钆塞酸二钠增强MRI在评估肝功能中的参数选择研究  

Gd-EOB-DTPA-enhanced 3 Tesla MR imaging in screening the optimal parameters in the evaluation of liver function

作　　者：李晨霞[1] 刘海甜 李香[1] 梁挺[1] 王蓉[1] 杨健[1] 张月浪[1] LI Chenxia;LIU Haitian;LI Xiang;LIANG Ting;WANG Rong;YANG Jian;ZHANG Yuelang(Department of Medical Image,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Radiology,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]西安交通大学第一附属医院医学影像科,西安710061 [2]河北医科大学第三医院放射科,石家庄050051

出　　处：《中华实用诊断与治疗杂志》2019年第12期1212-1216,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金面上项目(81771810);陕西省重点研发计划一般项目-社会发展领域(2019SF-007)

摘　　要：目的筛选钆塞酸二钠增强MRI在评估肝功能中的最优信号强度参数。方法63例肝硬化患者根据Child-Pugh分级分为Child-Pugh A组22例,Child-Pugh B组29例,Child-Pugh C组12例;19例体检健康者为正常对照组。4组均行3.0T钆塞酸二钠增强MRI,测量增强前和增强后20min肝脏、脾脏和竖脊肌的信号强度(signal intensity,SI),计算获得5个信号强度参数:肝脏相对强化程度(relative enhancement,RE)、肝胆期肝脏-脾脏信号比(SI liver/spleen)、肝胆期肝脏-肌肉信号比(SI liver/muscle)、脾脏对比增强指数(contrast enhanced index,CEI)spleen和肌肉对比增强指数CEI muscle。比较5个参数在4组间的差异,分析5个参数与肝功能分级的相关性。绘制ROC曲线,评估5个参数对肝功能分级的诊断效能。结果正常对照组、Child-Pugh A组、Child-Pugh B组、Child-Pugh C组RE(0.98±0.13、0.88±0.13、0.66±0.13、0.37±0.08)依次降低(P<0.05);Child-Pugh A组SI liver/spleen(1.25±0.17)高于正常对照组(1.16±0.14)和Child-Pugh C组(1.11±0.13)(P<0.05);Child-Pugh B组CEI spleen、CEI muscle(1.03±0.08、1.26±0.11)和Child-Pugh C组(0.95±0.06、1.11±0.06)低于正常对照组(1.15±0.11、1.38±0.14)和Child-Pugh A组(1.14±0.11、1.34±0.16)(P<0.05),Child-Pugh C组低于Child-Pugh B组(P<0.05),正常对照组与Child-Pugh A组比较差异无统计学意义(P>0.05);4组SI liver/muscle比较及4组间两两比较差异均无统计学意义(P>0.05);RE、SI liver/spleen、SI liver/muscle、CEI spleen和CEI muscle与肝功能分级均呈负相关(r=-0.84,P<0.001;r=-0.34,P=0.023;r=-0.25,P=0.042;r=-0.63,P<0.001;r=-0.56,P<0.001);RE诊断肝功能分级效能的AUC(0.917)高于SI liver/spleen(0.645)、SI liver/muscle(0.624)、CEI spleen(0.863)和CEI muscle(0.762)(P<0.05)。结论以肝脏自身为对照的参数RE可作为钆塞酸二钠增强MRI评估肝功能的最优信号强度参数。Objective To screen the optimal signal intensity parameters of Gd-EOB-DTPA-enhanced 3Tesla MR imaging in the evaluation of liver function.Methods According to Child-Pugh classification,63patients with cirrhosis were divided into Child-Pugh A group(n=22),Child-Pugh B group(n=29)and Child-Pugh C group(n=12),and another 19 healthy volunteers were as controls(control group).All four groups underwent Gd-EOB-DTPA-enhanced 3Tesla MR imaging to measure the signal intensity(SI)of the liver,spleen and erector spinae before and 20min after enhancement and calculate five signal intensity parameters as relative enhancement(RE),hepatobiliary liver-spleen signal ratio(SI liver/spleen),hepatobiliary liver-muscle signal ratio(SI liver/muscle),contrast enhanced index(CEI)of spleen and CEI of muscle.The differences of 5parameters were compared in 4groups,and the correlation of 5parameters with the liver function grading was analyzed.ROC curve was drawn to evaluating the diagnostic efficacy of 5parameters on liver function grading.Results RE decreased gradually in turn in control group(0.98±0.13),Child-Pugh A group(0.88±0.13),Child-Pugh B group(0.66±0.13)and Child-Pugh C group(0.37±0.08)(P<0.05).SI liver/spleen was higher in Child-Pugh A group(1.25±0.17)than that in control group(1.16±0.14)and Child-Pugh C group(1.11±0.13)(P<0.05).CEI spleen and CEI muscle were significantly lower in Child-Pugh B group(1.03±0.08,1.26±0.11)and Child-Pugh C group(0.95±0.06,1.11±0.06)than those in control group(1.15±0.11,1.38±0.14)and Child-Pugh A group(1.14±0.11,1.34±0.16)(P<0.05),lower in Child-Pugh C group than those in Child-Pugh B group(P<0.05),and showed no significant differences between control group and Child-Pugh A group(P>0.05).SI liver/muscle showed no significant differences among four groups and between each two groups(P>0.05).RE,SI liver/spleen,SI liver/muscle,CEI spleen and CEI muscle were negatively correlated with liver function grading(r=-0.84,P<0.001;r=-0.34,P=0.023;r=-0.25,P=0.042;r=-0.63,P<0.001;r=-0.56,P<0.001).The

关 键 词：钆塞酸二钠 磁共振 肝功能 信号强度 

分 类 号：R445.2[医药卫生—影像医学与核医学] R575.2[医药卫生—诊断学]