肝脏普美显增强MRI联合CT门静脉成像评估肝静脉压力梯度

目的探讨肝脏普美显增强MRI联合CT门静脉成像评估肝静脉压力梯度(HVPG)应用价值。方法回顾性分析40例行肝脏普美显增强MRI及腹部增强CT并在1周内完成HVPG测量的资料。分析门静脉、脾静脉管径、肝脾体积及其比值、肝胆期相对强化程度(RE)值与HVPG相关性,按照HVPG>12 mmHg及HVPG≤12 mmHg分为两组,使用多因素二元逻辑回归建立联合模型,绘制单一参数及延迟20 min RE20 min与肝脏体积/脾脏体积联合诊断指标受试者工作特征曲线(ROC),计算曲线下面积(AUC)。结果延迟10 min RE10 min及延迟20 min RE20 min与HVPG呈中度负相关(r值分别为-0.632、-0.688,P<0.05)。门静脉管径及脾脏体积与HVPG呈中度正相关(r值分别为0.690、0.592,P值<0.05),肝脏体积/脾脏体积与HVPG呈高度负相关(r=-0.794,P<0.05)。脾体积、肝脏体积/脾脏体积、门静脉管径、RE10 min及RE20 min、联合诊断模型(RE20 min与肝脏体积/脾脏体积)预测HVPG>12 mmHg AUC值分别为0.826、0.791、0.848、0.759、0.721、0.880。结论肝脏普美显增强MRI联合CTPV可较精确预测门静脉压力,RE20 min与肝脏/脾脏体积联合诊断模型可有效预测食管胃静脉曲张破裂出血,在门静脉高压无创诊断中有一定价值。

Objective To investigate the clinical value of GD-Eob-DTPA in predicting hepatic vein pressure gradient by measuring portal vein and splenic vein diameter,liver and spleen volume and ratio,liver and bile phase relative enhancement of GD-Eob-DTPA enhanced MRI.Methods 40 patients who underwent abdominal enhanced CT and hepatobiliary specific ENHANCED MRI and completed HVPG measurement within 1 week were retrospectively collected.Pearson correlationanalysis was performed between portal vein diameter,splenic vein diameter,liver and spleen volume and ratio,relative enhancement(RE)value of hepatobiliary phase and HVPG.Furthermore,all patients were further divided into two groups according to HVPG>12 mmHg and HVPG≤12 mmHg.T-test was performed on the mean between the two groups,and a joint diagnostic model was established by multi-factor binary logistic regression.The receiver operating characteristic(ROC)curves of single diagnostic index and combined diagnostic index of liver volume/spleen volume after 20 minRE20 min delay were plotted,and the area under the curve(AUC)was calculated.Results There was a negative correlation between HVPG and RE10 min of 10 min delay and RE20 min of 20 min delay(r=-0.632 and-0.688,P<0.05).Portal vein diameter and spleen volume were moderately positively correlated with HVPG(r=0.690,0.590,P<0.05),liver volume/spleen volume was highly negatively correlated with HVPG(r=-0.794,P<0.05).When HVPG>12 mmHg was diagnosed,AUC values of spleen volume,liver volume/spleen volume,portal vein diameter,RE10 min and RE20 min,combined diagnostic model(RE20 min and liver volume/spleen volume)were 0.826,0.791,0.848,0.759,0.721 and 0.880,respectively.Conclusion Enhanced MRI combined with CTPV can indirectly predict the level of portal vein pressure,and RE20 min combined with liver/spleen volume can effectively predict the rupture and bleeding of esophagogastric varices,so it has certain value in the non-invasive diagnosis of portal vein hypertension.