MRI Study Of Chronic Liver Disease And It's Liver Function Reserve

Purpose:Patients of chronic liver disease were undergone conventional magnetic resonance imaging and diffusion weighted imaging and phase contrast magnetic resonance imaging on 1.5 Tesla GE signal magnetic resonance imager.We view the morphous change in patients and investigated whether apparent diffusion coefficient values(ADCS)and the mean flow velocity of portal vein(PV)and the flow volume per minutes of portal vein(PVOL)are related to the hepatic functional reserve.Materials and Methods:Control group(30 cases,male 18 cases;female 12 cases;years of age 24～66 years),chronic type B hepatitis group(30 cases,male 24 cases;female 6 cases;years of age 24～68 years,),liver cirrhosis group(30 cases male 26 cases; female 4 cases;years of age 24～68 years).20 patients of experimental groups were confirmed by pathological biopsy.The rest of patients were confirmed by clinical manifestation and laboratory examination and imaging finding. According to the model for end-stage liver disease(MELD)scores,divided patients into MELD scores＜30 scores guoup or MELD scores 30～36 scores group or MELD scores＞36 scores group.Control group and all patients underwent liver MRI and DWI and PC-MRI using a GE 1.5-Tesla magnet equipped.Moreover,15 cases of patients underwent MRI and DWI and PC-MRI both pretherapy and post-treatment per month within half a year.Right lobe of liver maximal transverse diameter and left lobe of liver maximal sagittal diameter and caudate lobe of liver maximal transverse diameter and portal vein inner diameter were measured on the plane of porta hepatis.Original images of DWI were handled using a postprocessing workstation.To select three identical round region of interest(300mm²),measure apparent diffusion coefficient valus(ADCS),respectively and calculated mean value in liver right posterior lobe on the plane of porta hepatis.In the same time,measured ADCS of cerebrospinal fluid in vertebral canal on the same plane.And then standardized ADCS(standardized ADCS=ADCS of liver/ADCS of cerebrospinal fluid). Phase contrast magnetic resonance imaging(PC-MRI)scaned on the plane plumbed middle point of portal vein stem.After obtained original images,we measured the mean flow velocity of portal vein(PV)and flow volume per minutes of portal vein(PVOL)using CV-flow postprocessing software and and calculated mean values.Study liver morphological changes and size of portal vein inner diameter by contradistinction.To research imageological changes of chronic hepatitis and cirrhosis of liver.Study pathematological changes of its through observing pictures of DWI and ADC.Estimate changes of blood flow of its by PV and PVOL.Besides,analyzed the correlation between liver morphological changes and MELD scores,ADCS and MELD scores,PV and MELD scores,PVOL and MELD scores.All statistical analyses were conducted using SPSS for Windows version 13.0.One-way ANOVA and Nonparametric rank test and student-Newman-Keuls test and Pearman correlation analysis and Paired T test and multiple regression were used for data. For all tests P＜0.05 was considered statistically significant.Results:1,MRI plain scan:signal of liver parenchyma of control group were uniform,signal intensity like soft tissue on T₁WI and T₂WI,liver edge were smooth,disposition of liver blood vessel were natural.Spleen was normal.27 cases of chronic type B hepatitis group MRI plain scan appearance were normal, only 3 cases had crude egde,10 cases spleen enlarged.17 cases of liver cirrhosis had concavoconvex edge,8 cases had crude egde,23 cases had liver cirrhosis nodule,30 cases had bypass circuit vessel and spleed enlarged.Right lobe of liver transverse diameter:liver cirrhosis group＜chronic type B hepatitis group＜control group(P＜0.05).Left lobe of liver sagittal diameter of chronic type B hepatitis group was shrinked.There was not significant difference between control group and liver cirrhosis group.Caudate lobe of liver transverse diameter of experimentation groups were larger than control group.Right lobe of liver transverse diameter of all MELD scores groups were smaller than control group.There was not significant difference about left lobe of liver sagittal diameter in the three MELD scores groups each others.There was not significant difference between experimentation groups and control group in portal vein inner diameter.There were slightly statistically significant negative correlations between right lobe of liver transverse diameter and MELD scores(P=-0.33).There was not significant difference between left lobe of liver sagittal diameter and MELD scores,Caudate lobe of liver transverse diameter and MELD scores,portal vein inner diameter and MELD scores.2,DWI scan:diffusion of normal liver parenchyma were uniform, displayed green color region on ADC image.Vessel of liver was red color on ADC image.When patient'^s liver function of chronic type B hepatitis and liver cirrhosis were abnormal,liver outline form often normal but DWI can display the limited diffusion region of liver parenchyma,blue corlo region on ADC image..Standardized ADCS of experimentation groups(0.37±0.03;0.36±0.04)were lower than control group(0.47±0.02).When b=800,95% confidence interval of control group and experimentation groups were(0.46, 0.48),(0.35,0.37)respectively.There was not significant difference between PV,PVOL of control group(10.56±1.36 cm/s;883.86±133.77 ml/mim) and PV(11.16±2.77 cm/s;11.44±3.32 cm/s),PVOL(1031.55±268.29 ml/mim;995.32±328.50 ml/mim)of experimentation groups.There were statistically significant negative correlations between standardized ADCS,PV,of experimentation groups and MELD scores.There was not significant difference between PVOL and MELD scores.3,There was significant difference about standardized ADCS in the three MELD scores groups each others.The 95%confidence interval of the three groups(＜30 scores group,30～36 scores group,＞36 scores group)were(0.38, 0.39);(0.35,0.37);(0.30,0.34)respectively.4,There was significant difference between PV of MELD scores＜30 scores group and PV of MELD scores＞36 scores group.Their 95%confidence interval were(10.77,13.67);(8.02,11.04)respectively.5,There was not significant difference between pretherapeutic diameters of liver and post-treament.After treamtment,standardized ADCS,PV,PVOL of patients were heightened.There was significant negative correlation of the dynamic changes between standardized ADCS,PV,PVOL and MELD scores for the period between pretreatment to post-treatment.Multipel regression analysis suggested that standardized ADCS and PV influenced MELD scores greatly(P=0.70;0.72,respectively).Conclusion:1,As MELD scores raised up,right lobe of liver transverse diameter had a tendency to shrink,caudate lobe of liver transverse diameter had a tendency to enlarge.When patient's condition was not Severe,portal vein inner diameter had a tendency to widen,on the contrary state of illness,had a tendency to shrink.2,There were slightly statistically significant negative correlations (R=-0.33,P＜0.05)between right lobe of liver transverse diameter and MELD scores.3,ADCS of liver parenchyma of patient with chronic liver disease were degraded,When patient's condition was not Severe,PV and PVOL had a tendency to increase,on the contrary state of illness,had a tendency to diminish.There was not significant difference about PV and PVOL between experimental group and control group.4,Optimum b value of DWI were 800s/mm².If standardized ADCS exceeded 0.38,liver function of patient was damaged slightly,so prognosis of patient was well.If standardized ADCS were lower than 0.34,liver function of patient was damaged severely,mortality of patient was hight.When standardized ADCS between 0.34 and 0.38,prognosis of patient was badness.5,There were statistically significant negative correlations between standardized ADCS,PV,PVOL and MELD scores.There also were significant negative correlation of the dynamic changes between standardized ADCS,PV,PVOL and MELD scores for the period between pretreatment to post-treatment. Standardized ADCS and PV influenced MELD scores greatly.6,There were statistically significant negative correlations between standardized ADCS,PV,PVOL and MELD scores.Standardized ADCS,PV,PVOL will be useful indexes in estimating the hepatic functional reserve.