原发性胆汁性胆管炎患者磁共振检查肝脏表现特点分析

摘要/Abstract

摘要： 目的探讨MRI在诊断原发性胆汁性胆管炎(PBC)和肝纤维化评估中的价值。方法 2012年1月至2020年1月驻马店市第九九O医院收治的PBC患者42例。绘制ROC曲线,确定弥散加权成像(DWI)最佳诊断截断点,评价DWI对PBC分期的诊断。结果 PBC患者Ⅰ期7例,Ⅱ期12例,Ⅲ期17例,Ⅳ期6例。患者MRI征象包括弥漫性肝肿大20例(47.6%),脾肿大42例(100%),门静脉内径管腔增大23例(54.8%),门体侧支循环建立4例(7.7%),腹水9例(21.4%),T2加权肝实质信号强度不均匀22例(52.4%),门静脉周围T2加权高信号25例(59.5%),门脉周围晕征26例(61.9%),肝内胆管数量减少24例(57.1%),肝门淋巴结肿大24例(57.1%)。26例门脉周围晕征PBC患者中Ⅰ期2例、Ⅱ期4例、Ⅲ期15例、Ⅳ期5例;24例肝内胆管数量减少PBC患者中Ⅰ期0例,Ⅱ期4例,Ⅲ期15例,Ⅳ期5例。PBC患者平均ADC值分别为Ⅰ期(1.12±0.04)×10^-3 mm/s²,Ⅱ期(1.09±0.02)×10^-3 mm/s²,Ⅲ期(1.05±0.04)×10^-3 mm/s²,Ⅳ期(1.01±0.03)×10^-3 mm/s²。DWI诊断≥Ⅱ期PBC患者时的截断点、AUC(95%CI)、敏感度及特异度分别为1.10×10^-3 mm/s²、0.85(0.78～0.89)、70.8%及81.6%;诊断≥Ⅲ期PBC患者时的截断点、AUC(95%CI)、敏感度及特异度分别为1.06×10^-3 mm/s²、0.91(0.85～0.94)、83.2%及90.8%。结论门脉周围晕征、肝内胆管数量减少是PBC患者的MRI特异性征象,DWI能够有效诊断≥Ⅲ期PBC患者。

关键词: 原发性胆汁性肝硬化, 磁共振, 肝纤维化, 受试者工作特性曲线

Abstract: Objective To evaluate the MRI findings of primary biliary cholangitis patients with (PBC), and to explore the value of MRI in the diagnosis of PBC and the evaluation of liver fibrosis.Methods From Jan 2012 to Jan 2020, there were 42 patients with PBC (10 males and 32 females) with an average age of (52.9±9.8) years. T-test was used for measurement data, chi-square test was used for counting data, ROC curve was drawn, the best cut-off point for DWI diagnosis was determined, and the diagnosis of PBC staging by DWI was evaluated.Results According to Ludwig classification, there were seven cases of stage Ⅰ, twelve cases of stage Ⅱ, seventeen cases of stage Ⅲ and six cases of stage Ⅳ in patients with PBC. The MRI signs of the patients included diffuse hepatomegaly in 20 cases (47.6%), splenomegaly in 42 cases (100%), enlargement of portal vein lumen in 23 cases (54.8%), establishment of portosystemic collateral circulation in 4 cases (7.7%), ascites in 9 cases (21.4%), inhomogeneous signal intensity of hepatic parenchyma in 22 cases (52.4%), and T2-weighted high signal intensity around portal vein in 25 cases (59.5%). The periportal halo sign was found in 26 cases (61.9%), the number of intrahepatic bile ducts decreased in 24 cases (57.1%), and hilar lymph node enlargement in 24 cases (57.1%). Among the 26 PBC patients with periportal halo syndrome, there were two cases of stage Ⅰ (33.3%), four cases of stage Ⅱ (30.8%), fifteen cases of stage Ⅲ (83.3%) and five cases of stage Ⅳ (100%). Among the 24 patients with reduced number of intrahepatic bile ducts in PBC, there were zero cases in stage Ⅰ (0), four cases in stage Ⅱ (30.8%), fifteen cases in stage Ⅲ (83.3%) and five cases in stage Ⅳ (100%). There was significant difference in the number of cases in each stage (P<0.05), but no significant difference was found in other MRI signs (P>0.05). The average ADC values of patients with PBC were (1.12±0.04) ×10^-3 mm/s² in stage Ⅰ, (1.09±0.02)×10^-3 mm/s² in stage Ⅱ, (1.05±0.04)×10^-3 mm/s² in stage Ⅲ, and (1.01±0.03)×10^-3 mm/s² in stage IV, respectively. Comparing the average ADC value of each stage, there were significant differences between stage Ⅰ and stage Ⅲ, stage Ⅰ and stage Ⅳ, stage Ⅱ and stage Ⅳ (P< 0.05). The cutoff point, AUC (95%CI), sensitivity and specificity of DWI in patients with ≥stage Ⅱ PBC were 1.10× 10^-3 mm/s², 0.85 (0.78-0.89), 70.8% and 81.6%, respectively, and the cutoff point, AUC (95%CI), sensitivity and specificity in patients with ≥stage Ⅲ PBC were 1.06×10^-3 mm/s², 0.91 (0.85-0.94), 83.2% and 90.8%, respectively.Conclusion Periportal halo sign and decreased number of intrahepatic bile ducts are specific signs of MRI in patients with PBC. DWI can effectively diagnose patients with stage Ⅲ PBC. To sum up, MRI can be used as an effective non-invasive way to evaluate liver fibrosis in patients with PBC, and is helpful to evaluate the severity of PBC lesions.

Key words: Primary biliary cirrhosis, Magnetic resonance imaging, Hepatic fibrosis, Receiver operator characteristic curve

赵宏伟, 祝佳, 张国良, 白雪峰, 韩飞, 林光耀. 原发性胆汁性胆管炎患者磁共振检查肝脏表现特点分析[J]. 肝脏, 2021, 26(8): 903-906.

ZHAO Hong-wei, ZHU Jia, ZHANG Guo-liang, BAI Xue-feng, HAN Fei, LIN Guang-yao. The value of magnetic resonance imaging in the diagnosis of primary biliary cholangitis and the evaluation of hepatic fibrosis[J]. Chinese Hepatolgy, 2021, 26(8): 903-906.

参考文献

[1] Zhang HC, Hu RF, Zhu T,et al. Primary biliary cirrhosis degree assessment by acoustic radiation force impulse imaging and hepatic fibrosis indicators. World J Gastroenterol, 2016, 22: 5276-5284.
[2] Shi T, Zhang T, Zhang L, et al. The distribution and the fibrotic role of elevated inflammatory Th17 cells in patients with primary biliary cirrhosis. Medicine (Baltimore), 2015, 94:e1888.
[3] Xu P, Li L, Li G, et al. Insight into the natural history of primary biliary cirrhosis: a systemic review of data from placebo-controlled clinical trials. Turk J Gastroenterol, 2016, 27:342-348.
[4] Liu F, Pan ZG, Ye J, et al. Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome: simplified criteria may be effective in the diagnosis in Chinese patients. J Dig Dis, 2014, 15:660-668.
[5] Fang YQ, Lv DX, Jia W, et al. Case-control study on prednisolone combined with ursodeoxycholic acid and azathioprine in pure primary biliary cirrhosis with high levels of immunoglobulin G and transaminases: efficacy and safety analysis. Medicine (Baltimore), 2014, 93:e104.
[6] Terziroli Beretta-Piccoli B, Mieli-Vergani G, et al. The clinical usage and definition of autoantibodies in immune-mediated liver disease: a comprehensive overview. J Autoimmun, 2018, 95:144-158.
[7] Meng Y, Liang Y, Liu M. The value of MRI in the diagnosis of primary biliary cirrhosis and assessment of liver fibrosis. PLoS One, 2015, 10:e0120110.
[8] Cazzagon N, Lemoinne S, El Mouhadi S, et al. The complementary value of magnetic resonance imaging and vibration-controlled transient elastography for risk stratification in primary sclerosing cholangitis. Am J Gastroenterol, 2019, 114:1878-1885.
[9] Wenzel JS, Donohoe A, Ford KL 3rd, et al. Primary biliary cirrhosis: MR imaging findings and description of MR imaging periportal halo sign. AJR Am J Roentgenol, 2001, 176:885-889.
[10] Kovač JD, Ješić R, Stanisavljević D, et al. Integrative role of MRI in the evaluation of primary biliary cirrhosis. Eur Radiol, 2012, 22:688-694.
[11] 中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会. 原发性胆汁性肝硬化(又名原发性胆汁性胆管炎)诊断和治疗共识(2015). 中华传染病杂志, 2016, 34:385-394.
[12] Blachar A, Federle MP, Brancatelli G. Primary biliary cirrhosis: clinical, pathologic, and helical CT findings in 53 patients. Radiology, 2001, 220:329-336.
[13] Dodd GD, Baron RL, Oliver JH, et al. Enlarged abdominal lymph nodes in end-stage cirrhosis: CT-histopathologic correlation in 507 patients. Radiology, 1997, 203:127-130.
[14] Kovač JD, Ješić R, Stanisavljević D, et al. MR imaging of primary sclerosing cholangitis: additional value of diffusion-weighted imaging and ADC measurement. Acta Radiol, 2013, 54:242-248.

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