晚期肝硬化肝脏MR灌注成像的灌注量化分析  

Quantity Analysis of Hepatic Perfusion in Advanced-stage Cirrhotic Patients before Liver Transplantation by Using MR Perfusion Imaging

作　　者：张皓[1] 顾爱华[1] 缪竞陶[1] 胡运胜[1] 张贵祥[1] 何之彦[1] 

机构地区：[1]上海交通大学附属第一人民医院放射科,上海200080

出　　处：《放射学实践》2006年第12期1236-1239,共4页Radiologic Practice

摘　　要：目的:使用动态增强MR成像技术获得的肝灌注系数(HPI),评价其在反映肝移植前晚期肝硬化患者肝脏血供特点中的价值。方法:使用1.5T MR扫描仪对100例正常肝脏组和57例晚期肝硬化患者移植前的受体肝脏进行快速团注对比剂(Gd-DTPA)后的斜冠状断面单层2D SPGR序列的MR灌注成像检查,比较对照组和肝硬化组门静脉和肝实质的时间-信号强度变化曲线(TIC)特点及峰值时间。根据腹腔干水平腹主动脉和门静脉主干的TIC为参照设置时间参数,计算受检者肝脏实质动脉期和静脉期的正增强系数(PEI)。设定肝灌注系数(HPI)=动脉期PEI/(动脉期PEI+门脉期PEI)×100%。对两组受检者HPI进行统计分析,根据HPI的受试者工作特性曲线(receiver operator characteristiccurve,ROCcurve)选择诊断肝硬化的HPI参考标准。结果:对照组及肝硬化组门静脉曲线峰值时间分别为(38.66±4.14)s和(55.51±5.31)s,P<0.01;肝实质TIC峰值时间分别为(56.24±4.47)s和(81.39±7.02)s,P<0.01;对照组及肝硬化组肝实质的HPI分别为(18.9±3.5)%和(26.4±5.5)%,P<0.01;应用HPI>21.6%为诊断肝硬化的标准,敏感度为86%,特异度为85%,阳性预测值为77%,阴性预测值为91%,诊断符合率为85%。结论:MR灌注成像技术可以在活体状态下无创分析肝内血供,此技术可用于评估晚期肝硬化患者肝移植前肝脏内的血流灌注。Objective：To analyze the hepatic perfusion index （HPI） obtained by using dynamic enhanced MR imaging technique in normal adults and advanced-stage cirrhotic patients before liver transplantation and to evaluate its clinical value. Methods：100 adults without liver diseases and 57 pre-liver transplantation recipients with liver cirrhosis underwent MR perfusion imaging of the liver by using a single oblique coronal section FSPGR sequence after bolus injection of Gd- DTPA. The time signal-intensity curves （TIC） of the abdominal aorta, the portal vein and the hepatic parenchyma were got at the workstation. The form and the peak time of the TICs were compared between the two groups. PEI of the hepatic parenchyma was measured in both arterial and portal venous phase. HPI was calculated, and the receiver operator characteristic （ROC） curve of HPI was used to select the reference criterion for diagnosing cirrhosis. Results：The peak time of the portal vein time signal curves of the control group and cirrhotic group were （38.66±4.14）s and （55.51±5.31）s respectively （P〈0.01）. The peak time of the liver TICs of the control group and cirrhotic group were （56.24 ± 4.47）s and （81.39±7.02）s respectively （P〈0.01）. The HPI values of the control group and cirrhotic group were （18.9±3.5）0.% and （26.4 ± 5.5 ） % respectively （ P〈 0.01 ）. The sensitivity, specificity, positive predictive value, the negative predictive value and the accuracy of the HPI were higher than 21.6~ as the diagnostic criterion were 86% ,85% ,77% ,91% ,85% respectively. Conclusion：Dynamic MR imaging technique can analyze hepatic blood supply in vivo no invasively; It is feasible and useful in evaluating the perfusion of advanced-stage cirrhotic liver recipients before liver transplantation.

关 键 词：肝硬化 肝移植 磁共振成像 灌注成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]