| Objective: To investigate the value of the quantitative diagnosis of the fatty liver disease by in-phase and out-of-phase subtraction MR imaging and controlled attenuation parameter by Fibro Touch.Methods: 83 patients with fatty liver disease who diagnosed with unenhanced MRI were enrolled in the Affiliated Hospital of Yan’an University from October 2014 to March 2016, at the same time, their general situation and the related clinical information were also collected, and the result of liver stiffness and fat attenuation of 66 Yan’an district residents who were checked by Fibro Touch in the Affiliated Hospital of Yan’an University in July 2015 was collected. What’s more, to collect their general situation and the related clinical information. To evaluate the value of quantitative diagnosis of fatty liver disease through the diagnostic test by Fibro Touch-B ultrasonic diagnostic instrument measured controlled attenuation parameter, and to evaluate the diversity of fatty liver patients and non-fatty liver patients in general situation and biochemical index.For patients with MRI examination, proceeding contrastive analysis by the result of MRI and abdominal B ultrasound, to evaluate the accuracy of diagnosis by in-phase and out-of-phase subtraction MR imaging in patients with fatty liver disease. according to the result of MRI and abdominal B ultrasound. We analysed the method of calculating the content of liver fat, to further evaluate the diversity of the calculation method with liver fat content. We also had a correlative analysis between the content of liver fat and general situation, the biochemical indicators.Results:1. The patients were checked by Fibro Touch in the Affiliated Hospital of Yan’an University in July 2015, the results are the general clinical information, liver stiffness and fat attenuation were as follows.1.1 66 examiners were selected in the end, the average age was 46.9±11.36 y, the minimum age was 24 y, and the maximum age was 65 y. Abdominal ultrasound results showed 40 patients with fatty liver disease and 26 patients with non-fatty liver disease.Fatty liver disease and non-fatty liver disease had statistically significant differences in gender, history of drinking, BMI(?2 =9.860 P=0.002, ?2 =4.784 P=0.029, ?2 =15.614P=0.000). While the age stratification had not statistically significant differences(?2=1.032,P=0.597).1.2 66 inspectors by the single factor showed that TBi L had not statistically significant differences between fatty liver disease group and non-fatty liver disease(P=0.671).However, the major indexes of the metabolic syndrome(blood glucose, TG,TC, BMI, SBP, etc) and liver enzyme(AST, ALT, GGT, etc) in the fatty liver disease group were obviously higher than that in non-fatty liver disease group(all P was less than0.05). HDL-C which was the protective factor of atherosclerosis in non-fatty liver disease group was obviously higher than in fatty liver disease group(P<0.01).1.3 The value of liver stiffness and fat attenuation(CAP) had statistically significant differences between fatty liver disease group and non-fatty liver disease group( P <0.05).The fatty liver disease group of liver stiffness value was higher than that in non-fatty liver disease group(7.85±3.81 kpa VS 5.81±1.07kap). The fatty liver disease group of fat attenuation value was higher than that in non-fatty liver disease group( 270.48±29.72db/m VS 222.69±22.43db/m).The result by Spearman correlative analysis found that CAP had a positive correlation with ALT(r=0.305,P=0.013), AST(r=0.381,P=0.002), respectively. ROC curve is used to evaluate the accuracy of the CAP in the diagnosis of fatty liver disease, maximizing the Youden index space corresponding CAP values at the best cutoff value, obtaining the best cutoff value of the attenuation value was 247.5db/m in the diagnosis of fatty liver disease. Area under the ROC curve was 0.904, the sensitivity was 77.5%, specificity was 88.5%, positive predictive value was 0.913, negative predictive value was 0.715, positive likelihood ratio(LR+) was 6.74, negative likelihood ratio(LR-) was 0.25.2. The general clinical characteristics and imaging results of the patients who examined by in-phase and out-of-phase subtraction MR imaging.2.1 83 patients with fatty liver disease who diagnosed with unenhanced MRI, the patients had 58 men and 25 women, the average age was 45.90±10.71 y, the maximum age was 64 y, and the minimum age was 20 y. Professional to cadre in the majority, next were farmers and workers. Patients had non-alcoholic fatty liver disease in the majority,according to the diagnostic criteria of alcoholic fatty liver disease. The average BMI was6.86±2.83kg/m2, the patients with fatty liver disease to BMI≥25 kg/m2 in the majority. 83 inspectors who were in the merger of viral hepatitis were 25 cases,merger of type 2diabetes were 8 cases, combining the basic pathological changes were 50 cases,such as acute pancreatitis, acute calculous cholecystitis, etc. Abdominal ultrasound results showed 62 patients with fatty liver disease and 21 patients with non-fatty liver disease.2.2 The better methods of the application value to evaluate liver fat content by Clinical practice with in-phase and out-of-phase subtraction MR imaging.Fat signal fraction(FSF)=S脂/(S水+S脂)=(SIP-SOP)/2SIP;liver fat content(LFC)=SI减影图/SIIP;signal index1=(SL-IP-SL-OP)/SL-IP;signal index 4=(SL-IP/SS-IP-SL-OP/SS-OP)/(SL-IP/SB-IP).Signal index1,signal index 4,the FSF and LFC correlative analysis showed that FSF had a positive correlation among LFC,signal index 1and signal index 4(r=0.981 P=0.000,r=1.000,r=0.699 P=0.000).at the same time,LFC also had a positive correlation between signal index 1 and signal index 4(r=0.981 P=0.000,r=0.691 P=0.000).2.3 The correlative analysis between LFC and general situation, the biochemical indicators in patients measured by in-phase and out-of-phase subtraction MR imaging.The results showed that LFC had negatively correction with age(r=-0.305, P=0.005),while had positively relation with BMI(r=0.281, P=0.010),and had no correlation with gender, profession, fasting blood-glucose and systolic blood pressure. LFC had a positive correlation with TC, TG, LDL-C,(r=0.400 P=0.000, r=0.310 P=0.004, r=0.223 P=0.043)respectively. There was a negative correlation with HDL-C(r=-0.238, P=0.030).At the same time, LFC had positively related with ALT(r=0.253, P=0.021), while had no correlation with AST,GGT,ALP.Conclusion:1. Fibro Touch is a non-invasive, painless, low cost and no damage of liver tool which can evaluate and detect the liver fat content. It has the higher sensitivity and specificity in quantitative of fat content, it also can be used for the diagnosis of the general populationand the patients of regular follow-up, and it is not only the quantitative diagnosis of fatty liver disease, but also can be used to check the liver stiffness.2. The liver stiffness value and fat attenuation parameter in fatty liver disease group were higher greater than that in the non-fatty liver disease group.3. The fatty liver disease group about metabolic indices of metabolic syndrome and liver enzymes were higher than that in non-fatty liver disease group, while the cardiovascular protective factor of HDL-C testing result was just the opposite.4. Compared with B ultrasound, the imaging examination method of in-phase and out-of-phase subtraction MR imaging is a convenient and quick, non-radiation and less factors included, which is a better tool for the fatty liver disease with quantitative diagnosis.5. There was higher correlation among each other about different quantitative method of liver fat content by in-phase and out-of-phase subtraction MR imaging, among which LFC calculates of liver fat content was the most close to real liver fatty infiltration degree,which also can be used for the quantitative diagnosis of fatty liver disease and curative effect of follow-up.6. LFC measured by in-phase and out-of-phase subtraction MR imaging have good consistency with BMI, blood lipid spectrum, ALT. Biochemical index can be used as a reference index for evaluating of liver fatty changing. |
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