本文選題：非酒精性脂肪性肝病 + 磁共振波譜成像　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的本研究主要目的是利用六回波Dixon技術(shù)、HISTO技術(shù)及肝活檢三種方法量化分析非酒精性脂肪性肝病(Nonalcoholic fatty liver disease,NAFLD)患者肝內(nèi)脂肪沉積及鐵沉積情況,評(píng)估三者之間的相關(guān)性,探討非酒精性脂肪肝患者使用非侵入性方法定量分析肝臟脂肪變性及鐵沉積的可行性。方法選取30名到我院就診的NAFLD患者,患者中26例為男性患者,4例為女性患者,在行肝活檢前使用西門(mén)子3.0T MR設(shè)備進(jìn)行六回波Dixon序列及HISTO序列掃描肝臟,HISTO序列會(huì)自動(dòng)根據(jù)掃描前選擇的感興趣區(qū)繪制曲線(xiàn)并計(jì)算曲線(xiàn)下面積,得出目標(biāo)區(qū)域脂肪含量及R2值。六回波Dixon序列測(cè)量區(qū)域選擇肝右葉Ⅴ、Ⅵ段,盡可能避免血管和膽管進(jìn)入選擇區(qū),在得到的脂肪分?jǐn)?shù)圖和R2*弛豫圖中分別測(cè)定脂肪分?jǐn)?shù)(HFF)及鐵含量相對(duì)值(R2*),且測(cè)量的興趣區(qū)位置與面積與HISTO盡量一致。同時(shí)進(jìn)行肝穿刺病理檢查,根據(jù)組織學(xué)檢查測(cè)定脂肪含量及鐵含量,其中脂肪含量使用NASH標(biāo)準(zhǔn)將肝脂肪變性分級(jí)由0級(jí)到3級(jí)。0級(jí)脂肪變比例小于5%,1級(jí)輕度脂肪變?yōu)?%-33%之間,2級(jí)中度脂肪變?yōu)?3%-66%,重度3級(jí)脂肪變?yōu)?6%以上。并以此做為金標(biāo)準(zhǔn),使用單因素方差分析HISTO(HFF)及六回波Dixon序列(HFF)不同病理等級(jí)下肝臟脂肪分?jǐn)?shù)的均數(shù)差異性;同時(shí)應(yīng)用Spearman相關(guān)分析六回波Dixon技術(shù)及HISTO技術(shù)對(duì)肝臟脂肪堆積及鐵過(guò)載的量化測(cè)定與病理測(cè)定值間的相關(guān)性,并探討HISTO序列與六回波Dixon序列兩種方法測(cè)定值的準(zhǔn)確性差異。結(jié)果此項(xiàng)實(shí)驗(yàn)中包含30名NAFLD患者,平均年齡為46.4± 13.7歲(25-80歲),根據(jù)肝組織學(xué)評(píng)估,共有15名患者為1級(jí)(輕度脂肪變性),7名為2級(jí)(中度脂肪變性),2名為3級(jí)(重度脂肪變性),6名為FO級(jí)(無(wú)脂肪變性),病理測(cè)得平均脂肪變性百分?jǐn)?shù)為23.1%±22.0%(中位12.1%,范圍1.6%-78.8%),平均肝臟鐵沉積量為22.3μmol/g±7.2μmol/g(中位 21.1μmol/g,范圍 10.8μmol/g-38.4μmol/g)。肝活檢和 MRI檢查的中位間隔時(shí)間為21天(0-46天)。HISTO序列測(cè)得平均肝內(nèi)脂肪分?jǐn)?shù)為8.6%±7.0%(中位5.0%,范圍 0.6%-27.6%),平均R2值為 34 9±6.7s-1(中位34.5 s-1,20.4 s-1-50.8 s-1),六回波Dixon序列測(cè)得平均肝內(nèi)脂肪分?jǐn)?shù)8.2%± 7.1%(中位5.4%,范圍0.7%-24.9%),平均 R2*值為 47.3 s-1±11.9 s-1(中位 47.0 s-1,20.6 s-1-73.4 s-1)。在不同病理級(jí)別間HISTO序列與六回波Dixon序列測(cè)得肝內(nèi)脂肪分?jǐn)?shù)均數(shù)的差異均有統(tǒng)計(jì)學(xué)意義(F值分別為24.817,24.254,p值均0.05),且病理級(jí)別越高,兩種方法測(cè)得的HFF值也隨之升高。HISTO及六回波Dixon序列測(cè)得肝內(nèi)脂肪分?jǐn)?shù)與病理測(cè)定脂肪變性百分度有良好的相關(guān)性(r=0.901,p0.05;r=0.855,p0.05),HISTO測(cè)得R2值及六回波DIXON測(cè)得R2*值與病理鐵含量有良好的相關(guān)性(r=0.636,p0.05;r=0.502,p0.05),并且HISTO序列與組織學(xué)脂肪定量及鐵沉積量相關(guān)性略?xún)?yōu)于DIXON序列。結(jié)論兩種方法測(cè)得肝內(nèi)脂肪分?jǐn)?shù)與組織學(xué)脂肪變性百分?jǐn)?shù)有良好的相關(guān)性,HISTO技術(shù)測(cè)得R2值及六回波DIXON技術(shù)測(cè)得R2*值分別與病理鐵沉積量之間具有一定相關(guān)性,且HISTO序列與組織學(xué)脂肪定量及鐵沉積量相關(guān)性均略?xún)?yōu)于DIXON序列。在不同病理級(jí)別間HISTO序列與六回波Dixon序列測(cè)得肝內(nèi)脂肪分?jǐn)?shù)均數(shù)的差異均有統(tǒng)計(jì)學(xué)意義。
[Abstract]:The purpose of this study was to quantify the intrahepatic fat deposition and iron deposition in patients with non-alcoholic fatty liver disease (Nonalcoholic fatty liver disease, NAFLD) by using six echo Dixon techniques, HISTO technique and liver biopsy, and to evaluate the correlation between the three and non-alcoholic fatty liver patients. Methods to analyze the feasibility of hepatic steatosis and iron deposition. Methods 30 NAFLD patients in our hospital were selected, 26 were male patients and 4 were female patients. Before liver biopsy, the SIEMENS 3.0T MR equipment was used for six echo Dixon sequence and HISTO sequence scanning of the liver. The HISTO sequence would be automatically selected before the scan. The area in the region of interest was plotted and the area under the curve was calculated. The fat content and R2 value of the target area were obtained. Six echo Dixon sequence was used to measure the right lobe of the liver to select the V, VI segment, and to avoid the entry of the blood vessels and bile ducts into the selected area. The fat fraction (HFF) and the relative value of iron content (R2*) were determined respectively in the obtained fat fraction and the R2* relaxation map, and the measurement of the relative value of the iron content (R2*) was also measured. The location and area of the area of interest were the same as that of HISTO. At the same time, the liver biopsy was performed and the fat content and iron content were measured according to the histological examination. The fat content used NASH standard to make the liver fatty degeneration grade from grade 0 to grade 3.0 fat less than 5%, 1 grade mild fat into 5%-33%, and 2 grade medium fat to 33%- 66%, severe 3 fat became more than 66%, and used as the gold standard, using single factor analysis of variance analysis HISTO (HFF) and six echo Dixon sequence (HFF) the difference of liver fat fraction in different pathological grades, and Spearman correlation analysis six echo Dixon technology and HISTO technique for quantitative determination of liver fat accumulation and iron overload The correlation between the measured values and the diagnostic value of the HISTO sequence and the two methods of the six echo Dixon sequence. Results the experiment included 30 NAFLD patients with an average age of 46.4 + 13.7 years (25-80 years old). According to the liver histology, 15 patients were grade 1 (mild fatty degeneration), 7 was moderately fatty (moderate fatty change). The average fat denaturation percentage was 23.1% + 22% (median 12.1%, range 1.6%-78.8%), and the average liver iron deposition was 22.3 u mol/g + 7.2 mu mol/g (median 21.1 u mol/g, range 10.8 mol/g-38.4 mol/g). The median interval time of liver biopsy and MRI examination was 2. The average intrahepatic fat fraction was 8.6% + 7% (median 5%, range 0.6%-27.6%) for 21 days (0-46 days).HISTO sequence, and the average R2 value was 349 + 6.7s-1 (median 34.5 s-1,20.4 s-1-50.8 s-1). The average intrahepatic fat fraction was 8.2% + 7.1% (median 5.4%, 0.7%-24.9%), and the average R2* value was 47.3 S-1 + 11.9 S-1 (median), and the average R2* value was 47.3 S-1 + 11.9 S-1 (median). 47 s-1,20.6 s-1-73.4 s-1). The difference in the average number of intrahepatic fat scores between the HISTO sequence and the six echo Dixon sequence at different pathological grades were statistically significant (F value was 24.817,24.254, P value was 0.05), and the higher the pathological grade, the two methods of HFF also measured the intrahepatic fat with.HISTO and six echo Dixon sequence. There was a good correlation between the score and the percentile of fatty degeneration (r=0.901, P0.05; r=0.855, P0.05). The R2 value of HISTO and the R2* value measured by six echo DIXON had a good correlation with the pathological iron content (r=0.636, P0.05; r=0.502, P0.05), and the correlation between the sequence and the quantitative and iron deposits of the histology was slightly better than that of the sequence. There is a good correlation between the two methods to measure the fat fraction in the liver and the percentage of histological fatty degeneration. The R2 value and the six echo DIXON technique measured by HISTO technique have a certain correlation with the pathological iron deposit, and the correlation between the HISTO sequence and the histological fat quantitative and the iron deposit is slightly better than that of the DIXON sequence. The difference of liver fat fraction between HISTO sequence and six echo Dixon sequence was statistically significant.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R445.2;R575

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