Gd-EOB-DTPA增强MRI在大范围肝切除术后肝衰竭风险评估中的作用  

Role of Gd-EOB-DTPA-enhanced MRI in assessing the risk of liver failure after major liver resection

作　　者：余前军 程龙[2] 朱永强[2] 杜飞舟[3] 黄民 汪涛 YU Qianjun;CHENG Long;ZHU Yongqiang;DU Feizhou;HUANG Min;WANG Tao(Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学,四川泸州646000 [2]成都军区总医院全军普外中心 [3]成都军区总医院

出　　处：《山东医药》2018年第9期5-8,共4页Shandong Medical Journal

基　　金：国家自然科学基金资助项目(81300280);四川省青年科技基金项目(2016JQ0023)

摘　　要：目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI在评估大范围肝切除术后肝衰竭风险中的作用。方法纳入行三段或三段以上的肝部分切除患者36例,所有患者术前进行肝功能血清学指标、Child-Pugh评分、ICG R15检测,肝脏增强CT检查,Gd-EOB-DTPA增强MRI检查,分析术前残肝细胞摄取率(r HUI)、标准残肝细胞摄取率(Sr HUI)及术中相关指标与术后出现肝衰竭风险的关系,并应用受试者工作特征曲线(ROC)评估r HUI、Sr HUI对出现肝衰竭风险的预测价值。结果术后合并肝衰竭风险患者8例(22.22%),术后合并肝衰竭风险者与无肝衰竭风险者中r HUI、Sr HUI、白蛋白差异有统计学意义(P均<0.05)。r HUI与术后肝衰竭风险的ROC曲线下面积(AUC)为0.835,敏感度71.4%,特异度87.5%,临界值0.614,95%可信区间为0.692~0.978;Sr HUI与术后肝衰竭风险的AUC为0.864,敏感度85.7%,特异度75.0%,临界值0.344,95%可信区间为0.730~0.998。结论 GdEOB-DTPA增强MRI有助于评估大范围肝切除术后出现肝衰竭风险。Objective To investigate the role of Gd-EOB-DTPA-enhanced MRI in assessing the risk of liver failure after major liver resection.Methods Thirty-six patients with three or more segments of the liver partial resection were enrolled.All patients underwent Gd-EOB-DTPA-enhanced MRI,liver-enhanced CT,ICG clearance test,Child-Pugh score,and liver function serum test for preoperative checkup.The relationships of preoperative liver function,remnent hepatocellular uptake index(rHUI),standard remnant hepatocellular uptake index(SrHUI)and intraoperative relevant indicators with postoperative liver failure risk were analyzed.We used the receiver operating characteristic curve(ROC)to evaluate the diagnostic value of rHUI and SrHUI in predicting the risk of liver failure.Results Eight patients(22.22%)experienced the risk of hepatic failure.There were significant differences in the rHUI,SrHUI,and albumin of patients with the risk of liver failure and without the risk(all P<0.05).The ROC area under the curve(AUC)of rHUI and SrHUI was 0.835 and 0.864,respectively(sensitivity:71.4%and 85.7%,specificity:87.5%and 75.0%,cut-off value:0.614 and 0.344,95%confidence interval:0.654-0.947 and 0.730-0.998).Conclusion Gd-EOB-DTPA-enhanced MRI can accurately assess the residual liver function,and has important significance in assessing the risk of liver failure after major liver resection.

关 键 词：肝肿瘤 肝衰竭 钆塞酸二钠增强MRI 肝切除 

分 类 号：R735.7[医药卫生—肿瘤]