Gd-EOB-DTPA增强MRI肝胆期弥漫性门静脉周围高信号的影像表现分型及临床意义  

Intrahepatic Diffuse Periportal High Intensity on Hepatobiliary Phase of Gd-EOB-DTPA-Enhanced MRI:Imaging Classification and its Clinical Significance

作　　者：翟丽娟[1] 邢飞[1] 朱文静[1] 杜圣[1] 丁丁[1] 姜吉锋[1] 陆健[1] 张涛[1] ZHAI Lijuan;XING Fei;ZHU Wenjing(Department of Radiology,the Affiliated Nantong Third Hospital of Nantong University,Nantong,Jiangsu Province 226006,P.R.China)

机构地区：[1]南通大学附属南通第三医院影像科,226006

出　　处：《临床放射学杂志》2023年第1期72-76,共5页Journal of Clinical Radiology

基　　金：南通市卫生健康委员会科研立项课题(编号:MA2021025)。

摘　　要：目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI肝胆期(HBP)弥漫性门静脉周围高信号(PHI)的影像表现分型及临床意义。方法回顾接受Gd-EOB-DTPA增强MRI检查者,从中筛选出26例伴有HBP弥漫性PHI的患者。根据HBP与T_(2)WI肝内弥漫性PHI区匹配模式进行分型,比较不同影像分型之间临床及肝功能生化指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、总胆红素(TBil)、直接胆红素(DBil)、白蛋白(ALb)及总蛋白(TP)]的差异性。结果26例患者中,12例HBP与T_(2)WI肝内弥漫性PHI区相匹配(A型),14例HBP与T_(2)WI肝内弥漫性PHI区不相匹配,表现为前者(HBP)位于后者(T_(2)WI)的外围(B型,n=11)或后者无PHI(C型,n=3)。相匹配组主要与活动性肝炎相关,疾病包括戊型肝炎、自身免疫性肝炎、药物性肝损伤;不相匹配组主要与肝硬化等慢性病程相关,疾病包括原发性胆汁性胆管炎、自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征和各种病因的慢性肝炎、肝硬化。A型患者的ALT、AST、GGT、TBil、DBil水平显著高于(B+C)型,差异均有统计学意义(P值均<0.05);ALP、ALb与TP水平稍低于(B+C)型,差异均无统计学意义(P值均>0.05)。ALT、AST、GGT、TBil和DBil预测A型PHI的受试者工作特征曲线下面积均>0.8。结论HBP弥漫性PHI的影像学分型,可能反映肝功能损伤的严重程度,并作为判断疾病处于何种阶段的影像指标之一。Objective To investigate the imaging classification and clinical significance of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI of hepatobiliary phase(HBP)with intrahepatic diffuse periportal high intensity(PHI).Methods Clinical data of 26 patients with intrahepatic diffuse PHI on HBP who underwent Gd-EOB-DTPA-enhanced MRI were retrospectively collected.According to the matching pattern of periportal enhancement areas on HBP and PHI areas on T_(2)WI,the clinical and liver function biochemical indexes including alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-Glutamyl transpeptidase(GGT),alkaline phosphatase(ALP),total bilirubin(TBil),direct bilirubin(DBil),albumin(Alb),and total protein(TP)were compared between different imaging classification.Results In 12 of the 26 patients,periportal enhancement areas on HBP corresponded with the PHI areas on T_(2)WI(type A),and the remaining 14 patients,periportal enhancement areas on HBP did not correspond with the PHI areas on T_(2)WI,which showed that the former(HBP)were located immediately outside of the latter(T_(2)WI)(type B,n=11)or the latter(T_(2)WI)was absent(type C,n=3).The corresponding group was mainly associated with active hepatitis,including hepatitis E,autoimmune liver injury,and drug-induced liver injury.The noncorresponding group was mainly associated with a chronic change of cirrhosis,including primary biliary cirrhosis,autoimmune hepatitis-primary biliary cirrhosis overlap syndrome,and liver cirrhosis with miscellaneous etiology.The levels of ALT,AST,GGT,TBil,and DBil in patients with type A were significantly higher than those with type(B+C)(all P<0.05),and the levels of ALP,ALb,and TP were slightly lower than those of type(B+C)(all P>0.05).The area under curve of receiver operating characteristic(ROC)in ALT,AST,GGT,TBil,and DBil were all greater than 0.8.Conclusion The imaging classification of intrahepatic diffuse PHI on HBP may reflect the severity of liver function damage and serve as one of the im

关 键 词：钆塞酸二钠 肝胆期 门静脉周围高信号 影像学分型 

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