定量CT与改良Dixon技术在NAFLD诊断中的对比
Journal: Basic Medical Theory Research DOI: 10.32629/bmtr.v8i3.20426
Abstract
目的：针对非酒精性脂肪性肝病（NAFLD）现有诊断手段的局限性，对比分析定量CT与磁共振改良多回波Dixon技术（FACT序列）在肝脏脂肪定量评估中的临床效能，旨在确立一种兼具无创性、高精准度与重复性的影像学评估方案。方法：前瞻性选取2025年1月至2026年3月期间临床确诊的NAFLD患者及健康志愿者共20例。所有受试者均行上腹部16层螺旋CT及1.5T MRI六回波Dixon序列扫描。通过测量肝/脾CT比值（LSR）及MRI质子密度脂肪分数（PDFF），以临床及影像综合分级为基准，分析两种技术在不同脂肪变性程度中的诊断效能及相关性。 结果：本研究纳入正常对照组5例，NAFLD组15例。NAFLD组的LSR显著低于正常对照组（0.70 ± 0.23 vs 1.24 ± 0.06，P<0.001），而MRI-PDFF显著高于正常对照组（18.17% ± 10.25% vs 3.54% ± 1.28%，P=0.001）。Spearman相关性分析显示，MRI-PDFF与LSR呈极显著负相关（r=-0.962，P<0.001）。ROC曲线分析显示，LSR诊断NAFLD的曲线下面积（AUC）为1.000。在轻度脂肪肝的检出上，改良多回波Dixon技术敏感性优于定量CT，且不受铁沉积等因素干扰。 结论：改良多回波Dixon技术通过校正T2*衰减及T1偏倚，能提供客观真实的肝脏脂肪分数。相比于定量CT，其在微量脂肪量化及病情纵向监测方面具有显著优势，有望成为替代肝穿刺活检的“数字化活检”手段。
Keywords
非酒精性脂肪性肝病；体层摄影术；X线计算机；磁共振成像；多回波Dixon；脂肪定量
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[1] 杨伟,王奇志.游离脂肪酸与老年2型糖尿病合并原发性非酒精性脂肪肝临床研究[J].中华实用诊断与治疗杂志,2011,025(001):88-89.
[2] 胡良凯,孟健,张建民,等.2型糖尿病合并非酒精性脂肪肝患者颈动脉粥样硬化临床分析[J].中华实用诊断与治疗杂志,2011(05):436-438.
[3] Labrecque DR, Abbas Z, Anania F, et al. World Gastroenterology Organisation Global Guidelines: Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis[J]. Journal of Clinical Gastroenterology, 2014, 48(6):467-473.
[4] 陈克敏,林晓珠,柴维敏.脂肪性肝病的影像学检查[J].诊断学理论与实践,2014(004):444-445.
[5] Lee SS, Park SH, Kim HJ, et al. Non-invasive assessment of hepatic steatosis: Prospective comparison of the accuracy of imaging examinations[J]. Journal of Hepatology, 2010, 52(4):579-585.
[6] Kuroda H, Kakisaka K, Kamiyama N, et al. Non-invasive determination of hepatic steatosis by acoustic structure quantification from ultrasound echo amplitude[J]. World Journal of Gastroenterology, 2012, 18(29):3889-3895.
[7] Lee SS, Park SH. Radiologic evaluation of nonalcoholic fatty liver disease[J]. World Journal of Gastroenterology, 2014, 20(23):7392-7402.
[8] 刘建新,江永尧,朱映红,等.脂肪肝CT定量诊断与肝功能损伤的相关性研究及对临床疗效评价的价值[J].中外医学研究,2016(18):6-8.
[9] 王东宁,陶杨.超声、CT、MRI诊断脂肪肝的准确性比较[J].现代医学,2015(07):851-854.
[10] Masaki K, Takaki S, Hyogo H, et al. Utility of controlled attenuation parameter measurement for assessing liver steatosis in Japanese patients with chronic liver diseases[J]. Hepatology Research, 2013, 43(11):1182-1189.
[11] Hyodo T, Yada N, Hori M, et al. Multimaterial Decomposition Algorithm for the Quantification of Liver Fat Content by Using Fast-Kilovolt-Peak Switching Dual-Energy CT: Experimental Validation[J]. Radiology, 2017, 282(1):108-118.
[12] Tang A, Desai A, Hamilton G, et al. Accuracy of MR imaging-estimated proton density fat fraction for classification of dichotomized histologic steatosis grades in nonalcoholic fatty liver disease[J]. Radiology, 2015, 274(2):416-425.
[13] 赵黎明,宋彬,陈光文,等.3.0T1H-MRS和梯度回波化学位移MRI在定量分析肝脏脂肪含量中的价值[J].实用放射学杂志,2010,26(10):1452-1456.
[14] Kang BK, Yu ES, Lee SS, et al. Hepatic fat quantification: a prospective comparison of magnetic resonance spectroscopy and analysis methods for chemical-shift gradient echo magnetic resonance imaging with histologic assessment as the reference standard[J]. Investigative Radiology, 2012, 47(6):368-375.
[15] Joe E, Lee JM, Kim KW, et al. Quantification of hepatic macrosteatosis in living, related liver donors using T1-independent, T2*-corrected chemical shift MRI[J]. Journal of Magnetic Resonance Imaging, 2012, 36(5):1124-1130.
[16] 焦志云,李澄,何玲,等.运用3.0T磁共振IDEAL-IQ技术进行肝脏脂肪定量分析的可行性研究[J].中华临床医师杂志(电子版),2015(19):30-33.
[2] 胡良凯,孟健,张建民,等.2型糖尿病合并非酒精性脂肪肝患者颈动脉粥样硬化临床分析[J].中华实用诊断与治疗杂志,2011(05):436-438.
[3] Labrecque DR, Abbas Z, Anania F, et al. World Gastroenterology Organisation Global Guidelines: Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis[J]. Journal of Clinical Gastroenterology, 2014, 48(6):467-473.
[4] 陈克敏,林晓珠,柴维敏.脂肪性肝病的影像学检查[J].诊断学理论与实践,2014(004):444-445.
[5] Lee SS, Park SH, Kim HJ, et al. Non-invasive assessment of hepatic steatosis: Prospective comparison of the accuracy of imaging examinations[J]. Journal of Hepatology, 2010, 52(4):579-585.
[6] Kuroda H, Kakisaka K, Kamiyama N, et al. Non-invasive determination of hepatic steatosis by acoustic structure quantification from ultrasound echo amplitude[J]. World Journal of Gastroenterology, 2012, 18(29):3889-3895.
[7] Lee SS, Park SH. Radiologic evaluation of nonalcoholic fatty liver disease[J]. World Journal of Gastroenterology, 2014, 20(23):7392-7402.
[8] 刘建新,江永尧,朱映红,等.脂肪肝CT定量诊断与肝功能损伤的相关性研究及对临床疗效评价的价值[J].中外医学研究,2016(18):6-8.
[9] 王东宁,陶杨.超声、CT、MRI诊断脂肪肝的准确性比较[J].现代医学,2015(07):851-854.
[10] Masaki K, Takaki S, Hyogo H, et al. Utility of controlled attenuation parameter measurement for assessing liver steatosis in Japanese patients with chronic liver diseases[J]. Hepatology Research, 2013, 43(11):1182-1189.
[11] Hyodo T, Yada N, Hori M, et al. Multimaterial Decomposition Algorithm for the Quantification of Liver Fat Content by Using Fast-Kilovolt-Peak Switching Dual-Energy CT: Experimental Validation[J]. Radiology, 2017, 282(1):108-118.
[12] Tang A, Desai A, Hamilton G, et al. Accuracy of MR imaging-estimated proton density fat fraction for classification of dichotomized histologic steatosis grades in nonalcoholic fatty liver disease[J]. Radiology, 2015, 274(2):416-425.
[13] 赵黎明,宋彬,陈光文,等.3.0T1H-MRS和梯度回波化学位移MRI在定量分析肝脏脂肪含量中的价值[J].实用放射学杂志,2010,26(10):1452-1456.
[14] Kang BK, Yu ES, Lee SS, et al. Hepatic fat quantification: a prospective comparison of magnetic resonance spectroscopy and analysis methods for chemical-shift gradient echo magnetic resonance imaging with histologic assessment as the reference standard[J]. Investigative Radiology, 2012, 47(6):368-375.
[15] Joe E, Lee JM, Kim KW, et al. Quantification of hepatic macrosteatosis in living, related liver donors using T1-independent, T2*-corrected chemical shift MRI[J]. Journal of Magnetic Resonance Imaging, 2012, 36(5):1124-1130.
[16] 焦志云,李澄,何玲,等.运用3.0T磁共振IDEAL-IQ技术进行肝脏脂肪定量分析的可行性研究[J].中华临床医师杂志(电子版),2015(19):30-33.
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