本文選題：參數(shù)-造影劑到達(dá)時間成像 + 肝炎��； 參考：《中國人民解放軍醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：探討參數(shù)-造影劑到達(dá)時間成像（P-MFI）技術(shù)在肝纖維化分期方面的應(yīng)用價值。 材料和方法：前瞻性入組2013年3月至2014年2月受試者117例，其中包括擬行超聲引導(dǎo)下肝組織穿刺活檢且伴有乙型肝炎病毒（HBV）或（和）丙型肝炎病毒（HCV）感染的患者97例，以及健康者20例。全部正常受檢者經(jīng)肘前靜脈團(tuán)注超聲造影劑聲諾維（SonoVue）2.0ml，通過東芝Apilo500超聲診斷儀采集第5或第6肋間肝臟右葉最大切面動態(tài)造影圖像，，分為30秒組與10秒組，并利用commune軟件進(jìn)行彩色編碼并定量分析獲得相關(guān)參數(shù)，繼而結(jié)合肝纖維化病理分期結(jié)果進(jìn)行統(tǒng)計，分析各參數(shù)與肝纖維化分期之間的關(guān)系，得出各參數(shù)分別評估肝纖維化各期的診斷閾值，并判斷其敏感性、特異性與準(zhǔn)確性。30秒組的造影劑微泡灌注率（ratio of bubble region,%）為質(zhì)控指標(biāo)，該參數(shù)須達(dá)到90%以上，否則需再一次行超聲造影重新獲取造影動態(tài)圖像。 結(jié)果：（1）參數(shù)在肝纖維化各分期中的組間比較：30s-slope值隨著肝纖維化病理分期的增高而降低，而10s-slope值隨著肝纖維化病理分期的增高而增高，且兩組的各分期多組間比較均有統(tǒng)計學(xué)差異；30s-ratio at5s與10s-ratio at5s均隨著肝纖維化病理分期的增高而增高，且兩組的各分期多組間比較統(tǒng)計學(xué)有顯著性差異。（2）受試者工作特征曲線評估各參數(shù)分別預(yù)測肝纖維化分期≥F2期及≥F3期的最佳臨界值及其診斷能力。a）≥F2期：當(dāng)30s-slope≤0.062、10s-slope≥0.109、30s-ratio at5s≥22.00%或10s-ratio at5s≥29.05%時診斷肝纖維化分期≥F2期的靈敏度、特異度、精確度、Youden指數(shù)、陽性預(yù)測值及陰性預(yù)測值分別為87.2%、84.6%、86.3%、71.8%、91.9%及76.7%；83.3%、74.4%、75.2%、57.7%、78.2%及66.7%；61.5%、74.4%、66.7%、35.9%、83.1%及50.0%；85.9%、89.7%、86.3%、75.6、93.1%及75.6%。b）≥F3期：當(dāng)30s-slope≤0.059、10s-slope≥0.111、30s-ratioat5s≥26.85%、10s-ratio at5s≥30.35%時診斷肝纖維化分期≥F3期的靈敏度、特異度、精確度、Youden指數(shù)、陽性預(yù)測值及陰性預(yù)測值分別為87.9%、84.7%、86.3%、72.6%、85%及87.7%；89.7%、84.7%、86.3%、74.4%、83.9%及89.1%；62.1%、86.4%、75.2%、48.5%、83.7%及70.3%；89.7%、79.7%、87.2%、69.4%、84.1%及90.7%。 結(jié)論：參數(shù)30s-slope、10s-slope、30s-ratio at5s及10s-ratio at5s與肝纖維化的嚴(yán)重程度相關(guān)，其中30s-slope、10s-slope及10s-ratio at5s可以作為診斷肝纖維化嚴(yán)重程度的參數(shù)指標(biāo)，對中重度肝纖維化的診斷能力較高。因此P-MFI技術(shù)對于指導(dǎo)病毒性肝炎患者的抗病毒治療以及評估肝纖維化改善程度等方面有潛在的應(yīng)用價值。
[Abstract]:Objective: to investigate the application value of parameter-contrast medium arrival time imaging (P-MFI) technique in the staging of hepatic fibrosis. Materials and methods: from March 2013 to February 2014, 117 patients with hepatitis B virus (HBV) or / and hepatitis C virus (HCV) infection were included in this study. And 20 healthy people. All normal subjects were injected with ultrasound contrast agent Sono Vueo 2.0 ml through the anterior elbow vein mass. The dynamic images of the right lobe of the 5th or 6th intercostal liver were collected by Toshiba Apilo500 ultrasound diagnostic instrument. The images were divided into 30 second group and 10 second group. The correlation parameters were obtained by color coding and quantitative analysis with commune software, and then the relationship between the parameters and hepatic fibrosis staging was analyzed by statistical analysis combined with the pathological staging results of liver fibrosis. The diagnostic threshold, sensitivity, specificity and accuracy of each stage of hepatic fibrosis were evaluated. The contrast medium microbubble perfusion ratio of bubble region in the 30-second group was used as the quality control index, and the parameter should be above 90%. Otherwise, it is necessary to perform contrast-enhanced imaging again and obtain the dynamic image again. Results compared with each stage of hepatic fibrosis, the ratio of: 30s-Slope decreased with the increase of pathological stage of hepatic fibrosis, while the value of 10s-slope increased with the increase of pathological stage of hepatic fibrosis. There was statistical difference between the two groups in each stage, and the at5s and 10s-ratio at5s increased with the increase of pathological stage of liver fibrosis. There was significant statistical difference between the two groups. 2) the parameters of the evaluation of the operating characteristic curve of the subjects were used to predict the optimal critical value and diagnostic ability of liver fibrosis stage 鈮

本文編號：2025134