The Quantitatively Evaluating Of HBV-related Acute-on-chronic Liver Failure With 3.0t MRI

Objective: To investigate the value of MRI for evaluation of chronic HBV-related acute-on-chronic liver failure. Method: A total of 39 patients who satisfied the inclusion criteria were enrolled in our study between January, 2015 and January, 2016 in our hospital. This study consisted of 28 patients with acute-on-chronic liver failure, 11 patients with chronic hepatitis(case groups) and 14 healthy volunteers as a control group. Both the case groups and control group undergone a 3.0T MRI scan of upper abdomen and the MRI scan sequences included Dual FFE, TSE/T2WI/SPAIR, THRIVE, DWI,m-GRASE and VEN-BOLD. The corresponding imaging indexes including rSI,rSⅡ, SⅡT2WI, SⅡTHRIVE, ADC value, T2 relaxation time or R2 value, and SIIswI were calculated respectively. Simultaneously, blood biochemical indexes from case groups were collected in 2 days pre- or post-scan was calculated. The differences of imaging index among 3 groups were compared using an One-way ANOVA analysis or nonparametric test. The correlation were analysed using Spearman rank correlation analysis among imaging index and liver function staging.Receiving-operator characteristics(ROC) curve analysis was performed to assess the diagnostic efficiency of some imaging indexes for diagnosing acute-on-chronic liver failure. Results: rSI, SIIT2WI,ADC, T2/R2 and SIIswi value had statistical differences among the three groups. In our study, the patients with poorer liver function demonstrated statistically significant higher rSI, SⅡT2WI and T2 values. The corresponding spearman rank correlation coefficient was 0.410(P=0.003), 0.370(P=0.006), and 0.637(P=0.000),respectively. The differences were statistically significant. The patients with poorer liver function demonstrated statistically significant lower ADC, R2 and SIIswi value. The corresponding spearman rank correlation coefficient was-0.505(P=0.000), -0.637(P=0.000), and -0.455(P=0.002), respectively. The differences were statistically significant. However, the remaining two imaging indexes such as the rSⅡ and SⅡTHRIVE value had no correlation with liver function staging in this investigation. Pairwise comparison showed that: R2 and ADC valve could distinguish the acute-on-chronic liver failure group from control group and acute-on-chronic liver failure group from chronic hepatitis;rSⅠ、SⅡT2WI and SⅡSWI could distinguish the acute-on-chronic liver failure group from control group only. ROC curve for the hepatic R2 value in predicting acute-on-chronic liver failure showed area under the ROC curve was 0.863(P=0.000), and cutoff point was 57.73ms (R2 =0.0173). ROC curve for the hepatic ADC value in predicting acute-on-chronic liver failure showed area under the ROC curve was 0.794(P=0.001), and cutoff point was1.1261×10 3mm2/s. An overlap was observed in the cut-off value of ADC for distinguishing cute-on-chronic liver failure from chronic hepatitis. After the chronic hepatitis was deleted, ROC curve showed the area under the ROC curve of rSⅠ, SⅡT2W1 and SⅡSWI were 0.799(P=0.002), 0.737(P=0.013) and 0.798(P=0.003), respectively, in predicting acute-on-chronic liver failure, and the corresponding cutoff point was 1.5786、0.9856 and 0.5871, respectively.When any one of five indexes reach to or exceed the cutoff point, the sensibility for diagnosing acute-on-chronic liver failure increased to 86.74%～99.19%. The specificity for the diagnosis of acute-on-chronic liver failure increased to 92.85%～100% when any two of the five image indexes reach to or exceed the cutoff point. The T2 value had moderate positive correlation INR, PT and HA.The corresponding spearman rank correlation coefficient was 0.651(P=0.000),0.666(P=0.000),and 0.390(P=0.025), respectively. The differences were statistically significant. The moderate negative correlation was observed between R2 and PTA, ALB, PA. The corresponding spearman rank correlation coefficient was -0.667(P=0.000),-0.480(P=0.00), and -0.373(P=0.030). The differences were statistically significant. However, the remaining imaging indexes had correlation with only some laboratory indexes in this investigation.Conclusions: 1. The imaging indexes including rSI, SⅡT2WI, SⅡSWI, ADC and T2 value all could reflect the liver function, especially T2 or R2 value demonstrating favorable evaluation efficiency. However, SⅡTHRIVE value couldn’t reflect hepatic functional situation favorably. 2.R2 and ADC valve could distinguish the acute-on-chronic liver failure group from control group and acute-on-chronic liver failure group from chronic hepatitis. The ADC value had limited application value for evaluating liver function for an overlap between cut-off value of liver failure and chronic hepatitis.3. rSⅠ、SⅡT2WI and SIIswi could distinguish the acute-on-chronic liver failure group from control group only. Nonetheless, the sensibility and specificity of diagnose of liver failure can be increased with the combination of two or more image indexes.4.T2/R2 value could be used as favorable imaging index for evaluating the hepatic functional situation of chronic hepatitis for the favorable evaluation efficiency of acute-on-chronic liver failure and closely correlation with most laboratory indexes.