螺旋ＣＴ可诊断丙型肝炎肝纤维化分期及分布

张医生

传统的CT平扫是一种评价慢性丙型肝炎患者肝纤维化程度的检查方法。目前，数字化螺旋CT检查已应用于临床。西班牙学者Romero-Gomez等的研究表明，螺旋CT用于检查慢性丙型肝炎患者的肝纤维化程度，是一种有效的方法，它不仅可以确定肝纤维化的分期，还可以显示纤维化的分布。

研究者将受试患者分为评价组（34例）和验证组（107例），对其均进行螺旋CT检查。以每例患者的非线性加权F值计算评价接受螺旋CT检查患者的肝纤维化病情，然后，由2位病理学家采取盲法以Scheuer分级标准，对受试者进行F0～F4肝纤维化分期。

结果显示，根据螺旋CT检查确定的肝纤维化与病理学分级诊断的肝纤维化相关（r=0.69，P<0.001）。受试者工作特征（ROC）曲线显示，分别应用螺旋CT和组织学观察对肝纤维化进行分析，结果相似。与肝纤维化分布不均匀的患者相比，肝纤维化分布均匀者的螺旋CT检查结果与病理学结果更相关（r=0.77，P<0.05）。

研究者认为，螺旋CT可有效明确慢性丙型肝炎患者的肝纤维化分期和分布，且是一项简单、易行的无创检查方法，因此值得推荐临床应用。

Hepatology. 2007 Dec 20 [Epub ahead of print]

Optical analysis of computed tomography images of the liver predicts fibrosis stage and distribution in chronic hepatitis C.

Romero-Gomez M, Gomez-Gonzalez E, Madrazo A, Vera-Valencia M, Rodrigo L, Perez-Alvarez R, Perez-Lopez R, Castellano-Megias VM, Nevado-Santos M, Alcon JC, Sola R, Perez-Moreno JM, Navarro JM, Andrade RJ, Salmeron J, Fernandez-Lopez M, Aznar R, Diago M.

Unit for the Clinical Management of Digestive Diseases and CIBEREHD, Hospital Universitario de Valme, Sevilla, Spain.

This study was undertaken to evaluate an image processing method for assessing liver fibrosis in conventional computed tomography (CT) scans in patients with chronic hepatitis C. Two cohorts (designated "estimation," n = 34; and "validation," n = 107) of chronic hepatitis C patients were assessed using digitized conventional helical CT. Weighted CT mean fibrosis (Fibro-CT) was calculated as a nonlinear weighted mean F-score for each sample. Fibrosis was defined according to Scheuer on the F0 to F4 scale by 2 pathologists blinded regarding the Fibro-CT data. Fibrosis according to Fibro-CT correlated with histology-determined fibrosis (r = 0.69; P < 0.001) and with increasing F-stage: F0 = 0.23 +/- 0.39; F1 = 0.90 +/- 0.99; F2 = 1.41 +/- 0.94; F3 = 2.79 +/- 0.55; F4 = 3.15 +/- 0.35 [analysis of variance: P < 0.0001). The receiver operating characteristics curve to diagnose significant fibrosis (>/=F2) was 0.83; 95% confidence interval (95%CI), 0.75 to 0.91; and, to diagnose advanced fibrosis (>/=F3), was 0.86, 95%CI: 0.80 to 0.93. The correlation between Fibro-CT and fibrosis was higher in patients with homogeneous distribution of fibrosis than in patients with heterogeneous distribution (r = 0.77 versus r = 0.43; P < 0.05). Conclusion: Optical digital analysis of CT images of the liver is effective in determining the stage and distribution of liver fibrosis in chronic hepatitis C. In patients with homogeneous fibrosis distribution, the correlation between Fibro-CT and histology was better than in patients with heterogeneous distribution. Fibro-CT is a simple to use, readily available, and useful method for the diagnosis of fibrosis in patients with chronic hepatitis C. (HEPATOLOGY 2008.).