ABSTRACT
ObjectiveTo investigate the value of biliary score and hepatic signal intensity-to-muscle signal intensity ratio （HMR） obtained by multiphase contrast-enhanced MRI scan using Gd-EOB-DTPA in evaluating the pathological grade of liver fibrosis. MethodsA retrospective analysis was performed for the MRI and clinical data of 51 patients with chronic hepatitis B liver fibrosis in Wuming Hospital Affiliated to Guangxi Medical University from January 2020 to May 2023. The 51 patients with liver fibrosis were divided into low-grade group （S1-S2） and high-grade group （S3-S4）. GE Architact 3.0T MR scanner was used to perform MRI scans， including routine plain scan and contrast-enhanced scan at arterial phase， portal venous phase， delayed phase， hepatobiliary phase， and excretory phase， and biliary score and HMR were measured for the patients with different grades of liver fibrosis. The t-test was used for comparison of continuous data between groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The receiver operating characteristic （ROC） curve was plotted to evaluate the value of MRI indicators in determining the pathological grade of liver fibrosis. ResultsAmong the 51 patients with liver fibrosis， there were 30 patients in the low-grade group and 21 in the high-grade group. Compared with the high-grade group， the low-grade group had significantly higher biliary score （3.67±0.55 vs 2.57±0.75， t=6.05， P<0.001） and HMR at portal venous phase （2.38±0.76 vs 1.97±0.18， t=2.41， P=0.020）， delayed phase （2.48±0.70 vs 1.99±0.27， t=3.09， P=0.003）， and hepatobiliary phase （4.10±0.63 vs 3.16±0.47， t=5.81， P<0.001）. The above indicators had an area under the ROC curve （AUC） of 0.86， 0.79， 0.82， and 0.88， respectively， in distinguishing low- and high-grade liver fibrosis， with a positive rate of 70%， 63.3%， 83.3%， and 96.7%， respectively， and a negative rate of 90%， 95.2%， 74.1%， and 100%， respectively， in the diagnosis of high-grade liver fibrosis. Biliary score combined HMR had an AUC of 0.95， with a positive rate of 85.7% and a negative rate of 96.7%. ConclusionBiliary score and HMR at hepatobiliary phase obtained by multiphase contrast-enhanced MRI scan using Gd-EOB-DTPA has a relatively high diagnostic efficacy in distinguishing between low- and high-grade liver fibrosis and a certain guiding value for the diagnosis and treatment of liver fibrosis in clinical practice.
ABSTRACT
As a non-invasive， simple， and reproducible examination， Gd-EOB-DTPA-enhanced magnetic resonance imaging （MRI） has an important application value in evaluating liver reserve function. Currently in clinical practice， Gd-EOB-DTPA-enhanced MRI is mainly used to measure liver parenchymal signal intensity parameters， magnetic resonance relaxation time parameters， biliary tract enhancement parameters， and liver volume parameters to evaluate the liver reserve function of patients. In recent years， the use of Gd-EOB-DTPA-enhanced MRI in predicting liver reserve function in residual liver tissue after liver tumor surgery has become one of the hotspots in clinical research， and certain progress has been made in related studies in China and globally. This article reviews the research advances in recent years.
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Objective To investigate the CT and MRI manifestations and clinical features of liver fluke granuloma.Methods A retrospective analysis was performed for the clinical and imaging data of 5 patients with pathologically confirmed liver fluke granuloma who were hospitalized in The First Affiliated Hospital of Guangxi Medical University from January 2010 to September 2015.Results Liver fluke granuloma had slightly low density on CT plain scan,as well as a slightly low signal on T1 weighted images and a slightly higher signal on T2 weighted images of MRI plain scan.Three-phase contrast-enhanced CT scan showed delayed enhancement with mild dilatation of the intrahepatic bile duct,and normal vessels ran through the lesion.Conclusion Liver fluke granuloma is a rare disease in chnical practice.A history of eating raw fish,delayed enhancement on three-phase contrast-enhanced CT scan,and normal vessels running through the lesion all contribute to the diagnosis of liver fluke granulomas.
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Objective To evaluate clinical application value of DWI and reservation of liver function in patients with chronic liver disease. Methods Thirty cases of healthy control group, and 60 case group with chronic liver disease,including both 30 chronic hepatitis B and 30 cirrhosis. liver function in case group was analysed by venous blood samples. Case groups were divided into three groups according to MELD score: ＜30 group in 27 cases, 30 to 36 group in 17 cases, ＞36 group in 16 cases. All cases underwent liver magnetic resonance DWI. Among the case group, 15 cases were followed-up twice of pre- and aftertreatment. DWI images were read, ADC values of liver parenchyma were measured and standardized with the cephalospinal fluid (CSF) at the same slice. Used SPSS 13.0 for windows to treat the data, group comparison of ADC values were treated by one-factor analysis of variance, interclass comparison each other by SNK method, comparison between pretherapy and post-treatment by paired-samples t test. Results Healthy liver parenchyma of the control group is homogeneous signal on DWI. ADC pseudo-color pictures showed green on the homogeneous areas. Slightly restricted area of chronic hepatitis B showed irregular scattered patchy in DWI images, 25 cases in right and left lobes, 5 cases only in right lobe of the liver. ADC pseudo-color pictures reaveled blue region in proliferation-constrained areas. Restricted areas of the liver parenchymal become more evident, also showed an irregular liver edge in 30 cases of cirrhosis. The standarized ADC average values were: the healthy group (0. 47 ±0. 02) × 10-3 mm2/s, chronic hepatitis B group (0. 37 ±0. 03) × 10-3 mm2/s, cirrhosis group (0. 36 ±0. 04) × 10-3 mm2/s( F =97.05,P ＜0. 05).The difference between healthy group and patients group was statistically significant (P ＜ 0. 05 ). No statistically significant difference between groups of chronic hepatitis B and liver cirrhosis ( P ＞ 0. 05 ).Average ADC values of MELD score among groups of ＜ 30, 30 to 36, ＞ 36 were ( 0. 38 ± 0. 02 ) ×10-3 mm2/s,(0.35 ±0.02) × 10-3 mm2/s, (0.32 ± 0.03) × 10-3 mm2/s respectively. There is a significant difference among the three groups (P ＜0. 05). After treatment, DWI of 15 patients with chronic liver disease showed reduction in restricted areas, and the average ADC value from pre-treatment (0. 33 ±0. 03) × 10-3 mm2/s increased to(0. 38 ±0. 03) × 10-3 mm2/s, MELD score from pre-treatment 36. 01 ±6. 00 reduced to 27. 83 ± 4. 86. Conclusion DWI of chronic liver disease showed patchy diffuse restricted areas; more severe of the liver cell damage was, more worse the liver function was and lower ADC values was. ADC values increased after effective treatment, liver function recoved and diffuse restricted areas of liver parenchyma reduced.