Gd-EOB-DTPA增强MRI对肝硬化肝功能评价的应用

The application for liver function evaluation of cirrhosis with Gd-EOB-DTPA enhanced MRI

目的分析肝硬化患者钆塞酸二钠(Gd-EOB-DTPA)增强前后肝脏信号强度及胆管显示情况,以期评价肝脏储备功能。方法搜集行Gd-EOB-DTPA增强MRI扫描的50例乙肝肝硬化患者,并进行临床Child-Pugh分级。所有患者依次行MRI平扫、注射Gd-EOB-DTPA后动态增强扫描及20 min肝胆期扫描。根据肝胆期胆道评分对肝功能进行MRI分级,探讨肝功能MR注射分级与临床肝功能Child-Pugh分级有无一致性。测量肝脏增强前及肝胆期信号强度,求出增强前后信号强度净增值及全肝肝胆期相对强化程度。分析Child-Pugh A、B、C级之间增强前后信号强度、信号强度净增值及全肝肝胆期相对强化程度有无差异及其相关性。结果肝功能MRI分级与临床Child-Pugh分级一致性较好(K=0.740);MRI肝功能分级与临床Child-Pugh分级具有较高的相关性(r=0.800)。Child-Pugh A、B、C级增强后信号强度、信号强度净增值及全肝肝胆期相对强化程度差异有统计学意义(P<0.05)。Child-Pugh分级与增强前信号强度、增强后信号强度、信号强度净增值及全肝肝胆期相对强化程度呈负相关性(r分别为-0.310、-0.728、-0.713、-0.713)。结论 Gd-EOB-DTPA肝脏增强MRI可通过测量增强前后MRI上肝实质平均信号强度、信号强度净增值及全肝肝胆期相对强化程度定量评估肝实质对Gd-EOB-DTPA的吸收,进而评估肝功能,亦可通过评估肝胆期胆管显示情况而间接评估肝功能。使用影像学对肝功能进行评估,使肝功能评估更为精准客观,且具有不可替代的优势。

Objective To analyze of hepatobiliary phase （HBP） liver relative degree of reinforcement and bile duct show case, in order to evaluate liver function. Methods Collected 50 cases of patients with cirrhosis and clinical Child - Pugh classification,which were enhanced MRI scanning by Gd - EOB - DTPA. All of the patients were given MRI plain scanning, dynamic Gd - EOB - DTPA - en- hanced MRI and 20 minutes delayed HBP performed. According to the HBP biliary MRI classification of grading of liver function. Child - Pugh, MR classification of liver function and clinical liver function classification for consistency. And measured the liver and liver period before the enhancement signal strength, and enhance the signal strength before and after net added value and the relative degree of rein- forcement at the whole liver. Child - Pugh analysis between A, B, C grade enhance the signal strength and signal strength before and after net added value and the relative degree of reinforcement at the whole liver with indifference and their correlation. Results Gd - EOB - DTPA enhancement liver MRI different liver MR classification and clinical liver function Child -Pugh, grading Kappa value was 0. 740, that Child - Pugh,liver MRI classification and clinical grading acceptable consistency. Child - Pugh, grading and MRI classification of rank correlation coefficient was 0.8, showed that MRI Child - Pugh, liver function grade and clinical classification has high correlation. Signal strength net added value and the degree of liver cell relative strengthening （ P 〈 0.05 ）. That Child - Pugh, A, B, C level enhanced signal intensity, net added value and the relative degree of reinforcement was statistically significant. Before Child - Pugh, grading and en- hanced signal intensity, enhanced the signal strength and signal strength net added value and the degree of liver cell relative strengthening negative correlation, the correlation coefficient respectively - 0. 310, - 0. 728, - 0. 713, - 0.713. Conclusion Gd - EOB - DTPA en- hanced MRI can be measured by enhancing liver MRI before and after the liver parenchyma on average signal strength, net added value of signal intensity and the degree of liver relative strengthening of quantitative evaluation of liver parenchyma on the absorption of Gd - EOB - DTPA, and assess the liver function, can also assess liver bile duct show situation indirectly to assess function of liver.