肝脏功能对磁共振钆塞酸二钠增强诊断肝细胞肝癌的影响  

The effect of liver function on detection of hepatocellular carcinoma with Gd-EOB-DTPA-enhanced MRI in hepatobiliary phase

作　　者：吴建伟[1] 徐烜[1] 瞿献莉[1] 张艳[1] 高红[1] 

机构地区：[1]解放军第81医院影像科,江苏南京210002

出　　处：《实用放射学杂志》2015年第12期1975-1978,共4页Journal of Practical Radiology

摘　　要：目的 探讨肝脏功能对磁共振钆塞酸二钠增强诊断肝细胞肝癌的影响。方法 55例肝硬化疑肝细胞肝癌患者行上腹部磁共振钆塞酸二钠动态增强和延迟5、10、15、20、25 min肝胆期成像，对患者行Child-Pugh评分，测量肝癌病灶周围肝实质、肝癌病灶信号强度，计算各时间点两者比值并与Child-Pugh分级相联系，肉眼评估肝脏病灶在各时间点的显示率。结果 55例肝硬化患者Child-Pugh评分A级35例，B级18例，C级2例，33例共38个肝细胞肝癌，肝实质与肝癌病灶信号强度比值在延迟5,10,15,20 min和25 min有显著差异（F=23.196，P〈0.001），该比值在Child-Pugh A级和B/C级患者之间也有显著差异（F=22.306，P〈0.001），且随着时间的延长而增加（F=15.821，P〈0.001）。延迟10 min起，38个肝癌病灶中的30个（Child-Pugh A 患者的25个病灶和Child-Pugh B级患者的5个病灶）呈显著低信号，6个（Child-Pugh A级2个病灶和Child-Pugh B级4个病灶）呈低信号，2例Child-Pugh C级患者2个病灶分别呈略低信号和等信号。结论 肝硬化患者行磁共振钆塞酸二钠增强，肝实质与肝细胞肝癌病灶之间对比度随着肝功能下降而降低，从而影响肝细胞肝癌的的诊断。Objective To discuss the effect of liver function on detection of hepatoceliular carcinoma with Gd-EOB-DTPA-en- hanced MRI in hepatobillary phase. Methods The dynamic Gd-EOB-DTPA-enhanced MRI with delayed scans at 5,10,15,20 and 25 minutes were performed in 55 patients with cirrhosis,whose Child-Pugh scoring was performed according to the hepatic laboratory results. At each time point, the signal intensities of HCC and its neighboring liver parenchyma were measured, and the signal intensity ratios of liver-to-HCC were also calculated whose correlation with different Child-Pugh scores were analyzed. The visualization of HCC lesions was evaluated with naked eye at each time point. Results The 38 HCC lesions in 33 of 55 patients with liver cirrhosis （Child-Pugh A in 35 patients,B in 18 and C in 2） were confirmed finally. Differences in the signal intensity ratios of liver-to-HCC were significant among different time points （F=23.196, P〈0. 001） and between patients with Child-Pugh A and B/C （F= 22. 306, P〈0. 001） ,and those were increased with time（F=15. 821,P〈0. 001）. In hepatobiliary phase after t0 minutes,the 30 of 38 HCC lesions （25 with Child-Pugh A and 5 with Child-Pugh B） with lower signal, 6 ones （2 with Child-Pugh A and 4 with Child-Pugh B） with hypointensity,and the remaining 2 ones in 2 patients with Child-Pugh C with slight hypointensity and isointensity respectively were showed. Conclusion In cirrhotic patients with Gd-EOB-DTPA-enhanced MRI,the signal intensity ratios of liver-to-HCC lesion are decreased and correlated with the degree of liver function,which may affect the diagnosis of HCC.

关 键 词：钆塞酸二钠 磁共振成像 肝脏功能 肝细胞肝癌 

分 类 号：R445.2[医药卫生—影像医学与核医学] R322.47[医药卫生—诊断学]