利用钆塞酸二钠增强MR评估肝脏储备功能

Evaluation of liver function reserve with gadoxetate disodium-enhanced MR

目的建立基于钆塞酸二钠增强MR的肝脏储备功能评估方法，探讨其与肝硬化患者肝功能Child—Pugh分级的关系。方法回顾性分析40例接受钆塞酸二钠增强MR检查的肝硬化患者临床及影像资料，根据Child—Pugh分级将患者分为A、B和c级。通过钆塞酸二钠增强MR检测肝脏体积、全肝及肝脏各段肝细胞期相对强化程度等指标，构建全肝钆塞酸二钠相对摄取值作为肝脏整体储备功能的评价指标，并以肝脏各段肝细胞期相对强化程度作为肝脏各段储备功能的评价指标。采用单因素方差分析比较不同Child—Pugh分级全肝钆塞酸二钠相对摄取值及肝脏各段肝细胞期相对强化程度的差异。结果Child—PughA、B和c级患者分别为23、10和7例。A、B和c级全肝钆塞酸二钠相对摄取值分别为1212±168、695±161和234±55，差异有统计学意义（F=122．05，P〈0．01）。A级患者肝脏s1～s8各段的相对强化程度分别为1．13±0．22、1．12±0．50、0．81±0．24、1．08±0．32、1．41±0．25、1．10±0．30、1．16±0．41和1．17±0．23，差异有统计学意义（F=5．93，P〈0．01），B和C级患者各段的相对强化程度差异无统计学意义（F=1．95，1．83；P〉0．05）。结论钆塞酸二钠增强MR可用于定量评估肝硬化患者的肝脏整体储备功能，且其对肝脏功能分段评估具有很大潜力。

Objective To determine the values of gadoxetate disodium-enhanced MRI for quantitatively evaluating the liver function reserve. Methods Forty consecutive liver cirrhosis patients were enrolled in this retrospective study. All the patients underwent complete routine laboratory tests and the gadoxetate disodium-enhaneed MR imaging with the same parameters. Liver volume and the relative enhancement index of the whole liver in hepatocellular phase were used to calculate liver relative uptake value,which is supposed to represent the total liver function reserve. And the function reserve of all liver segments was evaluated respectively by the relative enhancement index of each liver segment. One-way ANOVA was used for statistical analyses. Results The patient number in Child-Pugh A, B and C group was 23,10 and 7 ,respectively. Significant differences was observed in liver relative uptake value among patients in different Child-Pugh classes （ F = 122.05, P 〈 0. 01 ）. Mean liver relative uptake value was highest in C hild-Pugh A group （1212 ± 168 ）, followed by B group and C group （695 ± 161,234 ±55 ）. In Child-Pugh A group,the relative enhancement index of SI to S8 was 1.13 ±. 22,1.12 ±0. 50,0. 81 ---0. 24,1.08 ±. 32, 1.41 ± 0. 25,1.10 ±0. 30,1.16 ±0. 41 and 1.17 ± 0. 23, respectively （ F = 5.93, P 〈 0.01 ）. There was no significant difference in B and C group （ F = 1.95,1.83 ; P 〉 0.05 ）. Conclusion Gadoxetate disodium- enhanced MRI can be used for evaluating whole liver function reserve quantitatively. This technique also has a potential value for evaluating of the segmental liver function reserve before partial hepatectomy.