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慢性肝病是全球性的健康问题,具有常见的肝纤维化过程[1]。慢性肝损伤可诱导炎症反应,激活纤维化发生。肝纤维化的特征是胶原细胞外基质(extracellular matrix,ECM)组分的过量沉积,导致门静脉高压、肝功能障碍和肝细胞癌。组织学将肝纤维化分为5期:S0期无纤维化;S1期汇管区纤维化扩大,局限窦周及小叶内纤维化;S2期汇管区周围纤维化,纤维间隔形成,小叶结构保留;S3期纤维间隔伴小叶结构紊乱,无肝硬化;S4期早期肝硬化。早期肝纤维化可通过有效治疗得到“逆转”,而晚期纤维化和肝硬化通常不可逆[2]。因此肝纤维化的早期诊断和准确分期对于改善患者预后、疾病分层管理和指导抗纤维化治疗至关重要。目前,肝活检术是肝纤维化诊断和分期的金标准。然而,由于其具有侵入性、取样变异性和并发症的风险且成本相对较高,同时患者开始接受抗纤维化治疗后往往拒绝肝活检,因此无法运用肝活检术进行长期随访。常规用于肝纤维化诊断和分期的非侵入性成像技术包括超声、CT和MRI。超声瞬时弹性成像和磁共振弹性成像可以测量与肝纤维化相关的肝硬度,这两种方法检测中、晚期肝纤维化的准确率较高,但在早期肝纤维化疾病诊断方面的准确率较低,并且在腹水或病态肥胖患者中的测试性能较低[3]。因此,研发非侵入性和高灵敏度的检测方法对肝纤维化的诊断非常必要。分子成像技术可提供患病肝脏的细胞和分子层面的信息。本文对磁共振分子显像技术和核医学分子显像技术在肝纤维化的诊断和分期的最新进展进行概述。
肝纤维化分子显像的研究进展
The research progress of molecular imaging of liver fibrosis
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摘要: 肝纤维化是一种伴随慢性肝病的病理过程,具有较高的发病率和病死率。目前诊断肝纤维化的金标准是肝活检术,但肝活检术有其局限性,且目前尚无有效的无创诊断肝纤维化的手段。在肝纤维化的早期阶段,其可通过治疗“逆转”,因此,肝纤维化的诊断和精确分期在控制该疾病中非常重要。由于分子影像学技术具有无创、特异度高等优点,因此其发展具有巨大潜力。笔者对磁共振分子影像学技术和核医学分子影像学技术在肝纤维化诊断和分期方面的最新进展进行概述。
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关键词:
- 磁共振成像 /
- 体层摄影术,发射型计算机,单光子 /
- 正电子发射断层显像术 /
- 肝纤维化
Abstract: Hepatic fibrosis is a pathological process associated with chronic liver diseases, with significant morbidity and mortality.The current gold standard for the diagnosis of liver fibrosis is liver biopsy, but liver biopsy has many limitations.Currently, there is no noninvasive means of effective diagnosis of liver fibrosis.In the early stages of the disease, it can be reversed by active therapy.Thus, diagnosis and precise stages of liver fibrosis are important in controlling progression of the disease.Because of its noninvasive, high specificity and other advantages, molecular imaging has great potential use in liver fibrosis.This paper provides an overview of the latest advances in the diagnosis and stages of liver fibrosis using magnetic resonance imaging and nuclear medicine imaging. -
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