影像量化脂肪肝含量分析在活體肝臟移植運用

Imaging Quantification of Hepatic Steatosis in Living Donor Liver Transplantation

蔣獻仁(Hsien-Jen Chiang)

指導教授 ： 黎俊蔚

高雄醫學大學/健康科學院/醫學影像暨放射科學系碩士在職專班/碩士(2015年)

https://doi.org/10.6832/KMU.2015.00101

摘要

在活體肝臟移植手術中，脂肪肝的程度是影響著捐贈者和受贈者的一大問題。這項研究的目的是以手術中病理切片為標準，比較分析電腦斷層掃描影像、磁振化學位移(IDEAL IQ)脂肪含量影像及氫質子磁共振頻譜三種分析肝臟脂肪含量檢查的診斷正確性及與檢查吻合度。這個研究經長庚人體試驗審查通過後執行，共有80位活體移植捐贈者參與，所有影像分別在肝臟右葉、左葉、及左側葉三個位置進行量測分析。以學生t檢定作為統計分析方法；同時以Pearson回歸方式分析不同檢查與病理組織切片結果的相關性，最後再利用受試者工作特徵曲線分析檢驗不同檢查的敏感性和特異性。
病理結果顯示有59位(73.8%)肝臟脂肪浸潤小於5%，17位有5％-10％脂肪浸潤，3位11％-15%脂肪浸潤，只有一位大於16％脂肪浸潤。學生t檢定結果顯示三種檢查方式對於分辨有無脂肪肝檢驗在統計結果均有顯著差異。IDEAL IQ脂肪含量分析影像在正常組別及脂肪肝組之結果分別是2.97±1.01及7.90±3.63，p <0.0001；氫質子磁共振頻譜分析結果分別是1.85±0.98及8.13±3.52， p <0.0001，而電腦斷層掃描影像分析結果則是1.54±2.82及8.48±8.02，p<0.0001。
氫質子磁共振頻譜分析與病理結果在Pearson回歸有著最高度的相關性(r=0.936，p<0.0001)。氫質子磁共振頻譜分析工作特徵曲線分析的敏感性(95.2%)和特異性(98.3%)高於IDEAL脂肪含量影像(95.2%，96.6%)，及電腦斷層掃描影像(85.7% and 74.6%)。氫質子磁共振頻譜分析與IDEAL IQ脂肪含量影像分析是具備高精確度及診斷準確率的脂肪肝定量檢查方式，可測出脂肪肝的相對定量，對於運用於臨床上，有著實際的幫助。

關鍵字

活體肝臟移植 ； 電腦斷層 ； IDEAL IQ脂肪含量 ； 氫質子磁共振頻譜分析

並列摘要

Hepatic steatosis is a major problem in both donors and recepinets in living donor liver transplantation (LDLT). The purpose of this study is to compare the diagnostic performance of non-enhanced computed tomography (CT), IDEAL IQ fat fraction imaging and one breath-hold 1H MR spectroscopy in liver fat quantification in LDLT comparison with intraoperative liver biopsy. This prospective study was approved by the institutional review board, 80 LDLT who received CT and both MR sequence and intraoperative liver biopsy were enrolled in this study (37 right, 33 left and 10 lateral segment graft). Imaginings evaluation of the liver fatty content in segment 5, 8 and left lateral segment. All results were correlated with histopathologic analysis of results of intraoperative liver biopsy. Accuracy was assessed through linear regression between each modality fat fraction and pathology grading. Sensitivity and specificity were also caculated by using receiver operating characteristic curve analysis. At histopathologic result, 59 donorts (73.8%) had no(0%-5%) fatty content, 17 donors(21.3%) had 5%-10% fatty liver, 3 donors (3.8%)had 11%-15% fatty liver, and only 1 donor>16 % fatty change. Different modality fat fraction correlation with the pathology grading between normal and fatty group were 1.85 ± 0.98, 8.13 ± 3.52, p <0.0001, in 1H MRS. 2.97 ± 1.01, 7.90 ± 3.63, p <0.0001, in IDEAL IQ fat fraction and 1.54 ± 2.82, 8.48 ± 8.02, p<0.0001 in CT.
1H MRS has highest correlation with histopathologic results (r = 0.936, p<0.0001). The sensitivity and specificity for detection of liver steatosis in 1H MRS were 95.2% and 98.3% (cutoff 4.965 area 0.999 p<0.0001, 95% CI 0.000-1.000) higher than IDEAL IQ (95.2% and 96.6%, cutoff 5.10 area 0.994 P <0.0001) and CT (85.7% and 74.6%, cutoff 2.5, area 0.837 p<0.0001 95% CI 0.731-0.943). MR IDEAL IQ fat fraction image and 1H MR spectroscopy had the highly precise and diagnosis accurate rate in quantification hepatic steatosis for the living donor.

並列關鍵字

living donor liver transplantation ； computed tomography ； IDEAL IQ fat fraction ； 1H MR spectroscopy

參考文獻

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