钆塞酸二钠增强磁共振成像相对强化率与肝功能的相关性研究

doi:10.19871/j.cnki.xfcrbzz.2021.02.003

摘要/Abstract

摘要： 目的探讨肝实质摄取钆塞酸二钠（Gd-EOB-DTPA）程度与Child-Pugh评分及定量指标的相关性,为临床对肝脏功能量化评估提供依据。方法回顾性分析2019年6月12日至2019年12月12日首都医科大学附属北京地坛医院因乙型肝炎肝硬化住院并接受Gd-EOB-DTPA增强磁共振成像检查的患者的影像资料。共纳入65例患者,按Child-Pugh评分分为4组,正常组（评分<5分）、A组（评分5~6分）、B组（评分7~9分）、C组（评分10~15分）,组间分别进行两两比较同期相对强化率(RE_10min、RE_15min、RE_20min);各组内部多期相对强化率进行两两比较;采用Pearson相关分析评价RE_20min与Child-Pugh评分及定量指标的相关性。结果正常组与A组同期（RE_10min、RE_15min、RE_20min）比较差异无统计学意义。正常组与B组、正常组与C组、A组与B组、A组与C组同期（RE_10min、RE_15min、RE_20min）比较差异均有统计学意义（P<0.05）。B组与C组同期（RE_10min、RE_15min、RE_20min）比较差异无统计学意义。RE_10min、RE_15min、RE_20min在正常组、A组、B组、C组各组内部两两比较差异无统计学意义;RE_20min与血清总胆红素、凝血酶原时间、Child-Pugh评分均呈负相关（r值分别为-0.491、-0.481、-0.619,P均<0.05）。RE_20min与血清白蛋白呈正相关（r值为0.352,P<0.05）;以RE_20min（0.445）为界值,诊断肝功能正常+Child-Pugh评分A级的敏感度和特异度最高,分别为89.2%、64.3%,ROC曲线的曲线下面积为0.813。结论肝实质摄取Gd-EOB-DTPA的程度可以对肝功能进行量化评估,对肝炎肝硬化患者肝脏的储备功能及预后做出判断。

关键词: 钆塞酸二钠, 肝功能, 磁共振成像, 信号强度

Abstract: Objective To investigate the correlation between liver parenchyma uptake of gadoxetic acid disodium (Gd-EOB-DTPA) and Child-Pugh score and quantitative indexes. Methods The imaging data of patients hospitalized for hepatitis B cirrhosis in Beijing Ditan Hospital Affiliated to Capital Medical University from June 12, 2019 to December 12, 2019 and undergoing Gd-EOB-DTPA enhanced magnetic resonance examination were retrospectively analyzed. A total of 65 patients were enrolled and divided into 4 groups according to Child-Pugh score: normal group (score<5), group A (score 5~6), group B (score 7~9) and group C (score 10~15). The relative enhancement rates (RE_10min, RE_15min and RE_20min) were compared between the groups respectively. The multi-stage relative enhancement rates in each group were compared in pairs. Pearson correlation analysis was used to evaluate the correlation between RE_20min and Child-Pugh score and quantitative indexes. Results There was no statistical difference between normal group and group A (RE_10min, RE_15min and RE_20min) at the same time. There were statistical differences (RE_10min, RE_15min and RE_20min) between normal group and group B, normal group and group C, group A and group B, group A and group C at the same time (P<0.05). There was no significant difference (RE_10min, RE_15min and RE_20min) between group B and group C. RE_10min, RE_15min and RE_20min in the normal group, group A, group B, group C in the comparison between the two groups did not show statistical difference; RE_20min was negatively correlated with serum total bilirubin, prothrombin time and Child-Pugh score (r=-0.491,-0.481,-0.619, respectively, P<0.05). There was a positive correlation between RE_20min and serum albumin (r=0.352, P<0.05); with RE_20min (0.445) as the threshold value, the sensitivity and specificity for diagnosing normal liver function + Child-Pugh A grade are the highest, 89.2% and 64.3%, respectively, and the area under ROC curve is 0.813. Conclusions the degree of uptake of disodium gadolinium acid in liver parenchyma can quantitatively evaluate liver function and judge the reserve and prognosis of liver function in patients with liver cirrhosis.

Key words: Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid, Liver function, Magnetic resonance imaging, Signal intensity

周安, 吕志彬, 杜艳妮, 关春爽, 陈步东, 谢汝明. 钆塞酸二钠增强磁共振成像相对强化率与肝功能的相关性研究[J]. 新发传染病电子杂志, 2021, 6(2): 88-91.

Zhou An, Lyu Zhibin, Du Yanni, Guan Chunshuang, Chen Budong, Xie Ruming. Correlation between relative enhancement rate of Gd-EOB-DTPA enhanced MRI and liver function[J]. Electronic Journal of Emerging Infectious Diseases, 2021, 6(2): 88-91.

参考文献

[1] 徐佳, 王萱, 游燕, 等. 钆塞酸二钠增强磁共振灌注与多期肝胆期成像定量评价大鼠肝纤维化[J]. 中国医学科学院学报, 2018, 40(6):809-816.
[2] 周元, 陈橼, 尹必辉, 等. 吲哚菁绿试验联合Child-Pugh评分分级评估老年肝细胞癌患者围术期肝功能储备的价值[J]. 中国临床医学, 2018, 25(3):400-404.
[3] 李琴, 王宝恩, 贾继东. 肝功能分级的演变及特点:从Child到MELD[J]. 中华肝脏病杂志, 2004, 12(5):319-320.
[4] PURYSKO AS, REMER EM, VENIERO JC.Focal liver lesion detection and characterization with GD-EOB-DTPA[J]. Clinical radiology, 2011, 66(7):673-684.
[5] VAN BEERS BE, PASTOR CM, HUSSAIN HK.Primovist, Eovist: what to expect?[J]. J hepatology, 2012 ,57(2):421-429
[6] NASSIF A, JIA J, KEISER M, et al.Visualization of hepatic uptake transporter function in healthy subjects by using gadoxetic acid-enhanced MR imaging[J]. Radiology, 2012, 264(3):741-50.
[7] 周忠洋,向颜韩,廖锦元.钆塞酸二钠增强磁共振成像T1-mapping评估肝纤维化评分的研究[J/CD]. 新发传染病电子杂志, 2020, 5(3):178-182.
[8] INFANTE-RIVARD C, ESNAOLA S, VILLENEUVE JP.Clinical and statistical validity of conventional prognostic factors in predicting short-term survival among cirrhotics[J]. Hepatology, 1987, 7(4):660-664.
[9] WILMAR DG, ROELOF JB, REETA V, et al.Nuclear imaging techniques for the assessment of hepatic function in liver surgery and transplantation[J]. J Nucl Med, 2010, 51(5):742-52.
[10] 宋彬. 肝细胞特异性磁共振对比剂Gd-EOB-DTPA—新的机遇[J].放射学实践, 2016, 31(1):17-18.
[11] 中华医学会肝病学分会. 肝硬化诊治指南[J]. 中华肝脏病杂志, 2019, 27(11):846-865.
[12] 易永祥. 乙型肝炎病毒的分子流行病学研究进展[J/CD]. 新发传染病电子杂志, 2020, 5(1):1-7.
[13] LEE S, DONGIL C, JEONG WK.Hepatic enhancement of Gd-EOB-DTPA-enhanced 3 Tesla MR imaging: Assessing severity of liver cirrhosis.Journal of magnetic resonance imaging[J]. JMRI, 2016, 44(5):1339-1345.
[14] 李亮杰, 贾啟龙, 刘志飞, 等. 普美显增强CE-MRC对肝硬化患者肝功能评价的应用价值[J]. 中国医学创新, 2020, 17(16):22-26.
[15] YOON JH, LEE JM, KANG H, et al.Quantitative Assessment of Liver Function by Using Gadoxetic Acid-enhanced MRI: Hepatocyte Uptake Ratio[J]. Radiology, 2019, 290(1):125-133.