本文選題：肝功能衰竭 + 磁共振成像�。� 參考：《西南醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:探討肝臟磁共振成像對(duì)慢性乙型病毒性肝炎所致慢加急性肝衰竭的評(píng)估價(jià)值。方法:收集我院2015年1月至2016年1月符合標(biāo)準(zhǔn)的病例39例,包括慢加急性肝衰竭患者28例、慢性肝炎患者11例,同時(shí)收集正常對(duì)照組14例。分別對(duì)其進(jìn)行3.0T肝臟磁共振檢查,檢查序列包括Dual FFE、TSE/T2WI/SPAIR、THRIVE、DWI、m-GRASE和VEN-BOLD序列,并分別計(jì)算出相應(yīng)的影像指標(biāo)(rSⅠ、rSⅡ、SⅢT2WI、SⅡTHRIVE、ADC值、T2值或R2值、SⅡSWI)。同時(shí)收集病例組磁共振檢查前后2天內(nèi)血液生化指標(biāo)。采用單因素方差分析或非參數(shù)秩和檢驗(yàn)分析三組間各影像指標(biāo)的組間差異,采用Spearman秩相關(guān)分析各影像指標(biāo)與三組肝功能等級(jí)的相關(guān)性,采用接受者工作特性(ROC)曲線評(píng)價(jià)部分影像指標(biāo)對(duì)慢加急性肝衰竭的診斷效能。結(jié)果:三組間rSⅠ、SⅡT2WI、ADC值、T2/R2值及SⅡSWI的差異有統(tǒng)計(jì)學(xué)意義。rSⅠ、SⅡT2W1及T2值隨著肝功能損害的加重而升高,其秩相關(guān)系數(shù)分別為0.410、0.370和0.637, ADC值、R2及SⅡSWI隨著肝功能損害的加重而降低,其秩相關(guān)系數(shù)分別為-0.505、-0.637和-0.455,余rSⅡ及SⅡTHRIVE與三組肝功能等級(jí)無相關(guān)性。兩兩比較顯示:R2值及ADC值能同時(shí)區(qū)別正常對(duì)照組與慢加急性肝衰竭組及肝炎組與慢加急性肝衰竭組;rSⅠ、SⅡT2WI及SⅡSWI僅能區(qū)別正常對(duì)照組與慢加急性肝衰竭組。ROC曲線示T2診斷慢加急性肝衰竭曲線下面積=0.863,P=0.000,最佳診斷界點(diǎn)57.73ms (R2 =0.0173)。ADC值診斷慢加急性肝衰竭曲線下面積=0.794,P =0.001,最佳診斷界點(diǎn)ADC=1.1261×10-3mm2/s,但該診斷截值與慢性肝炎組ADC值平均值明顯重疊。刪除慢性肝炎組后ROC曲線顯示,rSⅠ、SⅡT2WI及SⅡSWI診斷慢加急性肝衰竭的曲線下面積分別為0.799、0.737、0.798, P值分別為0.002、0.013、0.003,診斷截值分別為1.5786、0.9856、0.5871。五個(gè)影像指標(biāo)中任意兩個(gè)指標(biāo)之一陽性時(shí),診斷為慢加急性肝衰竭的敏感性提高的范圍為:86.74%至99.19%;當(dāng)五個(gè)影像指標(biāo)中任意兩個(gè)影像指標(biāo)同時(shí)陽性時(shí),診斷慢加急性肝衰竭其特異性提高的范圍為:92.85%至100%。T2與INR、PT及HA呈中度正相關(guān)(rs=0.651、0.666、0.390, P=0.000、0.000、0.025),與PTA、ALB、PA呈中度負(fù)相關(guān)(rs=-0.667、-0.480、-0.373, P=0.000、0.004、0.030),余各影像指標(biāo)只與少部分實(shí)驗(yàn)室指標(biāo)有相關(guān)性。結(jié)論:(1) rSⅠ、SⅡT2WI、SⅡSWI、ADC圖及T2圖均可較好的反映肝臟功能情況,其中T2/R2值對(duì)肝功能的評(píng)估效果較好,SⅡTHRIVE不能反映肝臟的功能狀態(tài);(2) R2值及ADC值能同時(shí)區(qū)別正常對(duì)照組與慢加急性肝衰竭組及肝炎組與慢加急性肝衰竭組,其中,慢加急性肝衰竭的ADC值診斷截值與慢性肝炎組有明顯重疊,故其運(yùn)用價(jià)值有限。(3) rSⅠ、SⅡT2WI及SⅡSWI僅能區(qū)別正常對(duì)照組與慢加急性肝衰竭組,但聯(lián)合運(yùn)用兩個(gè)或多個(gè)影像指標(biāo)可增加肝衰竭的診斷敏感性或特異性。(4) T2或R2值能夠較好的診斷或預(yù)測(cè)慢加急性肝衰竭,并且與較多的實(shí)驗(yàn)室指標(biāo)均均有相關(guān)性,可作為定量評(píng)估慢性肝炎肝臟功能的理想指標(biāo)之一。
[Abstract]:Objective: To evaluate the value of liver magnetic resonance imaging (MRI) for chronic hepatitis B caused by chronic hepatitis B and acute liver failure. Methods: 39 cases were collected from January 2015 to January 2016 in our hospital, including 28 patients with chronic acute liver failure, 11 cases of chronic hepatitis, and 14 cases of normal control group. The 3.0T liver was carried out respectively. The examination sequence included Dual FFE, TSE/T2WI/SPAIR, THRIVE, DWI, m-GRASE and VEN-BOLD sequences, and calculated the corresponding image indexes (rS I, rS II, S III T2WI, S II). The difference between the three groups of the three groups was analyzed by the nonparametric rank sum test. The correlation between the image indexes and the three groups of liver function grades was analyzed by the Spearman rank correlation analysis. The diagnostic efficiency of the partial image index for the chronic acute liver failure was evaluated by the receiver working characteristic (ROC) curve. Results: the three groups were rS I, S II T2WI, ADC value, T2/R2 value and the value of T2/R2 value. The difference of S II SWI was statistically significant.RS I, S II T2W1 and T2 value increased with the aggravation of liver function damage, and its rank correlation coefficients were 0.410,0.370 and 0.637, ADC value, R2 and S II SWI decreased with the aggravation of liver function damage. No correlation. 22 comparison showed that R2 and ADC values can distinguish between normal control group and chronic acute liver failure group and hepatitis group and chronic acute liver failure group. RS I, S II T2WI and S II SWI can only distinguish between normal control group and slow addition acute liver failure group,.ROC curve shows T2 diagnosis slow plus acute liver failure curve area =0.863, P=0.000, the best. The diagnostic boundary point 57.73ms (R2 =0.0173).ADC value was diagnosed as =0.794, P =0.001, and the best diagnostic point ADC=1.1261 x 10-3mm2/s under the curve of slow plus acute liver failure, but the diagnostic value overlapped with the average value of ADC in the chronic hepatitis group. The area under the line was 0.799,0.737,0.798, and the P value was 0.002,0.013,0.003 respectively. When the diagnostic cut-off value was one of the two indexes of 1.5786,0.9856,0.5871. five, the sensitivity of the diagnosis of slow and acute liver failure was 86.74% to 99.19%, while any two of the five image indexes was simultaneous. When the diagnosis was positive, the range of specific enhancement in the diagnosis of slow and acute hepatic failure was: 92.85% to 100%.T2 and INR, PT and HA had moderate positive correlation (rs=0.651,0.666,0.390, P=0.000,0.000,0.025), and had moderate negative correlation with PTA, ALB, PA (rs=-0.667, -0.480, -0.373,). Conclusion: (1) rS I, S II T2WI, S II SWI, ADC map and T2 map can better reflect the liver function, and T2/R2 value is better for evaluating liver function, S II THRIVE can not reflect the liver function state; (2) R2 value and ADC value can simultaneously distinguish between normal control group and chronic acute liver failure group and hepatitis group and chronic acute liver failure group. The value of ADC value diagnosis of slow and acute liver failure overlapped with chronic hepatitis, so its application value is limited. (3) rS I, S II T2WI and S II SWI can only distinguish between normal control group and chronic acute liver failure group, but combined use of two or more imaging indicators can increase the diagnostic sensitivity or specificity of liver failure. (4) T2 or R2 value can be used. Better diagnosis or prediction of chronic acute liver failure, and the correlation with many laboratory indicators, can be used as one of the ideal indicators for quantitative evaluation of liver function in chronic hepatitis.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R512.62;R575.3;R445.2

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