Gd-EOB-DTPA增强MRI对肝肿瘤术前肝储备功能评估的临床价值

Clinical value of Gd-EOB-DTPA enhanced MRI for preoperative evaluation of hepatic function preservation in patients with liver tumors

目的:探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI对肝肿瘤患者术前肝储备功能评估的可行性。方法:回顾性分析53例行Gd-EOB-DTPA增强MRI检查的肝肿瘤患者的肝胆期图像,计算肝胆期肝实质相对强化程度(RE)、功能性肝脏影像评分(FLIS),以及临床Child-Pugh评分。以术前吲哚菁绿(ICG)清除试验为肝储备功能参考标准,分析影像指标与ICG 15 min滞留率(ICG R15)之间的相关性。分别以滞留率10%、20%为界限分组,分析比较组间的肝功能影像参数及实验室指标之间的差异。采用ROC曲线评价诊断效能。结果:MRI测定参数RE、FLIS评分及Child-Pugh评分与ICG R15的相关系数分别为-0.660、-0.506、0.510(均P<0.001)。分别以ICG R1510%及20%分组,ICG R15<10%组与≥10%组、ICG R15<20%组与≥20%组的RE、FLIS评分、Child-Pugh评分和PLT比较,差异均有统计学意义(均P<0.05)。RE的AUC最高,以ICG R1510%及20%分组时,分别为0.809、0.874,最佳临界值分别为36.1%、32.2%。在以20%分组中,联合PLT后AUC达0.928。结论:Gd-EOB-DTPA增强MRI的肝胆期肝实质RE可定量评估肝肿瘤患者术前的肝储备功能,联合PLT后具有更高的诊断效能。

Objective:To investigate the feasibility of Gd-EOB-DTPA enhanced MRI in the evaluation of preoperative hepatic function preservation in patients with liver tumors.Methods:Gd-EOB-DTPA enhanced MRI hepatobiliary phase(HBP)images of 53 patients with liver tumor were retrospectively analyzed.Hepatic relative enhancement(RE),functional liver imaging score(FLIS)and clinical Child-Pugh score were calculated.Preoperative indocyanine green(ICG)clearance test was used as the reference standard for hepatic function preservation.The correlation between imaging indexes and ICG retention rate at 15 minutes(ICG R15)was analyzed.All cases were divided into groups with the criteria of 10%and 20%retention,and the differences of liver function MRI parameters and laboratory indexes between groups were compared.ROC curves were used to analyze the diagnostic efficacy.Results:The correlation coefficients between RE,FLIS,Child-Pugh score and ICG R15 were-0.660,-0.506 and 0.510,respectively(P<0.001).The differences were all statistically significant for RE,FLIS,Child-Pugh score and PLT between the ICG R15<10%group and ICG R15≥10%group and between the ICG R15<20%group and ICG R15≥20%group(all P<0.05).RE had the highest AUC value,with an AUC value of 0.809 and a cutoff value of 36.1%for the grouping criteria of ICG R1510%and an AUC value of 0.874 and a cutoff value of 32.2%for the grouping criteria of ICG R1520%The AUC of combining RE and PLT was 0.928 with the grouping criteria of ICG R1520%.Conclusions:The relative enhancement degree of the liver parenchyma in the HBP of Gd-EOB-DTPA-enhanced MRI can quantitatively measure the preoperative hepatic function preservation of patients with liver tumors,which showed stronger diagnostic performance when combined with PLT.