钆塞酸二钠增强MRI评估乙型病毒性肝炎患者肝脏储备功能的研究

Preliminary study of the value of Gd-EOB-DTPA enhanced MRI in evaluation of reserved liver function patients with hepatitis B

目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像(MRI)在评估乙型病毒性肝炎(简称乙肝)患者肝储备功能中的应用价值,以期建立更优的肝储备功能方法指导临床诊疗。方法回顾性分析2018年1月至2020年1月首都医科大学附属北京佑安医院收治的78例行Gd-EOB-DTPA增强MRI检查的乙肝患者的临床和影像资料。所有病例均在MRI平扫及注射Gd-EOB-DTPA后,对全肝以及肝实质各叶的信噪比(SNR)强化率、对比噪声比(CNR)强化率进行测量。依据Child-Pugh分级评分标准及终末期肝病模型(MELD)评分标准将患者进行分组:A级(50例)、B级(28例),MELD≤10分(57例)、MELD>10分(21例),分别对SNR强化率和CNR强化率进行组间差异性对比研究,并分析强化率与肝功能评分之间的相关性。结果乙肝患者肝实质各叶及全肝的SNR和CNR强化率差异均无统计学意义(均P>0.05);Child-Pugh A级乙肝患者的全肝强化率显著高于B级乙肝患者(P<0.05);MELD≤10分乙肝患者的全肝强化率显著高于MELD>10分乙肝患者(P<0.05);强化率与MELD分值之间呈负相关(r=-0.29、-0.31,P=0.02、0.01)。结论Gd-EOB-DTPA增强MRI对于乙肝患者的肝脏储备功能具有良好的评估价值,肝胆期分叶或全肝实质SNR强化率、CNR强化率可在一定程度上反映肝功能储备情况。

Objective To investigate the value of Gd-EOB-DTPA enhanced MRI in evaluation of reserved liver function patients with hepatitis B to establish a better method of liver reserve function to guide clinical diagnosis and treatment.Method The clinical and imaging data of 78 patients with hepatitis B who underwent Gd-EOB-DTPA enhanced MRI examination admitted to You’an Hospital from January 2018 to January 2020 were retrospectively analyzed.The enhancement ratios of SNR and CNR of whole liver and liver parenchyma were measured on the images from liver acquisition of hepatobiliary phase.Patients were divided into groups according to Child-Pugh grading standard and end-stage liver disease model(MELD)scoring standard respectively:Grade A(50 cases)/Grade B(28 cases),MELD≤10(57 cases)/MELD>10(21 cases),signal to noise ratio(SNR)enhancement rate and contrast to noise ratio(CNR)enhancement rate were compared between groups,and the correlation between enhancement rate and liver function score was analyzed.Result There were no significant differences in SNR and CNR enhancement rates in each lobe of liver parenchyma and whole liver(P>0.05).The SNR and CNR enhancement ratios of Class A were higher than those of Class B(both P<0.05).The SNR and CNR enhancement ratios of MELD≤10 were higher than those of MELD>10(both P<0.05).There was a negative correlation between enhancement rate and MELD score(r=-0.29,0.31,P=0.02,0.01).Conclusion The Gd-EOB-DTPA enhanced MRI has good evaluation value for liver function reserve of patients with hepatitis B.Measurement of the degree of parenchymal enhancement of any lobe or the whole liver on the images of Gd-EOB-DTPA-enhancement MRI in the hepatobiliary phase might reflect the reserved liver function to a certain extent.