基于钆贝葡胺增强的肝功能影像积分评价肝功能的价值

Evaluation of the value of functional liver imaging score derived from gadobenate dimeglumine-enhanced MR imaging in assessing liver function

目的探讨钆贝葡胺(Gd-BOPTA)增强MR肝胆期功能成像积分(FLIS)评价肝硬化患者肝脏储备功能的临床价值。方法选取192例肝功能分级分别为Child-Pugh A、Child-Pugh B和Child-Pugh C肝硬化患者,所有患者均行Gd-BOPTA增强肝胆期MR扫描。使用肝胆相图像的肝实质增强率、胆道排泄率、门静脉信号比三个半定量参数计算肝功能影像积分。使用Spearman相关性分析评价Gd-BOPTA增强MR FLIS与肝功能血液学指标及Child-Pugh分数的相关性、FLIS的三个参数与Child-Pugh分数之间的相关性。使用单因素方差分析比较不同Child Pugh分级组(Child-Pugh A、B和C组)中肝脏增强MR FLIS的差别。应用ROC曲线评价FLIS鉴别不同Child-Pugh分级组的最佳截断值及效能。结果肝功能成像三个半定量参数肝实质增强率评分、胆道排泄率评分、门静脉信号比评分均与Child-Pugh分数呈负相关(P<0.01),相关系数分别为(rho=-0.577,rho=-0.745,rho=-0.651,P<0.01);FLIS与总胆红素水平、凝血酶原时间、Child-Pugh分数呈负相关,相关系数分别为(rho=-0.669,rho=-0.562,rho=-0.799,P<0.01);FLIS与白蛋白水平呈正相关(rho=0.519,P<0.01)。Child-Pugh A、B和C三组的肝功能积分有差别(P均<0.01)。FLIS鉴别Child-Pugh A与B组,B组与C组,A与B或C组患者的效能分别为0.923、0.765、0.946。最佳临界值分别为2分、1分、2分。结论钆贝葡胺增强MR FLIS是一种简便、有效评价肝硬化患者肝功能的影像学方法。

Objective To investigate the value of the functional liver imaging score(FLIS)derived from gadobenate dimeglumine(Gd-BOPTA)-enhanced MR imaging for assessing hepatic function in patients with cirrhosis.Methods This retrospective study included 192 patients who underwent Gd-BOPTA-enhanced magnetic resonance imaging,and patients were classified as Child-Pugh A,Child-Pugh B,and Child-Pugh C.FLIS was used to evaluate three parameters at hepatobiliary phase images liver parenchymal enhancement,biliary contrast excretion,and portal vein sign.Spearman rank correlation was used to assess the association between FLIS andliver function biochemical indicators and Child-Pugh scores.Spearman rank correlation was also used to assess the association between each of the three FLIS parameters and Child-Pugh scores.One-way analysis of variance(ANOVA)was used to analyze differences in the FLIS between the Child-Pugh A,Child-Pugh B and Child-Pugh C groups.Receiver operating characteristic(ROC)curve analysis was performed to demonstrate the cutoff value of FLIS for differentiating between Child-Pugh classes.Results There were negative correlations between the Child-Pugh scores and the liver parenchymal enhancement(rho=-0.577,P<0.01),biliary contrast excretion(rho=-0.745,P<0.01),and portal vein sign(rho=-0.651,P<0.01).There were negative correlations between the FLIS and the total bilirubin(rho=-0.669,P<0.01),prothrombin time(rho=-0.562,P<0.01)and Child-Pugh scores(rho=-0.799,P<0.01);there was a positive relationship between the FLIS and albumin(rho=0.519,P<0.01).Significant differences were observed between the Child-Pugh A,Child-Pugh B and Child-Pugh C groups(P<0.01),with respect to the FLIS.The area under the curve(AUC)values for FLIS in differentiating Child-Pugh A with Child-Pugh B,Child-Pugh B with Child-Pugh C,Child-Pugh A with Child-Pugh B or C groups were 0.923,0.765,0.946,respectively,and the optimized cut-off values were 2 points,1 point,2 points,respectively.Conclusion FLIS derived from gadobenate dimeglumine(Gd-BOPTA)-enhanced MR imaging is a simplified and effective method for assessing hepatic function in patients with cirrhosis.