Gd-EOB-DTPA增强MR胆管成像对胆管的显示与肝硬化患者肝功能的关系

Visualization of the biliary ducts on contrast enhanced MR cholangiography with Gd-EOB-DTPA: Relation with liver function in patients with liver cirrhosis

目的研究肝硬化患者钆塞酸二钠(Gd-EOB-DTPA)增强MR胆管成像检查(EOB-MRC)显示胆管的能力与肝功能的关系。方法对39例肝硬化患者(肝硬化组)与23例非肝硬化患者(对照组)进行肝脏Gd-EOB-DTPA动态增强扫描。2名影像诊断医师随机评价注射对比剂后5、10、15、20min胆道结构及20min时胆管树总体解剖结构的显示程度,并对照肝硬化组的Child-Pugh分级、两组的MELD评分及肝功能指标,分析其间的关系。结果两组间每一时间点每一胆道结构显示差异有统计学意义(P均<0.001)。注射Gd-EOB-DTPA后20min对照组胆管树显示满意,而肝硬化组同期仅有48.72%(19/39)病例胆管树显示满意。两组肝功能指标中血浆凝血酶原时间、国际标准化率、血清总胆红素、γ-谷氨酰基转移酶、碱性磷酸酶差异均有统计学意义(P均<0.005)。ROC曲线示肝硬化组Gd-EOB-DTPA注射后20min胆管树不能充分显示的截止值为Child-Pugh分级≥A级,MELD评分≥8分,血清总胆红素≥24.64μmol/L。结论肝硬化患者EOB-MRC胆管树显影减弱或不显影,通过评价胆管树的显示程度可以判断肝硬化患者肝功能。

Objective To investigate the quality of biliary duct visualization using Gd-EOB-DTPA-enhanced magnetic resonance cholangiography （EOt3-MRC） in patients with hepatic cirrhosis, and the relation with hepatic function. Methods Thirty-nine adult patients with hepatic cirrhosis （cirrhosis group） and twenty-three adult patients without hepatic cirrhosis （control group） underwent EOB-MRC examinations. Visualization of biliary structure 5, 10, 15, 20 rain after injection of contrast agentand and the overall anatomical visualization of the biliary tree after 20 min was evaluated by two observers in consensus, and the correlation with Child-Pugh, MELD score and relative laboratory findings were analyzed. Results The grade of visualization of evaluated biliary structure at 5, 10, 15, 20 min was statistically different between the two groups （all P^0. 001）. The overall anatomical visualization of the biliary tree on EOB-MRC 20 min after Gd-EOB-DTPA administration was rated as excellent for each patient in the control group （23/23, 100%） and excellent in 19 patients （19/39, 48.72%） in the cirrhosis group. Laboratory indexes of two groups in prothrombin time, International Normalized Ratio, total serum bilirubin, alkaline phosphatase, γ-glutamyltransferase were significantly different （all P〈0. 005）. Analysis of the ROC curves revealed that the cut-off values for non-sufficient visualization of the biliary tree 20 min after Gd-EOB-DTPA administration were Child-Pugh class ≥A, MELD scores ≥8 and total serum bilirubin levels ≥24. 64 μmol/L. Conclusion Patients with liver cirrhosis result in a decreased or even non-visualization ability of the biliary tree on EOI3-MRC. Evaluation of visualization of the biliary tree can estimate liver function of patients with liver cirrhosis.