Department of Radiology and the Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, 712 Eonjuro, Gangnam-Gu, Seoul, Korea.
Korean J Radiol. 2011 Jul-Aug;12(4):431-8. doi: 10.3348/kjr.2011.12.4.431. Epub 2011 Jul 22.
We wanted to identify the geographic differences in hepatic fibrosis and their associations with the atrophy-hypertrophy complex in patients with chronic viral hepatitis using the dual-contrast material-enhanced MRI (DC-MRI) with gadopentetate dimeglumine and ferucarbotran.
Patients with chronic C (n = 22) and B-viral hepatitis (n = 35) were enrolled for determining the subjective grade of fibrosis (the extent and thickness of fibrotic reticulations) in the right lobe (RL), the caudate lobe (CL), the medial segment (MS) and the lateral segment (LS) of the liver, with using a 5-grade scale, on the gradient echo T2(*)-weighted images of DC-MRI. The fibrosis grades of different segments were compared using the Kruskal-Wallis test followed by post-hoc analysis to establish the segment-by-segment differences. The incidences of two pre-established morphologic signs of cirrhosis were also compared with each other between the two groups of patients.
There were significant intersegmental differences in fibrosis grades of the C-viral group (p = 0.005), and the CL showed lower fibrosis grades as compared with the grades of the RL and MS, whereas all lobes were similarly affected in the B-viral group (p = 0.221). The presence of a right posterior hepatic notch was significantly higher in the patients with intersegmental differences of fibrosis between the RL and the CL (19 out of 25, 76%) than those without such differences (6 out of 32, 19%) (p < 0.001). An expanded gallbladder fossa showed no significant relationship (p = 0.327) with the segmental difference of the fibrosis grades between the LS and the MS.
The relative lack of fibrosis in the CL with more advanced fibrosis in the RL can be a distinguishing feature to differentiate chronic C-viral hepatitis from chronic B-viral hepatitis and this is closely related to the presence of a right posterior hepatic notch.
我们希望使用钆喷替酸葡甲胺和 Ferucarbotran 的双重对比材料增强 MRI（DC-MRI）来识别慢性病毒性肝炎患者肝纤维化的地域差异及其与萎缩-肥大复合症的关系。
招募了 22 例慢性 C 型和 35 例慢性乙型病毒性肝炎患者，在 DC-MRI 的梯度回波 T2(*)-加权图像上，使用 5 级评分系统，确定右叶（RL）、尾状叶（CL）、内侧段（MS）和外侧段（LS）肝纤维化的主观程度（纤维化网的范围和厚度）。使用 Kruskal-Wallis 检验比较不同节段的纤维化程度，然后进行事后分析以确定节段间差异。还比较了两组患者之间两种预先建立的肝硬化形态学标志的发生率。
C 型病毒组各节段的纤维化程度存在显著的节段间差异（p = 0.005），与 RL 和 MS 的纤维化程度相比，CL 的纤维化程度较低，而 B 型病毒组各叶均受到相似的影响（p = 0.221）。RL 和 CL 之间存在纤维化节段差异的患者中，右后肝切迹的存在率明显高于无差异的患者（25 例中有 19 例，76%；32 例中有 6 例，19%）（p < 0.001）。扩大的胆囊窝与 LS 和 MS 之间纤维化程度的节段差异没有显著关系（p = 0.327）。
CL 相对缺乏纤维化，RL 纤维化程度更严重，这是区分慢性 C 型病毒性肝炎和慢性 B 型病毒性肝炎的一个特征，这与右后肝切迹的存在密切相关。
