肝脏扩散加权磁共振成像在酒精性肝病诊断中的现代可能性

F. Lozbenev, T. Morozova
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When comparing the results of a qualitative assessment of liver DWI MRI with the CAGE (Cut, Annoyed, Guilty, Eye-opener) test data and the results of patients and relatives survey about the use of alcoholic beverages, a high correlation was established between the diffusion restriction in the liver during MRI and impaired withdrawal regimen (r = 0.901). The diagnostic and prognostic significance of the developed criteria for liver DWI MRI in patients with ALD at admission was assessed: for qualitative assessment AUROC 0.827 (95% CI 0.792–0.873), for quantitative assessment AUROC 0.949 (95% CI 0.912–0.981); in dynamic observation: for qualitative assessment AUROC 0.958 (95% CI 0.925–0.984), for quantitative assessment AUROC 0.947 (95% CI 0.947–0.981).Conclusion. 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引用次数: 0

摘要

目的:评价扩散加权成像(DWI)在肝脏磁共振成像(MRI)中诊断酒精性肝病(ALD)的可能性。材料和方法。在第一临床医院(斯摩棱斯克)的基础上,接受检查的患者在胃肠科处于住院和门诊观察阶段,并接受了酒精病因的弥漫性肝病的治疗。该研究包括128名患者:76名(59%)男性和52名(41%)女性,平均年龄42.3±4.7岁。从2019年到2022年对患者进行监测。均行腹部脏器超声肝弹性成像和肝脏磁共振DWI成像;对34例患者进行了肝脏多层计算机断层扫描。后果当将肝脏DWI MRI的定性评估结果与CAGE(切割、烦恼、内疚、大开眼界)测试数据以及患者和亲属关于酒精饮料使用的调查结果进行比较时,MRI期间肝脏的扩散限制与停药方案受损之间建立了高度相关性(r=0.901)。评估了ALD患者入院时肝脏DWI MRI标准的诊断和预后意义:定性评估AUROC 0.827(95%CI 0.792–0.873),定量评估AUROC 0.949(95%CI 0.912-0.981);动态观察:定性评估AUROC 0.958(95%CI 0.925–0.984),定量评估AUROC 0.947(95%CI 0.947–0.981)。结论:所获得的肝脏DWI MRI定量指标可以预测ALD的临床形式:脂肪变性的表观扩散系数为2.66±0.9×,肝炎为1.75±0.6×10-3 mm2/s,肝硬化为1.15±0.6×10-6 mm2/s(AUROC 0.948;95%CI 0.922-0.983)。肝脏DWI MRI的定性参数(有/没有扩散限制)预测所有临床形式的ALD患者违反停药方案(AUROC0.931;95%CI 0.822-0.979)。
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Modern Possibilities of Liver Diffusion-Weighted Magnetic Resonance Images in the Diagnosis of Alcoholic Liver Disease
Objective: to evaluate the current possibilities of diffusion-weighted imaging (DWI) in liver magnetic resonance imaging (MRI) for the diagnosis of alcoholic liver disease (ALD).Material and methods. The examined patients were at the inpatient and outpatient stages of observation in the gastroenterology department on the basis of the Clinical Hospital No. 1 (Smolensk) and received treatment for diffuse liver diseases of alcoholic etiology. The study included 128 patients: 76 (59%) males and 52 (41%) females, mean age 42.3 ± 4.7 years. Patients were monitored from 2019 to 2022. All of them underwent abdominal organs ultrasound with liver clinical elastography and liver MRI with DWI; in 34 cases liver multi-slice computed tomography was performed.Results. When comparing the results of a qualitative assessment of liver DWI MRI with the CAGE (Cut, Annoyed, Guilty, Eye-opener) test data and the results of patients and relatives survey about the use of alcoholic beverages, a high correlation was established between the diffusion restriction in the liver during MRI and impaired withdrawal regimen (r = 0.901). The diagnostic and prognostic significance of the developed criteria for liver DWI MRI in patients with ALD at admission was assessed: for qualitative assessment AUROC 0.827 (95% CI 0.792–0.873), for quantitative assessment AUROC 0.949 (95% CI 0.912–0.981); in dynamic observation: for qualitative assessment AUROC 0.958 (95% CI 0.925–0.984), for quantitative assessment AUROC 0.947 (95% CI 0.947–0.981).Conclusion. The obtained quantitative indicators of liver DWI MRI make it possible to predict the clinical form of ALD: apparent diffusion coefficient for steatosis is 2.66 ± 0.9 × 10–3 mm2/s, for steatohepatitis – 2.14 ± 0.5 × 10–3 mm2/s, for hepatitis – 1.75 ± 0.6 × 10–3 mm2/s, for cirrhosis – 1.15 ± 0.6 × 10–3 mm2/s (AUROC 0.948; 95% CI 0.922–0.983). Qualitative parameters of liver DWI MRI (there is/is not a diffusion restriction) predict violations of the withdrawal regimen in patients with ALD in all its clinical forms (AUROC 0.931; 95% CI 0.822–0.979).
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