肝硬化对Gd-EOB-DTPA增强MRI后肝肾排泄途径的影响  

Gd-EOB-DTPA enhanced MRI imaging:difference and relationship of hepatic and renal excretion pathways in patients with liver cirrhosis

作　　者：何晴 谢双双[2] 石茜 季倩[2] He Qing;Xie Shuangshuang;Shi Qian;Ji Qian(First Central Clinical Collage,Tianjin Medical University,Tianjin 300192,China;Department of radiology,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津医科大学一中心临床学院放射科,天津300192 [2]天津市第一中心医院放射科,天津300192

出　　处：《实用器官移植电子杂志》2020年第5期353-360,共8页Practical Journal of Organ Transplantation(Electronic Version)

摘　　要：目的研究肝硬化患者在肝钆塞酸二钠(gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid,Gd-EOB-DTPA)增强后的排泄方式差异及联系,探讨肝肾增强程度之间以及与血液生化指标的关系。方法27例肝硬化患者〔CP(Child-Pugh)A级组17例,CP B/C级组10例〕和17例肝肾功能正常成人(对照组)接受平扫及Gd-EOB-DTPA增强MRI检查,测量并计算受试者肝胆期5、10、15 min和20 min的肝脏、门静脉与同层面竖脊肌信号强度比值和肾髓、皮质与同层面竖脊肌信号强度的比值,同时收集所有入组者血液生化指标,比较不同时间点3组之间的各比值差异,分析各比值与生化指标的相关性。结果肝胆期各时间点3组之间的SI肝/SI竖脊肌1差异均有统计学意义(P<0.05),肝胆期15 min及20 min 3组之间的SI门静脉/SI竖脊肌1差异均有统计学意义(P<0.05),其余各时间点各组间差异均无统计学意义(P>0.05)。SI肾髓质/SI竖脊肌2:对照组与CP B/C组在肝胆期15 min和20 min差异有统计学意义(P<0.05),CP A组与CP B/C组在5、15、20 min差异有统计学意义(P<0.05),而对照组与CP A组仅在5 min时差异有统计学意义(P<0.05)。SI肾皮质/SI竖脊肌2:对照组与CP B/C组、CP A组与CP B/C组在10、15和20 min差异有统计学意义(P<0.05),对照组与CP A组在15及20 min差异均有统计学意义(P<0.05)。20 min时SI肝/SI竖脊肌1与Alb呈高度正相关,与AST呈高度负相关,与TBiL、Glb、γ-GT、PT呈中度负相关;SI肾髓质/SI竖脊肌2、SI肾皮质/SI竖脊肌2与SI肝/SI竖脊肌1呈中度负相关,与SI门静脉/SI竖脊肌1呈中度正相关,与Cr、eGFR不相关。结论肾功能正常的肝硬化患者Gd-EOB-DTPA的胆道排泄减少,肾脏排泄代偿增加,排泄时间延长,且与肝硬化程度有关。Gd-EOB-DTPA增强MRI评估肝硬化程度具有较好的临床相关性,肾脏增强程度可以间接提示肝功能损害程度。Objective To study the differences and relationship of hepatic and renal excretion patterns in patients with liver cirrhosis after gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced magnetic resonance imaging(MRI).To explore the relationship between the level of liver and kidney enhancement and blood biochemical indicators.Methods Twenty-seven patients with cirrhosis CP(Child-Pugh),including17 patients with grade A(CP A),10 patients with grade B or C(CP B/C)and 17 adults with normal liver and kidney function(control group)underwent plain scan and Gd EOB-DTPA enhanced MRI.At 5,10,15 and 20 minutes after bolus administration of Gd-EOB-DTPA,the signal intensity ratios of liver,portal vein and the erector muscle of spine at the same level,and ratios of signal intensity of renal medulla and cortex to the erector muscle of spine at the same level were measured and calculated.The blood biochemical makers of all the participants were collected.The differences of ratios between the three groups at different time points were compared and the correlation between different indices were analyzed.Results There was significant difference in Sliver/SImuscle1 between the groups at each time point of hepatocyte-specific phase(P<0.05).There was significant difference in SIportal vein/SImuscle1 between the groups at 15 and 20 minutes of hepatocyte-specific phase(P<0.05)and no significant differences between the groups at other time points(P>0.05).Regarding the SImedulla/SImuscle2:significant differences were found between the control group and CP B/C group at 15 and 20 minutes(P<0.05).There was significant difference between the CP A group and CP B/C group at 5,15 and 20 minutes.There was significant difference between control group and CP A group at 5 minutes.Concerning the SIcortex/SImuscle2:there were significant differences between the control group and CP B/C group and between the CP A group and CP B/C group at 10,15 and 20 minutes.There were significant differences between the control group and CP

关 键 词：肝硬化 肝钆塞酸二钠 磁共振成像 排泄方式 

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]