Gd-EOB-DTPA增强MR胆管成像定量评估肝脏储备功能的价值

Quantitative Evaluation of Hepatic Functional Reserve with Gd-EOB-DTPA Enhanced MR Cholangiography

目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强MR胆管成像对乙型肝炎肝硬化患者肝脏储备功能的定量评估价值。方法回顾性分析本院115例乙型肝炎肝硬化患者。根据肝功能Child-Pugh分级分为三组:Child-Pugh A级55例、B级50例和C级10例;根据终末期肝病模型(MELD)评分分为两组:MELD评分≤10分70例和MELD评分>10分45例;根据吲哚氰绿15 min滞留率(ICG-R15)分为两组:ICG-R15≤20%组63例和ICG-R15>20%组52例。所有受试者均行上腹部Gd-EOB-DTPA增强MR扫描,计算胆总管相对信号强度(rSI)。采用单因素方差分析比较不同Child-Pugh分级肝功能组患者的胆总管rSI。采用独立样本t检验分别比较不同MELD评分组患者和不同ICG-R15组患者的胆总管rSI。采用受试者工作特征(ROC)曲线评价胆总管rSI鉴别肝功能Child-Pugh A级与Child-Pugh B级、C级,MELD评分≤10分与>10分及ICG-R15≤20%与>20%组患者的效能。采用多元逐步回归筛选胆总管rSI的重要预测因素。结果肝功能Child-Pugh A级、B级与C级患者的胆总管rSI依次为4.26±0.94、2.57±1.23和1.90±1.10,差异有统计学意义(F=40.972,P<0.01);A级与B级、A级与C级组间的差异均有统计学意义(P值均<0.01)。MELD评分≤10分与>10分患者的胆总管rSI分别为4.10±0.95、2.10±1.15,差异有统计学意义(P<0.01)。ICG-R15≤20%与>20%组患者的胆总管rSI分别为4.22±0.93、2.23±1.11,差异有统计学意义(P<0.01)。胆总管rSI判断为Child-Pugh B、C级、MELD评分>10分及ICG>20%的ROC曲线下面积(AUC)分别为0.887、0.912和0.925。ICG-R15和MELD评分是胆总管rSI的重要预测因素(偏回归系数分别为-0.049、-0.121,P值均<0.01)。结论Gd-EOB-DTPA增强MR胆管成像可以定量评估乙型肝炎肝硬化患者的肝脏储备功能,且胆总管rSI对鉴别轻度肝功能损伤与中、重度肝功能损伤有一定价值。

Objective To investigate the quantitative evaluation of Gd-EOB-DTPA-enhanced MR cholangiography(CE-MRC)for the assessment of liver reserve function in patients with hepatitis B cirrhosis.Methods 115 patients with HBV-related cirrhosis were collected retrospectively.Patients were classified as liver cirrhosis with Child-Pugh A(n=55)、Child-Pugh B(n=50)and Child-Pugh C(n=10)according to Child-Pugh Score.Patients were divided into MELD score≤10(n=70)group and MELD>10(n=45)group.Patients were also classified as ICG-R15≤20%(n=63)group and ICG-R15>20%(n=52)group.CE-MRC was scanned 20 minutes after Gd-EOB-DTPA injection.One-way ANOVA was conducted to compare the RSI of CBD among there groups with different Child-Pugh classification.Independent sample t-test was used to compare the RSI between two groups with different MELD score,either between two groups with different ICG-R15.ROC curve was performed to analyze the diagnostic performance of RSI in discriminating Child A group from Child B-C group,MELD score≤10 group from MELD score>10 and ICG-R15≤20%group from ICG-R15>20%group.Multivariate analysis was performed to screen the significant predictor of the RSI of CBD.Results The RSI of the CBD of Child-Pugh groups was 4.26±0.94,2.57±1.23 and1.90±1.10 respectively,and there were statistically significant difference between 3 groups(F=40.972,P<0.01).Statistically significant differences of the RSl were shown between group A and B,also between group A and C.The RSI of the CBD between MELD score groups was 4.10±0.95、2.10±1.15,and there was statistically significant difference between two groups(P<0.01).The RSI of the CBD between ICG-R15 groups was 4.22±0.93、2.23±1.11,and there was statistically significant difference between two groups(P<0.01).Child B-C group could be predicted with the AUC of 0.887.MELD score>10 group could be predicted with the AUC of 0.912.ICG-R15>20%group could be predicted with the AUC of 0.925.ICG-R15 and MELD score were significant predictors of the RSI of the CBD(β=-0.049、-0.121,P<0.01).Conclusion Gd-EOB-DTPA-enhanced MR cholangiography can quantitatively assess liver reserve function in patients with hepatitis B cirrhosis.The RSI of CBD has certain value in distinguishing moderate or severe injury of liver function from mild injury of liver function.