Gd—EOB—DTPA增强1．5T磁共振成像评估脑死亡供者供肝质量的研究  

Assessing brain death donor liver function with Gd-EOB-DTPA-enhanced MRI at 1. 5 Tesla

作　　者：王皓晨[1] 韩明[1] 王小平[1] 孙海兴[2] 焦兴元[1] 朱晓峰[1] 郭志勇[1] 何晓顺[1] 

机构地区：[1]中山大学附属第一医院器官移植科 广东省器官捐献与移植免疫重点实验室 广东省器官移植国际科技合作基地,广州510080 [2]中山大学附属第一医院东院放射科,广州510080

出　　处：《中华器官移植杂志》2016年第5期280-285,共6页Chinese Journal of Organ Transplantation

基　　金：国家高技术研究发展计划（863计划）（2012AA021008）;卫生部部属（管）医院临床学科重点项目（2010159）;国家自然科学基金面上项目（81170448、81373156和81471583）;公益性行业科研专项基金（201302009）;广东省器官捐献与移植免疫重点实验室建设项目（2013A061401007）;广东省器官移植国际科技合作基地（20158050501002）

摘　　要：目的探讨钆乙氧基苯甲基二乙烯五胺乙酸（Gd-EOB-DTPA）增强1．5T磁共振成像（MRI）在脑死亡器官捐献（DBD）供者供肝功能评估中的应用价值。方法纳入2014年9月3日至2014年12月3日间DBD供者16例。前瞻性收集供者实验室检查结果，按照其终末期肝病模型（MELD）评分，分为肝功能正常（NLF）组（MELD评分≤10分）及肝功能不全（ILF）组（MELD评分〉10分）。对供者行Gd-EOB-DTPA增强扫描，比较两组间肝实质增强前后信号值、相对增强值、肝肾增强比及造影剂胆管显影时间的差异。最后，根据造影剂排泄时间将全部受者分为两组：延迟显影组（〉20min）与正常显影组（≤20min），分析两组受者术后肝功能恢复及预后的差异。结果NLF组及ILF组的肝实质增强值分别为1920．7±304．6和1523．5±376．0，相对增强值分别为（36．6±7．9）％和（21．9±6．7）％，肝肾增强比分别为49．5±14．1和31．2±17．4，以及造影剂排泄时间分别为（15．6±7．7）min和（28．8±9．1）min，两组比较，差异均有统计学意义（P〈0．05）。16例受者全部得到随访，随访时间为术后90d。正常组无受者死亡，延迟组出现2例受者死亡。正常组受者术后7d内各项肝功能指标恢复较快。结论应用Gd-EOB-DTP增强1．5T MRI可有效评估DBD供者的供肝质量。Objective To evaluate the application of Gd-EOB-DTPA-enhanced 1. 5 T MRI combined with multi-sequence on assessing the hepatic function of brain death donor. Methods A total of 16 liver donors in our center were included according to brain death criteria. Firstly, all the results of liver function test were prospectively collected. The donors were divided into two groups according to Model of end-stage liver disease （MELD） score~ normal liver function group （NLF） （MELD≤10） and impaired liver function group （ILF） （MELDS10）. The Gd-EOB-DTPA-enhanced 1.5 T MRI was performed in brain death donors, and then the pre- and post-enhanced signal intensity, relative enhancement, liver to kidney enhancement ratio and bile duct contrast agent development time were compared. Finally, based on the time of Gd-EOB-DTPA secreted into the bile duct, 16 donors were divided into two groups, normal excretion group （420 min） and delayed excretion group （〉20 min）. After liver transplantation, the hepatic function and prognosis of the corresponding recipients were analyzed. Results Significant difference was found in the liver parenchyma post-enhanced signal intensity （1920. 7 ± 304. 6 vs. 1523.5± 376. 0）, relative enhancement （36. 6 ± 7. 9% vs. 21.9% ±6. 7%）, liver to kidney enhancement ratio （49. 5 ± 14. 1 vs. 31.2 ± 17. 4）, and bile duct contrast agent visualization time （15.6 ±7. 7 vs. 28.8 ±9. 1 min） between NLF group and ILF group （P〈0. 05 for all）. All the 16 recipients were followed-up for 90 days after transplantation. The serum liver function tests of recipients in normal excretion group returned to normal faster, and the significance was found in LDHDay1, 4 and ALTDay7 （P〈0. 05）. No recipients died in normal excretion group whereas 2 recipients died in delayed excretion group. Conclusion The application of Gd-EOB-DTPA-enhanced 1. 5T MRI could be applied to access the hepatic function of brain death donor.

关 键 词：脑死亡供者 肝脏 磁共振成像 评估 肝移植 

分 类 号：R445.2[医药卫生—影像医学与核医学] R657.3[医药卫生—诊断学]