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  本文選題：脂肪肝　切入點：IDEAL-IQ　出處：《鄭州大學》2016年碩士論文

【摘要】：背景和目的脂肪肝又稱肝細胞脂肪變性,指脂肪主要是甘油三酯在肝細胞內(nèi)的異常、過度沉積。脂肪肝按病因分類,可分為酒精性肝病(alcoholic fatty liver disease,AFLD)與非酒精性脂肪肝病(nonalcoholic fatty liver disease,NAFLD),這是其最常見的分類類型。脂肪肝發(fā)病率較高,據(jù)統(tǒng)計在普通人群中發(fā)病率為20-30%,在糖尿病及肥胖人群中發(fā)病率高達75-100%。脂肪肝發(fā)病率因地域差異而不同,歐美國家經(jīng)濟發(fā)達,脂肪肝發(fā)病率略高于平均水平;在我國發(fā)展中國家中,脂肪肝發(fā)病率相對較低,但近年來隨著生活水平和質(zhì)量的提升,我國脂肪肝發(fā)病率逐年增加,類型也趨于多樣化,嚴重影響了人們的生活,故早期診斷脂肪肝至關重要。診斷脂肪肝最常見的方法是超聲,可用于篩查和隨訪,但其診斷結果對于操作者的依賴性很大;其次是計算機斷層掃描(computed tomography,CT)通過測量肝實質(zhì)密度可快速診斷脂肪肝,但其存在電離輻射,且容易受肝臟其他沉淀物影響,其應用受到限制;近年來,磁共振成像(magnetic resonance imaging,MRI)技術對軟組織的顯示較以上兩種手段清晰,優(yōu)勢結合了優(yōu)異的軟組織對比度,無創(chuàng)性,功能成像和無電離輻射。以往文獻探討磁共振波譜成像(magnetic resonance spectroscopy,MRS)與病理結果的相關性,亦有文獻報道磁共振檢查分別與超聲、CT診斷脂肪肝的對比研究,但并未涉及到定量研究,本研究綜合探討磁共振定量診斷脂肪肝的效能,并引入MRI新定量方法IDEAL-IQ進一步來探討其定量診斷脂肪肝的效能。故本研究目的探討:1、制定IDEAL-IQ、MRS定量評估肝臟脂肪變性的分級標準;2、探討磁共振新技術IDEAL-IQ與MRS量化肝臟脂肪含量的相關性材料與方法采用GE Discovery750 3.0T MR掃描儀,對87例NAFLD患者及20例正常健康人進行前瞻性研究,囑被檢查者禁食禁水6-8h。常規(guī)掃描序列采用冠狀位屏氣單次激發(fā)快速自旋回波(T2WI/TSE)及軸位呼吸觸發(fā)脂肪抑制;快速擾相梯度雙回波序列(FSPGR-dual echo)。彌散加權成像(diffusion-weighted imaging,DWI):傳統(tǒng)DWI序列選取b=0、800 s/mm2;功能成像肝臟MRS采用單體素點分辨選擇性波譜(point resolved selective spectroscopy,PRESS)序列、“非對稱回波的最小二程估算法迭代水脂分離”技術(iterative decomposition of water and fat with Echo asymmetry and the Least Squares Estimation Quantification sequence,IDEAL-IQ)序列掃描。統(tǒng)計方法:所有數(shù)據(jù)利用SPSS17.0軟件包進行處理。結果1.107個受試者(87個脂肪肝患者,20個正常志愿者)中,IDEAL-IQ掃描成功者占95.8%(102/107);MRS掃描成功者占71.0%(76/107),其中脂肪肝患者60個,正常志愿者16個;掃描時間,IDEAL-IQ、MRS掃描時間分別為(21±1)s、(253.8±21.6)s,平均值分別為21s、253.8s。2.以CT作為金標準,分為脂肪肝組和正常人組,繪制ROC曲線,得到RLC、FF診斷脂肪肝的最佳閾值,分別為7.24%、8.50%;以此閾值判斷RLC、FF診斷脂肪肝的敏感度和特異度,敏感度分別為90.0%、90.0%,特異度分別為87.5%、93.7%。3.以CT作為金標準,將脂肪肝組分為輕、中、重度組,分別獲得IDEAL-IQ、MRS診斷輕度與中度、中度與重度脂肪肝的ROC曲線,獲得IDEAL-IQ診斷閾值分別為15.27%、27.00%;MRS診斷閾值分別為17.58%、26.04%;其中IDEAL-IQ、MRS鑒別輕度與中度的敏感度分別為97.0%、69.7%,特異度分別為94.4%、61.1%;二者鑒別中度與重度的敏感度分別為100%、66.7%,特異度分別為72.7%、81.8%。4.60例病例由MRS、IDEAL-IQ兩種方法測得RLC、FF分別為21.04±9.07、19.72±8.73,二者比較統(tǒng)計學無顯著差異(P=0.344),由散點圖可知二者有線性關系,Pearson相關性分析得到RLC和FF呈正相關(r=0.784,P=2.613)。結論1.MRS、IDEAL-IQ均可定量精確診斷脂肪肝。2.IDEAL-IQ與MRS定量評估脂肪肝的相關系數(shù)r為0.784;IDEAL-IQ、MRS診斷脂肪肝的閾值分別為8.50%、7.24%;二者診斷輕度與中度、中度與重度的閾值分別為15.27%、27.00%和17.58%、26.04%。3.在掃描成功率、掃描時間上,IDEAL-IQ均優(yōu)于MRS,可取代步驟繁瑣的MRS,作為診斷脂肪肝的獨立標準。
[Abstract]:Background and objective: fatty liver and fatty degeneration of liver cells, the fatty triglyceride is abnormal in liver cells. The excessive deposition of fatty liver according to the etiology, classification, can be divided into alcoholic liver disease (alcoholic fatty liver disease, AFLD) and non alcoholic fatty liver disease (nonalcoholic fatty liver disease, NAFLD), which is the most common type. Fatty liver disease incidence rate is high, according to statistics in the general population incidence of 20-30% in diabetes and obesity incidence rate is as high as 75-100%. incidence of fatty liver due to geographical differences and different European countries, developed economy, the incidence of fatty liver is slightly higher than the average level in China in developing countries;, the incidence of fatty liver is relatively low, but in recent years, with the quality of life and enhance the quality of our country, the incidence of fatty liver increased year by year, types tend to be diversified, serious impact on people's lives, so early The diagnosis of fatty liver is very important. The most common method of diagnosis of fatty liver is ultrasound, can be used for screening and follow-up, but its diagnosis result for large dependence on the operator; followed by computed tomography (computed tomography, CT) by measuring liver parenchyma density rapid diagnosis of fatty liver, but the existence of ionizing radiation, and are easily affected by influence of other liver sediment, its application is limited; in recent years, magnetic resonance imaging (magnetic resonance, imaging, MRI) technology for soft tissue display more than two kinds of means clear, combined with the advantages of excellent soft tissue contrast, non-invasive functional imaging and non ionizing radiation. The previous literature on magnetic resonance spectroscopy (magnetic resonance spectroscopy, MRS) associated with the pathological results, there are reports of MRI and ultrasound respectively, comparative study of CT diagnosis of fatty liver, but did not involve quantitative Study, this study to explore the effectiveness of magnetic resonance imaging in quantitative diagnosis of fatty liver, and the introduction of IDEAL-IQ MRI to further explore the new quantitative method for the quantitative diagnosis of fatty liver performance. The purpose of this study was to explore: 1, making IDEAL-IQ, grading of hepatic steatosis MRS quantitative assessment; 2, to investigate the correlation between the materials and methods of new magnetic resonance the technology of IDEAL-IQ and MRS to quantify liver fat content by GE Discovery750 3.0T MR scanner in 87 NAFLD patients and 20 healthy people were included in a prospective study, will be checked fasting water routine sequence 6-8h. scanning with coronal after single shot fast spin echo (T2WI/TSE) and axial respiratory triggered fat suppression; fast spoiled gradient echo sequence (FSPGR-dual echo) double. Diffusion weighted imaging (diffusion-weighted imaging, DWI): the traditional DWI sequence selected b=0800 s/mm2; functional imaging of the liver by MRS Single voxel spectroscopy (point resolved selective spectroscopy selectivity, PRESS) sequence, "minimum two-way asymmetric echo estimation method, iterative water fat separation technique (iterative decomposition of water and fat with Echo asymmetry and the Least Squares Estimation Quantification sequence, IDEAL-IQ) sequences. Statistical methods: all data using SPSS17.0 software package for processing. The results of 1.107 subjects (87 patients with fatty liver and 20 normal volunteers), IDEAL-IQ scan successfully accounted for 95.8% (102/107); MRS scan successfully accounted for 71% (76/107), including 60 patients with fatty liver and 16 normal volunteers; scanning time, scanning time IDEAL-IQ, MRS respectively (21 + 1) s, (253.8 + 21.6) s, respectively 21s, 253.8s.2. with CT as the gold standard, divided into fatty liver group and normal group, RLC, ROC curve, FF diagnosis of fatty liver The optimal threshold values were 7.24%, 8.50%; the threshold RLC, the diagnosis of fatty liver FF sensitivity and specificity, sensitivity was 90% and 90% respectively, the specificity was 87.5%, 93.7%.3. to CT as a gold standard, the fatty liver group was divided into mild and severe group, IDEAL-IQ, respectively. MRS diagnosis of mild and moderate, moderate and severe fatty liver ROC curve, IDEAL-IQ diagnostic thresholds were 15.27%, 27%; MRS diagnostic thresholds were 17.58%, 26.04%; IDEAL-IQ, MRS in the differential diagnosis of mild and moderate sensitivity was 97%, specificity was 94.4%, 69.7%, 61.1% and two respectively; identify and moderate severe sensitivity was 100%, specificity 66.7%, 72.7% cases respectively, 81.8%.4.60 by MRS, IDEAL-IQ two methods to measure the RLC, FF = 21.04 + 9.07,19.72 + 8.73, there was no significant difference among the two statistics (P=0.344), by the scatter diagram two is linear The relationship between Pearson, RLC and FF correlation analysis were positively correlated (r=0.784, P=2.613). Conclusion: 1.MRS, correlation coefficient R IDEAL-IQ can accurately quantitative diagnosis of fatty liver and.2.IDEAL-IQ MRS quantitative evaluation of fatty liver was 0.784; IDEAL-IQ, the diagnosis of fatty liver MRS thresholds were 8.50%, 7.24%; two cases were diagnosed with mild and moderate, moderate and severe thresholds were 15.27%, 27% and 17.58%, the success rate of 26.04%.3. in the scanning, scan time, IDEAL-IQ was superior to MRS, MRS can replace the cumbersome steps, as independent criteria for the diagnosis of fatty liver.

【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R575.5

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1 呂曉婷;非酒精性脂肪肝患者IDEAL-IQ與MRS定量評估及比較[D];鄭州大學;2016年

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本文編號：1680366