钆塞酸二钠增强MRI中基于肝叶的信号强度参数与白蛋白-胆红素分级关系的研究

Study on the relationship between signal intensity parameters of liver lobes and albumin-bilirubin grades in magnetic resonance images enhanced with Gd-EOB-DTPA

目的探讨在钆塞酸二钠(gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid,Gd-EOB-DTPA)增强MRI中慢性乙型肝炎相关肝硬化患者基于肝叶的信号强度参数与白蛋白-胆红素(Albumin-Bilirubin,ALBI)分级的关系。材料与方法对62例肝脏正常(n=15)、慢性乙型肝炎相关肝硬化ALBI 1级(n=23)、2级(n=18)、3级(n=6)患者的Gd-EOB-DTPA增强MRI图像进行了分析,分别计算出肝右叶、肝左内叶、肝左外叶、肝尾状叶的肝实质相对增强率(liver relative enhancement,LRE)及肝肌对比率(liver-to-muscle ratio,LMR),并在正常组和不同ALBI分级组之间进行比较。定量分析慢性乙型肝炎相关肝硬化患者各个肝叶的LRE、LMR与ALBI分级的关系,绘制ROC曲线评估各个肝叶区分ALBI 1级和ALBI 2~3级的准确性。结果正常组和不同ALBI分级组之间各个肝叶的LRE值和LMR值差异有统计学意义(P<0.05)。各组两两比较结果显示各肝叶LRE值在ALBI 2级和ALBI 3级组之间差异无统计学意义(P>0.05),各肝叶LMR值在任意两组之间差异均具有统计学意义(P<0.001)。肝硬化患者各个肝叶的LRE、LMR值与ALBI分级呈负相关(P<0.001),肝右叶LRE对于区分ALBI 1级和ALBI 2~3级准确率最高,受试者工作特征曲线下面积为0.913。结论Gd-EOB-DTPA增强MRI中慢性乙型肝炎相关肝硬化患者基于肝叶的LRE、LMR与肝功能ALBI分级存在相关性,LRE、LMR有望成为评估肝叶功能的影像学手段。

Objective:To investigate the relationship between lobar based signal intensity parameters and Albumin-Bilirubin(ALBI)grade in patients with chronic hepatitis B-related liver cirrhosis on gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid(Gd-EOB-DTPA)enhanced MRI.Materials and Methods:Gd-EOB-DTPA enhanced MRI images of 62 patients with normal liver(n=15),ALBI grade 1(n=23),ALBI grade 2(n=18),and ALBI grade 3(n=6)with chronic hepatitis B associated cirrhosis were analyzed.Liver parenchyma relative enhancement(LRE)and liver-to-muscle ratio(LMR)of right lobe,left medial lobe,left lateral lobe and caudate lobe were calculated,and compared between normal group and different ALBI grading groups.The relationship between LRE,LMR and ALBI grading of liver lobes in patients with chronic hepatitis B-related cirrhosis was quantitatively analyzed,and the accuracy of ALBI grade 1 and ALBI grade 2-3 were evaluated by ROC curve.Results:The LRE and LMR values of each liver lobe were significantly different between the normal group and different ALBI grading groups(P<0.05).The pairings of each group showed that there was no significant difference in LRE value of each liver lobe between ALBI 2 and ALBI 3 groups(P>0.05),and there was a significant difference in LMR value of each liver lobe between any two groups(P<0.001).The LRE and LMR of each lobe of liver in patients with chronic hepatitis B-related liver cirrhosis were negatively correlated with ALBI grade(P<0.001).LRE in the right lobe of the liver had the highest accuracy in distinguishing ALBI grade 1 from ALBI grade 2-3,and the area under the receiver operating characteristic curve is 0.913.Conclusions:There is a correlation between LRE and LMR based on liver lobe and ALBI grade of liver function in patients with chronic hepatitis B related cirrhosis in Gd-EOB-DTPA enhanced MRI.LRE and LMR are expected to be imaging methods to evaluate liver lobe function.