中文摘要：

目的 探讨MR DWI在慢性肝病及其肝功能储备评价中的临床应用价值.方法 搜集正常志愿者30名作为对照组,病例组共60例,包括慢性乙型肝炎和肝硬化各30例,均行肝脏DWI,病例组中15例进行了治疗前后的随访复查.病例组抽取静脉血行肝功能测定,根据终末期肝病模型（model for end-stage liver disease,MELD）评分不同分为3组,其中MELD评分＜30分组27例、30～36分组17例、＞36分组16例.测量肝实质的ADC值并与同层面椎管内脑脊液ADC值进行标准化处理.采用单因素方差分析比较组间ADC值,治疗前后ADC值比较采用配对组间t检验.结果 正常对照组肝实质在DWI上信号均匀,ADC伪彩图上表现为均匀的绿色区域;慢性乙型肝炎DWI示散在不规则斑片状稍高信号扩散受限区,25例分布于左右叶,5例局限在右叶,ADC图上扩散受限区表现为蓝色区域;30例肝硬化肝实质呈斑片状扩散受限区更为明显,同时显示肝边缘不规则.正常组ADC值为（0.47±0.02）× 10-3mm2/s,慢性乙型肝炎组为（0.37±0.03）×10-3mm2/s,肝硬化组为（0.36±0.04）×10-3mm2/s,差异有统计学意义（F=97.05,P＜0.05）,正常组与病例组ADC值差异有统计学意义（P＜0.05）,但慢性乙型肝炎组与肝硬化组间的差异无统计学意义（P＞0.05）.MELD评分＜30分组、30～36分组、＞36分组的ADC值分别为（0.38±0.02）×10-3mm2/s、（0.35±0.02）×10-3mm2/s、（0.32±0.03）×10-3mm2/s,正常组与这3组间差异均有统计学意义（P＜0.05）.治疗后,15例慢性肝病患者DWI显示扩散受限区减少,治疗后ADC值由治疗前的（0.33±0.03）×10-3mm2/s提高到（0.38±0.03）×10-3mm2/s（t=7.73,P＜0.01）;MELD评分由治疗前的36.01±6.00降低到27.83±4.86（t=9.01,P＜0.01）.结论 慢性肝病的DWI表现为斑片状扩散受限区,肝细胞损害越严重,肝功能越差,ADC值越低;治疗好转后,肝功能恢复,肝实质的扩散受限减少,ADC值升高.

英文摘要：

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