A Preliminary Study On The Clinical Value Of SWI In The Field Of Child-Pugh Classification Of Liver Function

Purpose: This study based on liver cirrhosis patients liver cells inside and outside components(iron content,collagen,etc.)changes,to quantitatively measure the signal intensity(SI)of liver and spleen parenchyma in the normal people and patients with cirrhosis on 3.0T magnetic resonance(MR)susceptibility-weighted(SW)imaging,and the signal intensity ratio(SIR liver / muscle,SIR spleen / muscle)was calculated by measuring the signal intensity(SI muscle),then to explore the sensibility of SWI as a tool to evaluate the iron content distribution characteristics of liver and spleen in the normal population and patients with cirrhosis.Methods:A total of 32 cases of patients with hepatic cirrhosis,according to the Child-Pugh classification of liver function,the Child-Pugh classification A and B respectively chose 17,15 cases.Besides a total of 50 cases of normal people were divided into two groups according to their age: youth group(14 to 44 years)and middle age group(45 to 59 years old),with 25 cases in each group.Each subject underwent a breathhold SWI sequence scan using 3.0T MR scanner,to obtain the SI of liver(the larger liver level at the first hepatic portal),spleen(spleen maximum level)and erector spine(at their same level),and to calculate liver-to-muscle SI ratios and spleen-to-muscle SI ratios,then iron content distribution character of liver and spleen and their trends among different age groups and among different Child-Pugh classification of liver function were analyzed,meanwhile iron content distribution character of liver and spleen among the normal people and patients with hepatic cirrhosis were compared.Results:1 The SI of normal liver and liver-to-muscle SI ratios respectively showed a weak negative correlation(r=-0.322,P=0.023)and no significant correlation(r=-0.201,P>0.05)with age;while the SI of normal spleen and spleen-to-muscle SI ratios showed a moderate negative correlation with age(r=-0.498,r=-0.487,P=0.000).2 It was showed that the SI of normal liver and spleen,liver-to-muscle SI ratio and spleen-to-muscle SI ratio all decreased with the age increasing,but only the differences of the SI of spleen and spleen-to-muscle SI ratio between the youth group and the middle age group were statistically significant(P<0.01),indicating that the spleen tissue iron content increased with the degree of age more obviously than the liver.3 The difference of liver and spleen SI between the normal group(including the youth group and the middle age group)was statistically significant(P<0.01).The iron content of spleen in normal human was higher than that in the liver.4 The SI of liver and the liver-to-muscle SI ratio showed no significant correlation with Child-Pugh classification of liver function(r=-0.125,r=-0.214,P>0.05).The SI of spleen and the spleen-to-muscle SI ratio respectively showed a strong and a very strong negative correlation with Child-Pugh classification of liver function(r=-0.675,r=-0.858,P=0.000).5 The patients of Child-Pugh classification A and B were compared,there was no statistically significant difference in the SI of liver and liver-to-muscle SI ratio between liver function class A and B patients(P>0.05),but there was statistically significant difference in the SI of spleen and spleen-to-muscle SI ratio between the two groups(P<0.01),indicating that liver and spleen iron deposits in patients with liver cirrhosis class B were more severe than those in patients with class A,and the deposition of spleen iron was more obvious than that of liver.6 In the patients with liver cirrhosis,the SI of liver and liver-to-muscle SI ratio was respectively bigger than that of spleen.There was no statistically significant difference in the patients with class A between that two groups(P>0.05);But there was statistically significant difference in the patients with class B between that two groups(P<0.01).May be due to the degree of spleen iron deposition was not as obvious as that of liver in the patients with class A group,the degree of spleen iron deposition was more pronounced than that of liver in the patients with class B group.7 Normal middle-aged group and middle-aged patients with liver cirrhosis class A were compared,except for the difference of liver-to-muscle SI ratio between the two groups was statistically significant(P<0.01),the remaining datas showed no statistically significant difference between the two groups(P>0.05);Normal middle-aged group and middle-aged patients with liver cirrhosis class B were compared,the datas all showed statistically significant difference between the two groups(P<0.05),indicating that compared with the normal group,the liver and spleen iron deposits in the patients with liver cirrhosis were more aggravated,but the patients of Child-Pugh classification B increased more significantly than the patients of Child-Pugh classification A,and the liver-to-muscle SI ratio may have greater diagnostic efficacy than the SI of liver.Conclusions:1 On the normal and cirrhosis Child-Pugh A,B patients with SWI scan,we could get more high-quality liver,spleen images,SWI was sensitive to changes in iron content in liver and spleen.2 SWI image measurement results showed that,the signal intensity of normal liver and spleen difference was statistically significant,normal spleen iron content higher than the liver,and with the gradual increase in age,liver and spleen iron content gradually increased,spleen iron content increased significantly more than the liver.3 Cirrhosis Child-Pugh B patients with liver and spleen iron deposition were more serious than the A-class patients,which the spleen iron deposition more obvious than the liver.4 Cirrhosis Child-Pugh A,B patients with liver and spleen iron deposition were more serious than normal people,which the B-class patients more obvious than the A-class patients.5 Whether the liver cirrhosis Child-Pugh A,B were compared or the different age groups were compared,the SI of spleen decreased more apparently with age or the increasing grade of liver cirrhosis than liver,Spleen monitoring may be more sensitive in the diagnosis of liver and spleen iron metabolic disorders and the assessment of liver cirrhosis.