-ADC),slow ADC(Dslow),fast ADC(Dfast),perfusion fraction(PF)],DKI[mean kurtosis(MK),mean diffusion(MD),kurtosis anisotropy(Ka),radial kurtosis(Kr),fractional anisotropy(FA),fractional anisotropy kurtosis(FAk)and IDEAL-IQ[(R2*,fat fraction(FF)].The univariate variance analysis and multiple comparisons between groups were used to compare each parameter value of different groups.The Spearman correlation analysis was used to evaluate correlation between pathological grading of each group and different parameters,and diagnostic efficacy of each parameter on pathological grading of HF were evaluated by receiver operating characteristic(ROC)curve.Results The DKI,IVIM and IDEAL-IQ parameter values were significantly different in different pathological gradings of HF group(P<0.05),while Kr and Dslow values were no significantly different be-tween 2 groups(P>0.05).The above indicators were all related to pathological grading of HF except for Ka,among those indicators IVIM parameters(standard-ADC,Dfast,PF)were strongly negatively correlated with HF pathological grading(r=-0.819,-0.780,-0.824,P<0.05);IDEAL-IQ related parameters(FF,R2*)were significantly positively correlated with HF pathological grading(r=0.907,0.918,P<0.05).The diagnostic efficiency of PF diagnosis≥S1 HF(area under ROC curve=0.882),Dfast diagnosis≥S2/S3 HF(area under ROC curve=0.869,0.854),and FF diagnosis S4 HF(area under ROC curve=0.883)were better than other parameters.Conclusion It is demonstrated that IVIM,DKI and IDEAL-IQ technology could quantitatively evaluate pathological staging of HF.PF contributes to the early diagnosis of HF(≥S1),which has potential to be the quantitative biomarker for predicting early HF.Dfast helps in early and mid-stage diagnosis of HF,and FF could provide valuable basis for evaluating severity of terminal-stage HF.
作者
陆婧
陈文
陈悦
孙敏
王婧婧
田由由
郑克华
王克军
LU Jing;CHEN Wen;CHEN Yue;SUN Min;WANG Jing-jing;TIAN You-you;ZHENG Ke-hua;WANG Ke-jun(Center of Medical Imaging,Taihe Hospital,Hubei University of Medicine,Shiyan 442000,Hubei,China;Center of Liver,Taihe Hospital,Hubei University of Medicine,Shiyan 442000,Hubei,China;Department of General Surgery IV,Taihe Hospital,Hubei University of Medicine,Shiyan 442000,Hubei,China)
出处
《生物医学工程与临床》
CAS
2021年第6期730-737,共8页
Biomedical Engineering and Clinical Medicine
基金
湖北陈孝平科技发展基金会肝胆胰恶性肿瘤研究基金(CXPJJH11800001-2018333)。
