钆塞酸二钠动态增强对肝功能评估的应用  

Application of Gd-EOB-DTPA Dynamic Contrast Enhanced MRI in Assessing Liver Function

作　　者：钱吉芳 叶建军[2] 朱晓华[2] 张雅滨[2] 陈纲[2] 张文娟[2] 罗雅萍[2] 马强华[2] 

机构地区：[1]甘肃省妇幼保健医院放射科,甘肃兰州730000 [2]兰州军区总医院影像科,甘肃兰州730050

出　　处：《中国医学影像学杂志》2016年第11期825-829,共5页Chinese Journal of Medical Imaging

摘　　要：目的研究不同肝功能分级的乙型肝炎肝硬化患者肝脏钆塞酸二钠（GdEOB-DTPA）动态增强时间-信号强度的变化特点,探讨肝脏特异性造影剂评估肝功能的可行性。资料与方法收集兰州军区兰州总医院2011年11月—2015年8月行Gd-EOB-DTPA肝脏MR动态增强扫描的乙型肝炎肝硬化患者159例（肝硬化组）,其中男84例,女75例,平均年龄（47.8±9.8）岁;另收集36例无肝炎病史,肝功能检查均正常的患者（对照组）。获得平扫期、动脉期、门静脉期、平衡期及第3~15分钟（每分钟扫描1次共17次扫描）的轴位图像。对肝脏右后叶感兴趣区采样,获得动态增强时间-信号强度变化率曲线,并按Child-Pugh分级进行分组。比较对照组与Child-Pugh A、B、C级曲线的差异,并分析组间关系。结果 4组时间-信号变化率曲线分别表现为N、A、B、C型。随着分级增加,门脉期增强率、波谷增强率、15 min增强率、重吸收斜率不断降低,波谷时间不断增加。其中,波谷时间、重吸收斜率在各组间差异有统计学意义（P〈0.05）。结论肝硬化患者不同肝功能分级的时间-信号强度变化率曲线存在差异,波谷时间和重吸收斜率可作为判断肝硬化患者肝功能的重要指标。Purpose To investigate the time signal-intensity cure（TIC） using Gd-EOBDTPA dynamic enhancement in hepatitis B patients with different liver function and to explore thefeasibilityof evaluating liver function with hepatocyte-specific contrast agents. Materials and Methods 159 hepatitis B patients with complete clinical data including 84 malesand 75 femalesaged（47.8±9.8） years and 36 cases with normal liver function as control group underwent Gd-EOB-DTPA dynamic contrast enhanced MRI of the liver. 17 phases of axial images at 1 minute/phase were obtained including no-contrast scan, arterial phase, venous phase and equilibrium phase. Area of interest was sampled in the right posterior lobe to create TIC and its main features were analyzed according to the different liver function classification of Child-Pugh score, and compared to normal control. The difference and relationship among four groups（normal control and Child-Pugh A, B, C） were determined. Results The TIC was divided into N, A, B and C types. The contrast enhancement ratio of portal venous phase（PVP-CER）, contrast enhancement ratio of valley（V-CER）, contrast enhancement ratio of fifteen minutes（15＇-CER） and reabsorption slope（RS） decreased with the increase of Child-Pugh grades, and time to valley（TTV） increased. TTV and RS were statistical different in each group（P0.05）. Conclusion The TICs are different among hepatitis B patients with different liver function grading. TTV and RS may be used as animportant indicator of liver function.

关 键 词：肝硬化 肝炎 乙型 磁共振成像 图像增强 钆塞酸二钠 

分 类 号：R575.2[医药卫生—消化系统] R445.2[医药卫生—内科学]