斜矢位Care bolus技术在肝钆塞酸二钠MRI增强检查中的应用

Application of oblique-sagittal-positioning of Care bolus in Gd-EOB-DTPA enhanced liver MRI

目的利用磁共振荧光示踪技术Care bolus不同定位方法表现个体循环差异性,探讨斜矢位定位法对提高钆塞酸二钠(Gd-EOB-DTPA)磁共振肝检查动脉晚期捕获率的可行性。方法收集本院2019年2~4月行Gd-EOB-DTPA磁共振肝检查的220例患者的临床资料,随机均分为斜矢位定位组和冠状位定位组,2组患者分别采用Care bolus技术确定单期动脉期的触发采集时机。斜矢位定位组采用斜矢状位Care bolus图,观察右心房、肺动脉、左心室以及主动脉全程,根据肺循环、体循环实时强化充盈速率选取不同的扫描时机;冠状位定位组采用常规冠状位Care bolus图,腹主动脉强化即开始动脉期的扫描。比较2组患者动脉晚期的捕获率以及肝细胞癌-邻近肝实质强化对比度。结果斜矢位定位组动脉晚期的捕获率为85.45%,显著高于冠状位定位组的72.72%,差异具有统计学意义(P<0.05);斜矢位定位组肝细胞癌-邻近肝实质强化对比度平均值明显高于冠状位定位组,差异具有极显著性统计学意义(P<0.01);斜矢位定位组抓捕动脉晚期的平均时间大于冠状位定位组,差异具有极显著性统计学意义(P<0.01),其中斜矢位定位组耗时14~39 s,中位数为24 s,冠状位定位组耗时20~26 s,中位数为23 s。结论行Gd-EOB-DTPA磁共振肝检查时患者之间存在个体差异,对动脉晚期的抓捕存在较大影响,根据个体差异利用斜矢位定位的实时荧光示踪技术观察对比剂充盈速率情况,选取不同的动脉期采集时机可以提高患者肝动脉晚期的抓捕率。

Objective To explore the feasibility of oblique-sagittal-positioning Care bolus in showing individual circulation and improving the late arterial capture rate by Ga-EOB-DTPA enhanced MRI with different localization methods.Methods The clinical data of 220 patients with Ga-EOB-DTPA enhanced MRI in our hospital from February to April 2019 were randomly divided into oblique-sagittal-positioning group and coronary-positioning group.Care bolus technique was used to determine the timing of the two groups′trigger collection at the single arterial stage.In oblique-sagittal-positioning group,oblique-sagittal-positioning Care bolus was used to observe the enhancement of the right atrium,the pulmonary artery,left ventricle and the whole process of aorta.Different scanning opportunities were adopted according to the pulmonary circulation and systemic circulation real-time enhancement filling rate.In coronary-positioning group,routine coronary-positiong Care bolus was used to initiate the trigger scan at the same time of the abdominal aorta enhancing.The capture rate of late arterial phase and HCC-to-adjacent liver contrast were compared between the two groups.Results The capture rate of late arterial phase in oblique-sagittal-positioning group(85.45%)was significantly higher than that in coronary-positioning group(72.72%),the difference was significant(P<0.05).Mean HCC-to-adjacent liver contrast and mean expending times in oblique-sagittal-positioning group were significantly higher than those in coronary-positioning group,the differences were extremely significant(P<0.01).The time of late arterial phase in oblique-sagittal-positioning group(rang:14~39 seconds;the median:24 seconds)was longer than that in coronary-positioning group(rang:20~26 seconds;the median:23 seconds),the difference was extremely significant(P<0.01).Conclusion There are individual differences among patients in Gd-EOB-DTPA enhanced MRI,it has great influence on the capture of arterial time phase.According to individual differences,oblique-sagittal-positioning Care bolus may improve the capture rate of late arterial phase in Gd-EOB-DTPA enhanced MRI.