本文選題：磁共振　切入點：動態(tài)增強　出處：《川北醫(yī)學院》2014年碩士論文　論文類型：學位論文

【摘要】：目的：探討肝臟及脾臟磁共振動態(tài)增強成像（dynamiccontrast-enhanced magnetic resonance imaging, DCE-MRI)評價肝纖維化分期的可行性及應用價值。 方法：實驗專用健康中國小型豬16只，體重20-24kg，采用40%四氯化碳建立肝纖維化疾病模型。造模之前及造模開始后第5、9、16、21周末，分別依次對所有存活的動物行肝臟及脾臟DCE-MRI檢查。獲得對應肝臟及脾臟血流參數(shù)：達峰時間（time to peak,TTP)、陽性增強積分(positive enhancement integral, PEI)、最大上升斜率(maximum slope ofincrease, MSI)、最大下降斜率(maximum slope of decrease, MSD)。DCE-MRI檢查結束后，24小時內(nèi)在超聲引導下行肝臟穿刺活檢，所取得肝組織標本行Masson染色，并參照METAVIR分期標準對小型豬肝纖維化進行分期。所測DCE-MRI數(shù)據(jù)采用SPSS17.0統(tǒng)計軟件包進行統(tǒng)計學分析。 結果：（1）隨著肝纖維化程度的進展，肝臟TTP值逐漸增加，肝臟MSI、MSD和PEI逐漸降低，（r=0.689、-0.820、-0.343、-0.492，P 0.05）。其中肝PEI從F3期至F4期輕度升高, MSD從F1期至F3期輕度升高（P0.05）。肝臟TTP和MSI可用于區(qū)分肝纖維化區(qū)分肝纖維化F0與F1-4期，F(xiàn)0-1和F2-4期，F(xiàn)0-2與F3-4期和F0-3與F4期（P 0.05）；肝臟PEI可以區(qū)分F0與F1-4期，F(xiàn)0-1和F2-4期，F(xiàn)0-3與F3-4期（P 0.05）；肝臟MSD可用于區(qū)分肝纖維化F0與F1-4期、F0-3與F4期（P 0.05）。肝臟MSI是區(qū)分肝纖維化F≥1期、≥2期、≥3期的最好指標，當MSI臨界值分別為11.591/s、9.651/s、8.931/s，其診斷效能曲線下面積(area underreceiver operating characteristic curve, AUC)分別為0.920、0.913、0.917。當肝臟TTP以臨界值20.92s區(qū)分肝纖維化F4期時，其診斷效能曲線下面積最大，AUC值為0.963。 （2）隨著肝纖維化程度的進展，脾臟TTP從正常至F4期逐漸增大(r=0.647, P 0.001)；脾PEI從正常至F4期逐漸降低(r=-0.709, P 0.001)；脾MSD從正常至F2期逐漸增大(P0.05)，F(xiàn)2期至F4期逐漸降低(P 0.05)；脾MSI從正常至F1期先輕度增加，F(xiàn)1期到F4期再降低(P0.05)。脾TTP和PEI能區(qū)分肝纖維化F≥1期、≥2期、≥3期及第4期（P0.05）。MSD僅能區(qū)分肝纖維化F≥3期(P=0.006)、4期(P=0.012)。當脾TTP以臨界值70.82s、73.75s診斷肝纖維化F≥1、2期時，其診斷效能最好，，其AUC值分別為0.851和0.783；當以5.46、4.75作為脾臟PEI臨界值診斷肝纖維化F≥3、4期時，能獲得較高診斷效能，AUC為分別為0.903和0.968。 結論：肝臟及脾臟DCE-MRI可用于評價肝纖維化病變的嚴重程度，其中肝臟血流動力學參數(shù)MSI能更好的用于區(qū)分肝纖維化≥F1、2、3期，脾臟血流動力學參數(shù)PEI能更好的用于區(qū)分肝纖維化F4期。
[Abstract]:Objective: to evaluate the feasibility and value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in evaluating hepatic fibrosis staging. Methods: a total of 16 healthy Chinese miniature pigs, weighing 20-24 kg, were used to establish hepatic fibrosis model with 40% carbon tetrachloride. The liver and spleen blood flow parameters of all living animals were examined by DCE-MRI in turn. The corresponding blood flow parameters of liver and spleen were obtained as follows: peak time to peak-tpp, positive enhancement integral of positive enhancement, pei, maximum ascending slope of maximum slope ofincrease, maximum decrease of maximum slope. Slope of decrease, liver biopsy guided by ultrasound within 24 hours after MSD).DCE-MRI examination, The liver tissue samples were stained with Masson, and the small pig liver fibrosis was staging according to the standard of METAVIR staging. The DCE-MRI data were statistically analyzed by SPSS17.0 statistical software package. Results with the progression of liver fibrosis, the TTP value of liver increased gradually. Liver PEI increased slightly from F3 to F4. Liver TTP and MSI could be used to distinguish hepatic fibrosis from F0, F1-4, F0-1, F2-4 and F3-4, respectively, and liver TTP and MSI could be used to differentiate hepatic fibrosis from F0, F1-4, F0-1 and F2-4, F0-2 and F3-4 phases respectively, and liver TTP and MSI could be used to distinguish hepatic fibrosis from F0, F1-4, F0-1, F2-4, F0-2 and F3-4 phases, and liver TTP and MSI could be used to distinguish hepatic fibrosis from F0, F1-4, F0-1, F2-4, F0-2 and F3-4 phases. Liver PEI could distinguish F0 from F1-4 and F2-4 from F3-F0-3 from F3-4, and liver MSD could be used to distinguish hepatic fibrosis from F0 and F1-4 stages of F0-3 and F4 stages (P 0.05). Liver MSI could differentiate hepatic fibrosis from F0 and F1-4 phases (P 0.05), and hepatic MSI could be used to distinguish hepatic fibrosis from F0 and F1-4 phases. Liver MSI could differentiate hepatic fibrosis F 鈮

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