| Objective: To investigate the diagnostic value of intravoxel incoherent motion imaging and ultrasonic real-time shear wave elastography in the assessment of liver fibrosis, and then compare their diagnostic ability, in order to provide a more effective, noninvasive and safe examination method for clinical assessment of liver fibrosis.Methods: This study collected a total of 65 subjects, including male 39 cases and female 26 cases, aged from 22 to 70 years old and average(41.8 + 12.4) years old, of which 38 cases with liver fibrosis different pathological stages were confirmed by surgery pathology or liver tissue puncture biopsy(2 cases of S0 stage, 5 cases of S1 stage, 7 cases of S2 stage, 10 cases of S3 stage and 14 cases of S4 stage), including male 21 cases, female 17 cases, aged from 25 to 70 years old and average(48.9 +12.2) years old; another 27 healthy volunteers were(the clinical diagnosis of S0 stage)included in the study, 18 men and 9 women, aged 22 to 60 years old, the average(32.1 + 12.5) years old. All subjects received conventional MRI plain scanning and IVIM sequence scanning and liver elastic modulus determination by using optima MR360 1.5T MRI scanner of GE company and Aixplorer real time shear wave ultrasonic diagnostic instrument of French Supersonic Imagine company. IVIM selected a total of 11 b value as 0, 10, 20, 30, 50, 80, 100, 200, 400, 600, 800s/mm2.The images obtained by IVIM sequence scanning were processed by using the post processing software. The software automatically calculates the standard ADC, fast ADC, slow ADC and perfusion scores f value in liver tissue. Using the Single factor analysis of variance to compare the difference of IVIM parameters(standard ADC,fast ADC, slow ADC and perfusion fraction f value) and liver elastic modulus E value among different pathological stages of liver fibrosis, and Analysis of correlationbetween the 5 values and different pathological stages of liver fibrosis with Spearman rank correlation,while drawing receiver operating characteristic curve and calculating the area under the curve(AUC) of the five numerical values. the comparison between the two with Z test. The sensitivity and specificity of IVIM parameters and Young’s modulus of SWE in the diagnosis of hepatic fibrosis were also calculated, and the diagnostic critical value were determined by Youden index(sensitivity + specificity- 1) according to the highest critical points.Results: 1. With the progress of the degree of liver fibrosis, standard ADC, slow ADC, fast ADC and perfusion fraction f value decreased, while liver elastic modulus increased. there was a significant difference among them(P<0.05).2. There were significant differences in S0 and S1-2, S3, S4, S1-2and S4 for standard ADC value and perfusion fraction(P <0.05);Slow ADC was statistically different in S0 and S1-2, S3, S4, Fast ADC was statistically different in S0 and S4,S1-2 and S4, Elastic modulus E value had significant difference in each group.3. Spearman rank correlation analysis showed that there was a high positive correlation between different pathological stages of liver fibrosis and the E values of elastic modulus(r=0.857, P = 0.000), and there was moderate negative correlation relationship between different pathological stage and the standard ADC value, slow ADC value and perfusion fraction f values(r=-0.565, P = 0.000; r =- 0.416, P =0.002, r =- 0.602, P = 0.000). The correlation coefficient between the E value of the elastic modulus and the f value was statistically significant(Z=2.863, P< 0.005), and the correlation between E value and liver fibrosis stage was higher than that of f value.4. For ≥ S1 the area under the ROC curve of perfusion fraction was the biggest(0.800), followed by the standard ADC(0.790),slow ADC(0.728)and fast ADC(0.679); For ≥S3 and =S4, the area under the curve of perfusion fraction was also the largest(0.847 and 0.855), followed by the standard ADC(0.802, 0.791), fast ADC(0.724, 0.739) and slow ADC(0.697 0.731).The critical values of elastic modulus E value for liver fibrosis ≥ S1, ≥ S3, =S4 were 6.05 Kpa, l0.22 Kpa,14.51 Kpa, area under the ROC curve were Correspondingly 0.948,0.966,0.951,sensitivity were 86.1%, 94.4%, 100%, specificity were 96.7%, 85.4%, 80.4%. Elastic modulus E and perfusion fraction f value of liver fibrosis ≥ S1, ≥ S3, =S4 had a higher diagnostic efficiency, but the diagnostic efficiency of elastic modulus E value was higher than the perfusion fraction f(P < 0.01, P < 0.02, P < 0.05).Conclusion: 1. Magnetic resonance IVIM parameters have a certain value in the diagnosis of liver fibrosis, and f has a high diagnostic efficacy on the degree of liver fibrosis, which may be a more sensitive indicator to assess the severity of liver fibrosis.2. SWE has good discrimination ability with liver fibrosis S0, S1-2, S3, S4 patients.The critical value of SWE in different pathological stages of liver fibrosis(≥ S1, ≥ S3, =S4) are 6.05 Kpa, l0.22 Kpa, 14.51 Kpa with high sensitivity and specificity, it is suggested that SWE has a high diagnostic value for the assessment of fibrosis.3. The diagnostic efficacy of SWE for liver fibrosis ≥ S1, ≥ S3, =S4 is better than magnetic resonance diffusion weighted IVIM imaging. |
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