机构地区:[1]广西医科大学第一附属医院放射科,南宁530021
出 处:《中华放射学杂志》2006年第12期1237-1240,共4页Chinese Journal of Radiology
基 金:广西自然科学基金资助项目(桂科基0144013)
摘 要:目的 采用MRI和MR氢质子波谱(^1H-MRS)的方法,研究慢性肝病脑部的异常信号及代谢改变,探讨苍白球T1WI异常高信号的临床意义及MRI和^1H-MRS在肝性脑病诊断和治疗中的应用价值。方法选择50例经临床和(或)手术病理确诊为慢性肝病的患者和健康志愿者20例进行MRI和。^1H-MRS检查。测量苍白球指数(PI)和^1H-MRS中观察到的谷氨酰胺及谷氨酸复合物(Glx)的峰高。对各组PI值和Glx峰高进行分析,并对MR信号改变和代谢物的变化与肝功能ChildPugh积分和血氨之间的关系进行相关性分析。对5例并发慢性肝性脑病(CHE)患者(其中3例行肝移植)进行治疗前、后的对比研究。结果 PI值在正常对照组、慢性肝炎组和肝硬化组中逐渐增高,分别为1.01±0.04、1.06±0.09、1.18±0.09,各组间差异有统计学意义(F=22.294,P〈0.01)。^1H-MRS分析显示Glx峰在对照组、慢性肝炎组、肝硬化组、CHE组峰高平均秩次分别为25.25±0.04、25.85±0.07、39.47±1.10、57.77±2.17,差异有统计学意义(Kruskaz-Wallist值=30.21,P〈0.01)。相关性分析显示PI值与ChildPugh积分及Glx问呈正相关(r值分别为0.768、0.545),而与血氨无明显相关性(r=0.314)。慢性肝病治疗前、后对比研究显示,苍白球T1WI高信号随肝功能改善而减轻,于肝移植成功后5—6个月完全消失。脑内代谢物异常的恢复要早于信号改变,移植后1—3个月可恢复到正常水平。结论 PI指数可作为评估肝功能衰竭程度的一项参考指标,^1H-MRS Glx峰能较血氨更好地反映脑损害严重程度,MRI和^1H-MRS在肝性脑病诊断和治疗中有肯定的临床应用价值。Objective To study the abnormal findings and metabolic alterations of the brain in chronic hepatic disease with MRI and 'H magnetic resonance spectroscopy (^1H-MRS) for better understanding the clinical significance of pallidal hyperintensity and the role in the diagnosis and treatment of hepatic encephalopathy (HE) . Methods Brain MRI and 'H-MRS examination were performed in 50 patients with chronic hepatic disease and 20 healthy volunteers. The pallidus index (PI) was calculated and the height of resonance peaks of Glx was measured. The correlation between PI and Child/Pugh classification, and the association between blood ammonia and the spectroscopic alterations were studied. Pre-and post-therapeutic comparative study was also conducted in 5 cases with chronic HE. Results PI was gradually increased from healthy volunteers to patients with chronic hepatitis and liver cirrhosis ( 1.01± 0. 04, 1.06 ±0. 09, and 1.18 ±0. 09), and the differences in PI value among them were significant ( F = 22. 294, P 〈0. 01 ). The Glx signal was more frequently seen in patients with chronic HE and the Glx peak was higher than that in patients with severe cirrhosis (Kruskal-WaUis t = 30. 21, P 〈 0. 01 ). There was positive correlation between PI and Child/Pugh classification ( r = 0. 768 ) and between PI and Glx alterations (r = 0. 545 ), but no correlation between PI and blood ammonia (r = 0. 314). Pallidal hyperintensity on T1-weighted MRI disappeared and the abnormal metabolic alterations returned to normal range 5 to 6 months after successful liver transplantation. However, the normalization of ^1H-MRS alterations preceded the disappearance of pallidal hyperintensities. Conclusion PI can be an index of reference for liver dysfunction. Glx is more sensitive than blood ammonia in detecting the brain dysfunction. MRI and ~ H-MRS are reliable techniques in the diagnosis and evaluation of therapy for hepatic encephalopathy.
分 类 号:R445.2[医药卫生—影像医学与核医学]
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