非侵入性 DWI-MRI 指标用于分期慢性乙型肝炎患者的肝纤维化和炎症活动度分级。
Noninvasive DW-MRI metrics for staging hepatic fibrosis and grading inflammatory activity in patients with chronic hepatitis B.
机构信息
Department of Medical Imaging, Henan Provincial People's Hospital & People's Hospital of Zhengzhou University, 7 Weiwu Road, Zhengzhou, 450003, Henan, China.
Department of Pathology, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, China.
出版信息
Abdom Radiol (NY). 2021 May;46(5):1864-1875. doi: 10.1007/s00261-020-02801-2. Epub 2020 Oct 19.
PURPOSE
To assess the value of various diffusion parameters obtained from monoexponential, biexponential, and stretched-exponential diffusion-weighted imaging (DWI) models for staging hepatic fibrosis (HF) and grading inflammatory activity in patients with chronic hepatitis B (CHB).
METHODS
82 patients with CHB and 30 healthy volunteers underwent DWI with 13 b-values on a 3T MRI unit. The standard apparent diffusion coefficient (ADC) was calculated using a monoexponential model. The true diffusion coefficient (D), pseudo-diffusion coefficient (D), and perfusion fraction (f) were calculated using a biexponential model. The distributed diffusion coefficient (DDC) and water-molecule diffusion heterogeneity index (α) were calculated using a stretched-exponential model. Receiver operating characteristic (ROC) curves were performed for diffusion parameters to compare the diagnosis performance.
RESULTS
The distributions of hepatic fibrosis stages and the inflammatory activity grades (METAVIR scoring system) were as follows: F0, n = 1; F1, n = 16; F2, n = 31; F3, n = 19; and F4, n = 15. A0, n = 1; A1, n = 14; A2, n = 46; and A3, n = 21. ADC, D and DDC values showed negative correlation with the fibrosis stage (r = - 0.418, - 0.717 and - 0.630, all P < 0.001) and the inflammatory activity grade (r = - 0.514, - 0.626 and - 0.550, all P < 0.001). The area under the ROC curve (AUC) of D (AUC = 0.854, 0.881) and DDC (AUC = 0.794, 0.834) were significantly higher than that of ADC (AUC = 0.637, 0.717) in discriminating significant fibrosis (≥ F2) and advanced fibrosis (≥ F3) (all P < 0.05). Although D (AUC = 0.867, 0.836) and DDC (AUC = 0.810, 0.808) showed higher AUCs than ADC (AUC = 0.767, 0.803), there was no significant difference in their ability in detecting inflammatory activity grade ≥ A2/A3 (P > 0.05).
CONCLUSIONS
D and DDC are promising indicators and outperform ADC for staging HF. While both D and DDC have similar diagnostic performance compared with ADC for grading inflammatory activity.
目的
评估单指数、双指数和扩展指数扩散加权成像（DWI）模型中获得的各种扩散参数在慢性乙型肝炎（CHB）患者肝纤维化（HF）分期和炎症活动分级中的价值。
方法
82 例 CHB 患者和 30 名健康志愿者在 3T MRI 仪上进行了 13 个 b 值的 DWI。使用单指数模型计算标准表观扩散系数（ADC）。使用双指数模型计算真实扩散系数（D）、假性扩散系数（D）和灌注分数（f）。使用扩展指数模型计算分布扩散系数（DDC）和水分子扩散异质性指数（α）。为扩散参数绘制受试者工作特征（ROC）曲线，以比较诊断性能。
结果
HF 分期和炎症活动分级（METAVIR 评分系统）的肝脏纤维化分布如下：F0，n=1；F1，n=16；F2，n=31；F3，n=19；F4，n=15。A0，n=1；A1，n=14；A2，n=46；A3，n=21。ADC、D 和 DDC 值与纤维化分期呈负相关（r=-0.418，-0.717 和-0.630，均 P<0.001）和炎症活动分级（r=-0.514，-0.626 和-0.550，均 P<0.001）。D（AUC=0.854，0.881）和 DDC（AUC=0.794，0.834）的 ROC 曲线下面积（AUC）明显高于 ADC（AUC=0.637，0.717）在区分显著纤维化（≥F2）和进展性纤维化（≥F3）（均 P<0.05）。尽管 D（AUC=0.867，0.836）和 DDC（AUC=0.810，0.808）的 AUC 高于 ADC（AUC=0.767，0.803），但它们在检测炎症活动分级≥A2/A3 方面的能力无显著差异（P>0.05）。
结论
D 和 DDC 是有前途的指标，在 HF 分期方面优于 ADC。而 D 和 DDC 在炎症活动分级方面与 ADC 相比具有相似的诊断性能。
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