金　军，汤小俐，香　辉，王小宜

（1.广东省深圳市南山区蛇口人民医院放射科，广东 深圳 518067；2.甘肃省兰州市西固区兰州石化总医院西区放射科，甘肃 兰州730060；3.中南大学湘雅医院放射科，湖南 长沙 410008）



DWI和超声瞬时弹性成像在肝纤维化诊断中的价值

金军1，汤小俐1，香辉2，王小宜3

（1.广东省深圳市南山区蛇口人民医院放射科，广东 深圳 518067；2.甘肃省兰州市西固区兰州石化总医院西区放射科，甘肃 兰州730060；3.中南大学湘雅医院放射科，湖南 长沙 410008）

目的：对比DWI和超声瞬时弹性成像（Fibroscan，FS）对肝纤维化的诊断价值。方法：对37例肝纤维化患者（研究组）及23例健康志愿者（正常对照组）行DWI（b=0、600 s/mm2）扫描，并测量ADC值；2组同时行FS检查，检测指标为肝脏弹性测量值（liver stiffness measurement，LSM）。分析并对比不同组间ADC值和LSM的变化规律。结果：LSM随肝脏纤维化分期（从S1～S4期）逐步呈升高趋势，而ADC值则呈降低趋势（P＜0.01）。肝纤维化各组与正常对照组间比较差异均有统计学意义，肝纤维化各组组间比较差异均有统计学意义。结论：在肝纤维化定量中，DWI和FS均具备一定的检测能力。在诊断肝纤维化敏感度方面，FS高于DWI；而在特异度方面，DWI优于FS，两者皆可检测重度肝纤维化及肝硬化。

肝硬化；磁共振成像，弥散；弹性成像技术

［Abstract］Objective：To investigate the value of diffusion weighted imaging（DWI）and Fibroscan（FS）in diagnosis of liver fibrosis.Methods：Thirty-five hepatic fibrosis patients and 21 normal controls received DWI scan（b1=0 s/mm2，b2=600 s/mm2），ADC value of different fibrosis stages was measured，while 33 patients and all 21 normal controls received FS.The liver stiffness measurement（LSM）achieved in 10 successful FibroScan examinations was taken as Fi-brosan index.Analysis of variances was performed to compare the difference among the groups in both examinations.Results：The LSM was gradually increased from the liver fibrosis stage S0 to S4，while the mean ADC value decreased as the severity of liver fibrosis increased （P＜0.01）.There were significant differences between control group and liver fibrosis groups，and the difference among fibrosis groups were also significant.Conclusion：In liver fibrosis quantitative evaluation，DWI and FS can all have a certain detection ability.Sensitivity of FS is higher than DWI，while specificity of DWI is superior to FS.At the same time，DWI and FS can detect severe liver fibrosis and cirrhosis of the liver.

［Key words］Liver cirrhosis；Diffusion magnetic resonance imaging；Elasticity imaging techniques

肝纤维化是一种纤维结缔组织异常沉积于肝脏的病理过程，若持续发展则可造成肝小叶改建伴结节形成，最终转变为肝硬化［1］。肝纤维化是一种可逆性病变，而肝硬化则相反。所以，在慢性肝病的诊断及治疗过程中，早期诊断肝纤维化并准确分期非常重要［2］。……