【摘要】 目的 探讨磁共振扩散加权成像（DWI）联合肝特异性对比剂Gd-EOB-DTPA评估肝纤维化的价值。方法 对79例慢性肝炎患者行DWI及Gd-EOB-DTPA肝胆期成像,分别测量及计算其表观扩散系数（ADC）和肝胆期相对强化值（RE）。采用Logistic回归分析RE、ADC与肝纤维化病理分期的相关性。以肝纤维化S≥2和S≥3为阳性标准,分别对ADC组、RE组及ADC+RE组行受试者工作特征曲线（ROC）分析,曲线下面积（AUC）两两分析采用Z检验。结果 经Logistic回归分析,RE、ADC均为S≥2和S≥3级肝纤维化的独立影响因素。在诊断S≥2时,ADC组AUC为0.861,以ADC=0.56×10^-3 mm²/s为阈值,其敏感度为83.33%,特异度为85.71%;RE组AUC为0.771,以RE=1.03为阈值,其敏感度为86.67%,特异度为71.43%;ADC+RE组AUC为0.922,以Logit（P）=8.16为阈值,其敏感度为90.00%,特异度为91.84%。在诊断肝纤维化S≥3时,ADC组AUC为0.807,以ADC=0.53×10^-3 mm²/s为阈值,其敏感度为86.96%,特异度为78.57%,;RE组AUC为0.748,以RE=0.89为阈值,其敏感度为78.26%,特异度为76.799%;ADC+RE组AUC为0.906,以Logit（P）=8.73为阈值,其敏感度为82.61%,特异度为89.29%。除诊断S≥3时ADC组敏感度最高外,ADC+RE组在诊断肝纤维化S≥2、S≥3时敏感度、特异度及AUC均较单一指标更高,且其AUC分别与ADC组(Z_S2=2.352、Z_S3=2.158)和RE组(Z_S2=2.465、Z_S3=2.487)两两比较有统计学差异（P<0.05）。结论 ADC及RE均能用于量化评估肝纤维化,2个指标联合评估能明显提高判定效能。更多还原

【Abstract】 Objective To explore the value of combination of diffusion weight imaging（DWI） and Gd-EOB-DTPA in the staging of liver fibrosis.Methods 79 patients with chronic hepatitis underwent DWI and Gd-EOB-DTPA MRI,meanwhile the apparent diffusion,coefficient（ADC） with DWI of the liver were measured and relative enhancement ratio（RE） with hepatobiliary phase imaging of Gd-EOB-DTPA were also calculated,Logistic regression analysis was used to analyze the correlation between the pathological stages of liver fibrosis and the values of ADC and RE.According to the pathological stages of liver fibrosis,the abilities of ADC,RE and ADC+RE in the staging of liver fibrosis were assessed by using receiver operating characteristic（ROC） curve.Moreover,the Z statistics were used to analyze the area under the curve（AUC） between each two groups.Results The results of Logistic regression analysis showed that both RE and ADC were independent variables in the staging of liver fibrosis（S≥2,S≥3）.In diagnosis of liver fibrosis S≥2,the AUC was 0.861,and the sensitivity and specificity were 83.33% and 85.71 % with cutoff of ADC=0.56×10^-3 mm²/s in ADC group.Meanwhile,the AUC was 0.771,and the sensitivity and specificity were 86.67% and 71.43% with cutoff of RE=1.03in RE group.The AUC was 0.922,and the sensitivity and specificity were 90.00% and 91.84% with cutoff of Logit（P）=8.16 in ADC+RE group.Moreover,in diagnosis of liver fibrosis S≥3,the AUC was 0.807,and the sensitivity and specificity were 86.96% and 78.57% with cutoff of ADC=0.53×10^-3 mm²/s in ADC group.The AUC was 0.748,and the sensitivity and specificity were 78.26%and 76.79% with cutoff of RE=0.89 in RE group.The AUC was 0.906,and the sensitivity and specificity were 82.61 % and 89.29%with cutoff of Logit（P）=8.73 in ADC+RE group.In addition,the combination of ADC+RE achieved higher sensitivity,specificity and AUC than single ADC or RE besides the hightest sensitivity of ADC in diagnosis of S≥3.Furthermore,there were significant differences in AUC between combined indicator and ADC(Z_S2=2.352,Z_S3=2,158),RE(Z_S2=2.465,Z_S3=2.487) groups by means of Z statistics（P <0.05）.Conclusion Both of ADC and RE can be used to quantitatively evaluate the stage of liver fibrosis,and the combination of ADC and RE may improve the diagnostic effect.更多还原