顾均玉　赵虹　张晶　林锦仕　林晓瑞　贝金玲

【摘要】 目的：比较多回声T2*加權序列与扩散加权成像（DWI）鉴别慢性肝病病患纤维化阶段的效力。方法：选取慢性肝病肝纤维化患者42例为试验组，24名健康成人志愿者为对照组。均进行MRI检查，比较肝纤维化各阶段的肝T2*值与ADC值，分析T2*值和ADC值对S1～4期纤维化分期的诊断效果，以及T2*值和ADC值在预测纤维化0期患者出现纤维化1期或更高阶段（≥S1），纤维化1期和以下患者出现2期或更高阶段（≥S2），纤维化2期或以下患者出现3期或更高阶段（≥S3）的效力。结果：每个纤维化阶段的T2*值和ADC值在2～4期均有明显的重叠，纤维化期和T2*及ADC值均呈显著正相关（r=0.389、0.665，P<0.001），T2*值和ADC值在不同纤维化阶段比较差异均有统计学意义（H=19.904、28.954，P<0.001）;ROC分析显示，T2*值和ADC值的AUC分别为0.814和0.762，比较差异有统计学意义（P<0.001），且与ADC值比较，T2*值在区分≥S1、≥S2、≥S3时的AUC值均有更好的表现（P<0.05），另外在识别≥S1期时，T2*值和ADC值的AUC、敏感性和特异性为0.988、100%和89.7%。结论：多回声呼吸控制T2*加权梯度回波序列对肝纤维化期的快速、无创和准确评估有重要意义，可以作为一种技术用于判定抗病毒治疗和监测慢性肝炎患者的治疗反应，并替代部分患者的肝活检。

【关键词】 慢性肝炎; 纤维化; 肝脏; 多回声T2*加权序列; 扩散加权成像

【Abstract】 Objective：To compare the effectiveness of multiple echo T2* weighted sequence and diffusion weighted imaging（DWI）in differentiating fibrosis stage in chronic liver disease.Method：A total of 42 patients with chronic liver disease and liver fibrosis were selected as experimental group and 24 healthy adult volunteers as control group.They all underwent MRI examinations.The value of hepatic T2* and ADC in different stages of hepatic fibrosis were compared，the diagnostic effect of T2* and ADC values on stage S1-4 fibrosis were analyzed，and the effectiveness of T2* and ADC values in predicting patients with fibrosis stage 0 had stage 1 or higher（≥S1），patients with fibrosis stage 1 and below had stage 2 or higher（≥S2），patients with fibrosis stage 2 or below have stage 3 or higher（≥S3）.Result：The value of T2* and ADC in each stage of fibrosis overlapped significantly in 2-4 stages，and there was a significant positive correlation between the value of T2* and ADC in fibrosis stage（r=0.389，0.665，P<0.001），the T2* and ADC values at different stages of fibrosis were compared，the differences were statistically significant（H=19.904，28.954，P<0.001）.ROC analysis showed that the AUC values of T2* and ADC were 0.814 and 0.762 respectively，the difference was statistically significant（P<0.001），compared with ADC value，T2* value has better performance in AUC value when distinguishing between ≥S1，≥S2，≥S3（P<0.05），in addition，the AUC，sensitivity and specificity of T2* and ADC values were 0.988，100% and 89.7% for stage ≥S1.Conclusion：Multi-echo breath-controlled T2* weighted gradient echo sequence is important for rapid，non-invasive and accurate assessment of hepatic fibrosis.It can be used as a technique to determine antiviral therapy and monitor the response of patients with chronic hepatitis，and to replace liver biopsy in some patients.

【Key words】 Chronic hepatitis; Fibrosis; Liver; Multiple echo T2* weighted sequence; Diffusion weighted imaging

First-authors address：Zhuhai Integrated Traditional Chinese and Western Medicine Hospital，Zhuhai 519000，China

doi：10.3969/j.issn.1674-4985.2019.04.004

慢性乙型肝炎和丙型肝炎病毒感染患者发生肝纤维化和肝硬化的风险较高，易导致终末期肝病和肝细胞癌。在慢性肝病患者中，准确测定纤维化阶段是评估治疗需要和反应的关键[1-2]。目前肝活检是肝硬化诊断和分类的黄金标准。然而在实践中，有限的取样位置、出血和感染的可能性是肝臟活检的主要缺点。因此，对肝硬化的误诊率会人为增加[3]。磁共振成像的优点是无创、无辐射、快速，此外磁共振的高空间分辨率也为软组织的结构提供更好的成像。肝纤维化会导致胶原蛋白、糖胺聚糖和蛋白聚糖的细胞外聚集，从而限制水分子的扩散，所以，扩散加权成像（DWI）可能对评估纤维化有所帮助。同时，肝纤维化的变化程度对肝脏的生物结构有明显的改变，这会反映在T2弛豫率上。……