摘要
目的 对比分析体素内不相干运动(intravoxel incoherent motion,IVIM)和扩散峰度成像(diffusion kurtosis imaging,DKI)在肝纤维化分期中的应用价值。材料与方法 前瞻性纳入来我院就诊慢性肝病患者64例,同期招募健康对照组17例,所有受试者均行多b值扩散加权成像(diffusion‑weighted imaging,DWI)和肝脏瞬时弹性成像(transient elastography,TE)检查,慢性肝病患者随后经肝组织穿刺活检病理确定肝纤维化分期。多b值DWI检查经后处理,得到DKI和IVIM两种扩散模型共计5组参数图,获取相应5个参数值平均扩散系数(apparent diffusivity,MD)、扩散峰度(excess kurtosis,MK)、单纯扩散系数(true diffusion coefficient,D)、微循环灌注系数(pseudo-diffusion coefficient,D^(*))和灌注分数(perfusion fraction,f),TE检查获得肝脏硬度值(liver stiffness measurement,LSM)。分析不同肝纤维化分期组间参数差异、DKI及IVIM各参数与LSM的相关性,以及DKI、IVIM联合TE参数对显著肝纤维化(significant fibrosis,SF)(≥S2期)的诊断效能。结果 5个参数(MK、MD、f、D及D^(*))中仅IVIM的D值在不同组间差异具有统计学意义(P=0.029)。参数D(ρ=-0.270,P=0.031)、f(ρ=-0.288,P=0.021)、MD(ρ=-0.278,P=0.026)与LSM呈负相关关系。单一影像参数对SF分期具有中度诊断效能[受试者工作特征曲线下面积(area under the curve,AUC)为0.537~0.627],IVIM模型对SF分期的AUC为0.714[95%置信区间(confidence interval,CI):0.598~0.831],DKI模型对SF分期的AUC为0.717(95%CI:0.597~0.836),IVIM-TE融合模型对SF分期的AUC为0.897(95%CI:0.825~0.970),DKI-TE融合模型对SF分期的AUC为0.901(95%CI:0.825~0.978),显著优于单一DWI模型的诊断效能(P<0.001)。校准曲线显示IVIM-TE融合模型拟合度最优。结论 DKI和IVIM尚不能单独用于肝纤维化无创性分期,IVIM-TE融合模型在SF分期中具有较好的临床价值,DWI与超声瞬时弹性成像的融合或可成为诊断SF的潜在生物学标志物。
Objective:This study aimed to compare the application value of intravoxel incoherent motion(IVIM)and diffusion kurtosis imaging(DKI)in the staging diagnosis of liver fibrosis.Materials and Methods:A total of 64 patients with chronic liver disease and 17 healthy controls were prospectively enrolled.All participants underwent multi‑b‑value diffusion‑weighted imaging(DWI)and liver transient elastography(TE).Liver fibrosis stage was confirmed by subsequent liver biopsy in patients.The DWI data were post‑processed to generate five parameter maps derived from DKI and IVIM models,yielding the parameters apparent diffusivity(MD),excess kurtosis(MK),true diffusion coefficient(D),pseudo-diffusion coefficient(D^(*))and perfusion fraction(f).TE provided liver stiffness measurement(LSM).Biopsy results served as the gold standard for fibrosis staging.We analyzed parameter differences across fibrosis stages,correlations between DKI/IVIM parameters and LSM,and the diagnostic performance of combined DKI,IVIM,and TE parameters for significant fibrosis(≥S2).Results:Among all parameters,only D showed statistically significant differences across groups(P=0.029).D(ρ=−0.270,P=0.031),f(ρ=−0.288,P=0.021),and MD(ρ=−0.278,P=0.026)were negatively correlated with LSM.Individual imaging parameters demonstrated moderate diagnostic efficacy for significant fibrosis,with area under the curve(AUC)of receiver operating characteristic ranging from 0.537 to 0.627.The IVIM model achieved an AUC of 0.714[95%confidence interval(CI):0.598 to 0.831]for diagnosing significant fibrosis,and the DKI model reached an AUC of 0.717(95%CI:0.597 to 0.836).Fusion models combining IVIM with TE and DKI with TE showed significantly higher diagnostic performance,with AUCs of 0.897(95%CI:0.825 to 0.970)and 0.901(95%CI:0.825 to 0.978),respectively(P<0.001 vs.single DWI models).Calibration curves indicated that the IVIM‑TE fusion model had the best calibration performance.Conclusions:DKI and IVIM alone are insufficient for non‑invasive diagnosis and staging of liver fibrosis.However,the IVIM‑TE fusion model demonstrates promising clinical value for diagnosing significant fibrosis.Integrating multiple imaging modalities may serve as a potential biomarker for significant fibrosis assessment.
作者
杨树义
赵雪莲
赵丽晨
姜艳丽
YANG Shuyi;ZHAO Xuelian;ZHAO Lichen;JIANG Yanli(Department of Radiology,Zhouqu County People's Hospital,Gannan Tibetan Autonomous Prefecture 746300,China;Second Clinical School,Lanzhou University,Lanzhou 730000,China;Department of Magnetic Resonance,Lanzhou University Second Hospital,Lanzhou 730030,China)
出处
《磁共振成像》
北大核心
2026年第2期94-100,共7页
Chinese Journal of Magnetic Resonance Imaging
关键词
肝纤维化
磁共振成像
扩散加权成像
体素内不相干运动
扩散峰度成像
超声瞬时弹性成像
hepatic fibrosis
magnetic resonance imaging
diffusion‑weighted imaging
intravoxel incoherent motion
diffusion kurtosis imaging
transient elastography
