| Objective: To explore a new noninvasive scoring tool for hepatic fibrosis by using the hepatocyte-specific contrast agent gadolinium serrate disodium as a tool.Methods: The first part is the retrospective study,203 cases were collected to accept Gd-EOB-DTPA enhanced MR in order to get imaging data and serological test results,relative enhancement ratio of T1(rr T1)and liver volume(LV)were calculated through the hepatobiliary-phase images,and volume-assisted relative enhancement ratio of T1(va T1)were calculated based on rr T1 and liver volume.At the same time,FIB-4 index and APRI score were calculated as a serological result.The single factor analysis of variance can be compared to the normal control group patients with different Child-pugh,after the optimal curve fitting,the results of coefficient transformation were analyzed by linear regression with rr T1 and va T1.Second part is the prospective study,35 patients were enrolled for observation received treatment like anti hepatitis b virus or drop of enzyme treatment,patients’ scan data and serological test results were collected before and after treatment.rr T1,FIB-4 index and APRI score were tested for normal distribution,afterwards the heteroscedastic paired t test contrast analysis were taken between the various parameters.By comparing the correlation between the data before and after treatment of rr T1,FIB-4 and APRI,we can get the stability of these imaging quantitative parameters in evaluating the progression of liver fibrosis after clinical treatment.The third part is the animal model validation studies,this research previously established liver fibrosis model is adopted to establish the TAA induced liver injury model,discusses MMP9 missing cases of liver fibrosis development and dynamic characteristics of fading,with Gd again-EOB-DTPA signal enhancement rate change,validation of Gd-EOB-DTPA uptake rate in the process of liver fibrosis progression.Results: the first part of the data show that,compared with patients with Child-Pugh class A Child-Pugh,B and C patients rr T1 increased obviously(p = 0.0057 vs.p = 0.0312);the rr T1 value between Child-Pugh,A to B group of patients were statistically significant(p < 0.05).But in the difference between normal group and mild liver fibrosis group,rr T1 slightly less va T1(p = 0.484 vs.p = 0.026).There were significant differences in liver volume between the obvious cirrhosis group,the normal group and the mild to moderate fibrosis group.Pairwise comparison of va T1 between different child-pugh groups showed significant differences(p<0.05).The data of the second part showed that there was a difference in the FIB-4 index and APRI scores before and after treatment(p = 0.009 and p = 0.0002),while there was no difference in the relative enhancement ratio of T1 before and after treatment(p = 0.31).Further analysis showed that rr T1 had a high correlation between the results of rr T1 examination before and after normase treatment,and the linear correlation coefficient was r = 0.905,indicating that rr T1 had little change before and after treatment and could reflect the level of liver fibrosis clinically without being affected by clinical drug treatment.In the third part of the verification experiment,although the TAA modeling process,two kinds of different genotypes of mice with fiber protein expression differences I and fibrin III,but Gd-EOB-DTPA signal enhancement rate is able to distinguish between fibrosis degree of difference,between the two groups in research into the nearly 8 weeks,between the two groups of Gd-EOB-DTPA signal enhancement rate,and fibrous protein quantitative results consistent with pathology results.Conclusion: Enhanced MR with Gd-EOB-DTPA not just obtain the pathological of liver nodules,but also provide important information in the follow-up of chronic hepatitis B patients,such as distinguish low-risk nodules(LGDN/RN)from high-risk nodules(HGDN/ early HCC or advanced HCC).In addition,relevant information of the development level of liver fibrosis can be obtained to evaluate the degree of liver fibrosis stably and effectively.It can be said that Gd-EOB-DTPA enhanced MR can provide one-stop cytological information of background liver tissue and lesion tissue.Therefore,this examination method is expected to become a necessary examination method for follow-up of chronic hepatitis B patients,and has a good application prospect in the future. |
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