Ren H W, Ye H Y, An W M, Dong J H, Liu Y
Chinese PLA Medical School, Department of Radiology, 302 Hospital of PLA, Beijing 100039, China.
Zhonghua Yi Xue Za Zhi. 2017 May 23;97(19):1484-1490. doi: 10.3760/cma.j.issn.0376-2491.2017.19.012.
To study the correlation between ADC values of diffusion weighted imaging (DWI) and the pathological grading in inflammation activity of chronic hepatitis B, and combined with conventional MRI features to predict the diagnosis effectiveness. A total of 142 cases of patients with chronic hepatitis B were selected as inflammatory group in 302 Hospital of PLA from January 2014 to December 2015, while 20 cases of healthy subjects without history of liver disease were chosen as control group.All patients underwent MR plain scan and dynamic contrast enhancement and DWI examinations (b=0, 800 s/mm(2)) for liver, and were performed liver biopsy within two days.According to the degree of inflammation activity (G), the inflammation group was divided into G1, G2 and G3-4 level.The apparent diffusion coefficient (ADC) value, and the MRI features of each group were analyzed. The ADC values showed statistical difference (=8.392, <0.01) within inflammation group of chronic hepatitis B from different pathologic grading, and there was significant negative correlation between ADC values and liver inflammation activity grading (=-0.613, <0.01). The ADC value of inflammation group and control group was (1.31±0.16), (1.12±0.15)×10(-3) mm(2)/s, the difference was statistically significant (<0.05). The ADC value of G1, G2 and G3-4 level was (1.22±0.12), (1.05±0.12), (0.98±0.10)×10(-3) mm(2)/s respectively, and there was statistical difference (<0.05) between G1 and G2, G1 and G3-4. The receiver operating characteristic (ROC) curve in diagnosis of equal and above G2 level showed the area under the curve (AUC) was 0.880, the sensitivity and the specificity was 82.4% and 76.8% respectively, the diagnostic cut-off value was 1.09×10(-3) mm(2)/s.Besides, the detection rate of portal around its orbit and gallbladder wall edema in inflammation group had statistical difference (<0.05), and there was no statistical difference in the detection rate of abnormal liver arterial enhancement, hilus lymph node increases and ascites in inflammation group(>0.05). The ROC in diagnosis of equal and above G2 level by ADC values combined with the MRI characteristic signs showed AUC was 0.938, the sensitivity and the specificity was 88.4% and 88.9% respectively. ADC values can predict the inflammation activity of chronic hepatitis B with quantitatively and non-invasively.Combining with characteristic MRI signs, ADC values can improve the diagnosis efficiency.
研究慢性乙型肝炎炎症活动中扩散加权成像（DWI）的表观扩散系数（ADC）值与病理分级的相关性，并结合传统MRI特征预测诊断效能。选取2014年1月至2015年12月解放军第302医院收治的142例慢性乙型肝炎患者作为炎症组，选取20例无肝脏疾病史的健康受试者作为对照组。所有患者均行肝脏MR平扫、动态增强及DWI检查（b=0，800 s/mm²），并于2天内行肝脏穿刺活检。根据炎症活动度（G）将炎症组分为G1、G2及G3-4级，分析各组ADC值及MRI特征。慢性乙型肝炎炎症组不同病理分级间ADC值差异有统计学意义（F=8.392，P<0.01），ADC值与肝脏炎症活动度分级呈显著负相关（r=-0.613，P<0.01）。炎症组与对照组ADC值分别为（1.31±0.16）、（1.12±0.15）×10⁻³ mm²/s，差异有统计学意义（P<0.05）。G1、G2及G3-4级ADC值分别为（1.22±0.12）、（1.05±0.12）、（0.98±0.10）×10⁻³ mm²/s，G1与G2、G1与G3-4间差异有统计学意义（P<0.05）。诊断G2级及以上水平的受试者工作特征（ROC）曲线下面积（AUC）为0.880，灵敏度和特异度分别为82.4%和76.8%，诊断界值为1.09×10⁻³ mm²/s。此外，炎症组门静脉周围及胆囊壁水肿检出率差异有统计学意义（P<0.05），炎症组肝动脉异常强化、肝门淋巴结增大及腹水检出率差异无统计学意义（P>0.05）。ADC值联合MRI特征性征象诊断G2级及以上水平的ROC曲线AUC为0.938，灵敏度和特异度分别为88.4%和- 88.9%。ADC值可定量、无创地预测慢性乙型肝炎的炎症活动度。结合MRI特征性征象，ADC值可提高诊断效能。
