钆贝葡胺增强MRI评估肝硬化患者肝功能

Gd-BOPTA-enhanced MRI evaluation of liver function in patients with cirrhosis

目的探讨钆贝葡胺(Gd-BOPTA)增强MRI分析肝胆期肝实质相对强化程度(RE)与肝功能指标的相关性及影响肝实质RE的因素。方法回顾性分析238例接受腹部Gd-BOPTA增强MRI患者,将其分为肝功能正常组(NLF组)、肝硬化Child-Pugh A、B和C级组(LCA、LCB和LCC组),测量其肝胆期肝实质RE,分析其与临床指标的相关性及独立预测因素。结果Gd-BOPTA增强MRI肝胆期肝实质RE与总胆红素(TB)、凝血酶原时间(PT)、国际标准化比率(INR)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)及肝硬化Child-Pugh分级均呈负相关(P均<0.01),与白蛋白(Alb)、胆碱酯酶(ChE)正相关(P均<0.01);腹腔积液患者肝胆期肝实质RE低于无腹腔积液者(P<0.001);NLF组肝胆期肝实质RE高于其余3组(P均<0.001),LCA组高于B、C组(P均<0.001)。TB、Alb、腹腔积液及ALP是Gd-BOPTA增强MRI肝胆期肝实质RE的独立预测因素(P均<0.01)。结论Gd-BOPTA增强MRI肝胆期肝实质RE与肝功能相关。TB、Alb、腹腔积液及ALP是Gd-BOPTA增强MRI肝胆期肝实质RE的独立影响因素。

Objective To investigate the relationship between liver function parameters and liver parenchymal relative enhancement(RE)at hepatocyte phase with gadobenate dimeglumine(Gd-BOPTA)-enhanced MRI,and to clarify clinical predictive factors affecting liver parenchymal RE.Methods Data of 238 patients underwent abdominal Gd-BOPTA-enhanced MRI were retrospectively analyzed and classified into 4 groups,i.e.normal liver function group(NLF group)and liver cirrhosis Child-Pugh A,B and C group(LCA,LCB and LCC groups).Liver parenchymal RE at hepatocyte phase was calculated,and the relationship between liver parenchyma RE and liver function parameters were analyzed,then clarified clinical predictive factors affecting liver parenchymal RE.Results Liver parenchyma RE of hepatocyte phase were negatively correlated with the changes of total bilirubin(TB),prothrombin time(PT),international normalized ratio(INR),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP)and Child-Pugh classification(all P<0.01),but positively correlated with albumin(Alb)and cholinesterase(ChE)(both P<0.01).Liver parenchyma RE at hepatocyte phase in NLF group were significantly higher than that in LCA,LCB and LCC groups(all P<0.001),respectively,and lower in patients with ascites than in those without ascites(P<0.001).Compared with LCB and LCC groups,liver parenchyma RE at hepatocyte phase in LCA group were significantly higher(both P<0.001),and predicted factors of liver parenchymal RE in hepatocyte stage included TB,Alb,ALP,and presence of ascites.Conclusion There are significant correlations of liver parenchyma RE and liver functional parameters in liver cirrhosis,predictive factors of liver parenchymal RE in hepatocyte stage with Gd-BOPTA-enhanced MRI include TB,Alb,ALP and presence of ascites.