吴李贤 王文佳 汤曦 洪居陆 陈永凤 白红莲 徐慧娟

【摘要】目的 以MRI多回波水脂分離技术（IDEAL-IQ）为评判标准， 分析探讨FibroTouch 受控衰减参数对肝脏脂肪变性的诊断价值。方法 选取健康体检的受试者作为观察对象，以MRI IDEAL-IQ为评判标准，分析FibroTouch 受控衰减参数对轻、中、重度脂肪肝的诊断价值及定量分析的准确性。结果 共纳入104名受试者，男女比例为2.47∶1，年龄为（41.6±12.2）岁， 脂肪衰减参数为（288.2±5.1）dB/m。经FibroTouch诊断为脂肪肝患者、中度和重度脂肪肝患者、重度脂肪肝患者分别为82、66、50例，检出率分别为78.8%、63.5%、48.1%。经MRI IDEAL-IQ诊断为脂肪肝患者、中度和重度脂肪肝患者、重度脂肪肝患者分别为82、51、11例，检出率分别为78.8%、49.0%、10.6%。根据FibroTouch相对于MRI IDEAL-IQ的ROC曲线，计算出曲线下面积为0.956、0.956、0.839（P均< 0.01），截断值分别为264.5、300.2、327.0。结论 FibroTouch 受控衰减参数在脂肪肝的定性和定量诊断方面，同MRI IDEAL-IQ一样有较高的诊断价值，是经济、可重复性高的无创性检查方法，有望成为脂肪肝筛查和治疗后复查的首选方法。

【关键词】核磁共振;FibroTouch;脂肪肝;多回波水脂分离技术

【Abstract】Objective To evaluate the diagnostic value of FibroTouch controlled attenuation parameters for hepatic steatosis with MRI IDEAL-IQ sequence as the criterion.  Methods The subjects receiving physical examination were recruited in this study. Regarding MRI IDEAL-IQ sequence as the assessment criterion， the diagnostic value and the accuracy of quantitative analysis of FibroTouch controlled attenuation parameters for moderate and severe hepatic steatosis were analyzed.  ResultsA total of 104 subjects were recruited with a male-to-female ratio was 2.47∶1， aged （41.6±12.2） years on average， and the fat attenuation parameter was （288.2±5.1） dB/m. The number of patients diagnosed with fatty liver， moderate or severe fatty liver and severe fatty liver by FibroTouch was 82， 66 and 50， respectively. The diagnostic rates were calculated as 78.8%， 63.5%and 48.1%， respectively. The number of patients diagnosed with fatty liver， moderate or severe fatty liver and severe fatty liver by MRI IDEAL-IQ was 82， 51 and 11， respectively. The diagnostic rates were 78.8%， 49.0% and 10.6%， respectively. Compared with the ROC curve of MRI IDEAL-IQ，the areas under the curve of ROC were 0.956，0.956 and 0.839（all P < 0.01）， respectively. The cut-off values were 264.5， 300.2 and 327.0， respectively.  Conclusions FibroTouch controlled attenuationparamaters have similar diagnostic value in terms of qualitative and quantitative diagnosis of fatty liver with MRI IDEAL-IQ. FibroTouch is an economical and reproducible noninvasive examination method， which may become the optimal option after the screening and treatment of fatty liver.

【Key words】Magnetic resonance imaging;FibroTouch;Fatty liver;

Iterative decomposition of water and fat with echo asymmetry and least-squares

estimation quantitation sequence

非酒精性脂肪性肝病（NAFLD）是临床常见病，全球成人NAFLD 的患病率在6.3% ～ 45.0%，非酒精性脂肪性肝炎（NASH）占10% ～ 30%。其中中东地区和南美洲NAFLD患病率最高，非洲最低，中国在内的亚洲多数国家NAFLD患病率高于25%[1]。上海、北京等地区的流行病学调查结果显示，近10年NAFLD患病率从15%增加到31%[2]。影像学诊断及肝脏组织活检是目前国际公认的两种诊断标准。肝脏组织活检是脂肪肝诊断的“金标准”，但因其有创伤等因素，临床工作中无法广泛推广。MRI多回波水脂分离技术（IDEAL-IQ）通过一次屏息内快速完成全肝脂肪含量的测定，已成为肝脏组织活检的替代金标准，但其价格昂贵。最新的成像技术FibroTouch通过B超影像引导准确定位，可以无创而且定量的评估肝脏脂肪变性的程度。FibroTouch作为脂肪肝检测手段，不但操作简单方便，而且实现了诊断结果的量化分级。……