胃肠道恶性肿瘤新辅助化疗引起相关肝窦阻塞综合征患者的钆塞酸二钠增强MRI的影像学特征分析

Analysis of gadoxetic acid-enhanced MRI features of neoadjuvant chemotherapy-related hepatic sinusoidal obstruction syndrome in patients with gastrointestinal malignant tumors

目的探讨在接受新辅助化疗的胃肠道恶性肿瘤患者中,出现肝窦阻塞综合征(hepatic sinusoidal obstruction syndrome,HSOS)的患者与未出现HSOS患者的相关指标差异,并借助钆塞酸二钠增强MRI分析HSOS患者的影像学特征。方法回顾性分析2013年7月至2021年7月在复旦大学附属中山医院接受新辅助化疗、并行钆塞酸二钠增强MRI的69例胃肠道恶性患者的临床及影像学资料。采用5分制评估所有患者钆塞酸二钠增强MRI中肝胆特异期网格状低信号存在的置信水平。在MRI上评分为4分或5分的被记作HSOS阳性组,其余为HSOS阴性组。采用t检验或Mann-Whitney U检验来比较2组实验室数据及肝胆特异期相关参数,描述HSOS阳性组患者的影像学征象。结果HSOS阳性组20例,阴性组49例。观察者一致性良好,Kappa值为0.80。2组患者血小板(platelets,PLT)计数差异具有统计学意义(P<0.05),其余实验室指标差异均无统计学意义。2组患者MRI相关参数增强前信号强度SIPre分别为136.10±28.62和141.90±28.52,差异无统计学意义,而肝胆特异期信号强度SIHbp分别为204.40±53.29和274.35±66.83,相对强化率RE分别为0.51±0.24和0.93±0.24,差异均有统计学意义(P<0.05)。HSOS阳性组中,呈弥漫网格状低信号患者11例(55%),斑片状低信号9例(45%);病灶分布情况中,肝右叶为主8例(40%),肝左右叶均有12例(60%)。其中3例患者在化疗结束后继续进行了钆塞酸二钠增强MRI的随访,不均匀低信号有所缓解或消失。结论钆塞酸二钠增强MRI中的肝胆特异期不均匀低信号提示新辅助化疗引起相关HSOS,并且肝胆特异期相关参数SIHbp及RE可以有效识别HSOS。

Objective To explore the differences of related indicators between patients with hepatic sinusoidal obstruction syndrome(HSOS)and those without hepatic sinusoidal obstruction syndrome in patients with gastrointestinal malignant tumors receiving chemotherapy,and to analyze the imaging features of HSOS with gadoxetic acid-enhanced MRI.Methods We retrospectively analyzed the clinical and imaging data of 69 patients with gastrointestinal malignancies who had undergone neoadjuvant chemotherapy in Zhongshan hospital,Fudan University from July 2013 to July 2021.Each observer used a 5-point scale to assess the confidence level of the presence of hepatobiliary phase heterogeneous low signal in gadoxetic acid-enhanced MRI.The patients with a score of 4 or 5 on MRI were regarded as HSOS-positive diagnosis,and the rest were HSOS-negative.Using t test or Mann-Whitney U test to compare both groups of laboratory data and hepatobiliary specific phase-related parameters.Describing the imaging signs of patients in the HSOS-positive group.Results Interobserver agreement was 0.80.According to the scoring results,20 patients were included in the HSOS-positive group and 49 patients were included in the HSOS-negative group.There was statistical differences in PLT between the two groups(P<0.05),but no statistical differences in the remaining laboratory data.The hepatobiliary specific phase-related parameters SIPre of the HSOS-positive group and the HSOS-negative group respectively were 136.10±28.62,141.90±28.52,and there was no statistical difference,while SIHbp were 204.40±53.29,274.35±66.83,and RE were 0.51±0.24,0.93±0.24,which were statistically significant difference(P<0.05).Among the 20 patients in the HSOS-positive group,hepatic distribution was diffuse in 11(55%),patchy in 9(45%).In the distribution of lesions,lobar predominance was right in 8 patients(40%),both right and left in 12 patients(60%).Three of the patients were followed up with gadoxetic acid-enhanced MRI after the end of chemotherapy,and the heterogeneous low signal were relieved or disappeared.Conclusions Heterogeneous low signal on hepatobiliary specific-phase of gadoxetic acid-enhanced MRI indicates the presence of HSOS caused by neoadjuvant chemotherapy.MRI hepatobiliary specific phase-related parameters SIHbp and RE can effectively identify HSOS.