钆塞酸二钠增强MRI功能性肝脏影像学评分及影像征象与ALBI分级评估肝功能的对照研究

A Comparative Study of FLIS and Imaging Signs Derived from Gd⁃EOB⁃DTPA⁃Enhanced MRI with Albumin⁃Bilirubin(ALBI)Grade in Evaluating Liver Function

目的 以白蛋白-胆红素(ALBI)分级作为肝功能评估标准,通过分析慢性肝病患者钆塞酸二钠(Gd-EOB-DTPA)增强MRI肝胆期图像,探讨功能性肝脏影像学评分(FLIS)及其三个影像学征象在评估肝功能方面的应用价值。方法 回顾性分析2022年2月至2023年4月于本院行Gd-EOB-DTPA增强MRI检查的170例慢性肝病患者的临床及影像资料。根据实验室指标计算ALBI评分并将患者分为ALBI 1级、2级、3级。两名放射科医师独立评估Gd-EOB-DTPA增强MRI肝胆期图像并计算FLIS及其3个影像学征象(肝实质强化、胆管对比剂排泄、门静脉征)得分。采用Spearman检验评估FLIS及影像学征象与ALBI评分之间的相关性并用Kruskal-Wallis H检验分析上述影像学参数在不同ALBI评分之间的组间差异。采用受试者工作特征(ROC)曲线评价FLIS及影像学征象鉴别不同ALBI分级的诊断效能。采用组内相关系数(ICC)评估不同审阅者之间评分的一致性。结果 FLIS及3个影像学征象得分与ALBI评分之间均有较高的相关性,其中FLIS的相关系数最高,r=-0.735,P<0.001。Kruskal-Wallis H检验示仅ALBI 1级和ALBI 2级之间的胆管对比剂排泄得分差异无统计学意义(P=0.111),余影像学指标均有明显统计学差异(P=0.000)。ROC曲线分析示FLIS相较于其他三个影像学征象在鉴别不同ALBI分级时的诊断效能最高,曲线下面积(AUC)值分别为0.846(ALBI 1级vs. ALBI 2级或3级)、0.952(ALBI 3级vs. ALBI 1级或2级)。两位审阅者对FLIS、肝实质强化、胆管对比剂排泄及门静脉征评估的一致性均较高,ICC值分别为0.951、0.847、0.930、0.945。结论 FLIS相较于其他3个影像学征象与ALBI评分之间具有更高的相关性且能较准确地鉴别不同ALBI分级。FLIS有望作为一种简单无创的影像学指标评估慢性肝病患者的肝功能并对其临床管理具有一定的指导价值。

Objective With ALBI grade as the reference of liver function assessment,to evaluate the efficacy of func⁃tional liver imaging score(FLIS)and its three imaging signs in predicting liver function by analyzing the hepatobiliary phase(HBP)images of patients with chronic liver disease.Methods The clinical and imaging data of 170 patients with chronic liver disease who underwent Gd⁃EOB⁃DTPA enhanced MRI from February 2022 to April 2023 were retrospectively analyzed.ALBI score was calculated according to laboratory indicators and patients were divided into three groups:ALBI grade 1,2 and 3.FLIS and the scores of three imaging signs(liver parenchymal enhancement,biliary contrastexcretion,por⁃tal vein sign)were evaluatedusing HBP images independently by two radiologists.The correlations between ALBI score and both FLIS and its three parameters were assessed by Spearman’s rank correlation and Kruskal⁃Wallis H test was used to an⁃alyze the differences of these imaging parameters among different ALBI grades.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the diagnostic efficacy of FLIS and imaging signs in distinguishing different ALBI grades.Inter⁃reader agreements were evaluated by intraclass correlation coefficient(ICC).Results FLIS and three ima⁃ging signs all showed strong correlations with ALBI grades.The correlation coefficient of FLIS was the highest(r=-0.735,P<0.001).Kruskal⁃Wallis H test showed that there was no significant difference in biliary contrast excretion score be⁃tween ALBI grade 1 and grade 2(P=0.111>0.05),but other imaging parameters showed significant differences among different ALBI grades(P=0.000).ROC curve analysis showed that FLIS had the highest diagnostic efficacy in distinguis⁃hing different ALBI grades compared with the other three imaging signs,with AUC values of 0.846(ALBI 1 vs.ALBI 2 or 3)and 0.952(ALBI 3 vs.ALBI 1 or 2),respectively.The inter⁃reader agreements for FLIS,liver parenchymal enhance⁃ment,biliary contrast excretion and portal vein sign were excellent,with ICC values of 0.951,0.847,0.930 and 0.945,re⁃spectively.Conclusion Compared with other three parameters,FLIS showed the strongest correlation with ALBI score and can accurately stratify the ALBI grades.FLIS is expected to be a simple and non⁃invasive imaging indicator to evaluate liver function in patients with chronic liver disease and has the potential to guide patients’clinical managements.