摘要
目的探讨钆塞酸二钠(gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid,Gd-EOB-DTPA)增强MRI肝胆期信号强度及直方图在评估肝脏储备功能中的价值。材料与方法回顾性研究2014年1月至2019年6月我院87例患者的临床资料及影像学资料,其中Child-Pugh A级58例、Child-Pugh B级15例、Child-Pugh C级1例;对照组肝功能正常者13例。使用单因素方差及两两比较的方法分析Gd-EOB-DTPA增强MRI肝胆期肝脏相对信号强化程度(relative enhancement at hepatobiliary phase,RE_(HBP))及肝实质直方图参数在不同肝功能组之间的差异性。采用受试者工作特征(receiver operating characteristic,ROC)曲线评价RE_(HBP)及直方图参数在Child-Pugh A级与Child-Pugh B+C级间的诊断效能。使用Spearman相关分析RE_(HBP)、直方图参数与吲哚菁绿15分钟滞留率(indocyanine green retention rate at 15 min,ICG R15)的相关性。结果RE_(HBP)、偏度、最小值、第5、10、15、20百分位数及第0.025分位数在各组间差异有统计学意义(P值分别为<0.001、<0.001、0.015、0.026、0.029、0.034、0.039、0.025,P<0.05);对照组与Child-Pugh A组间差异无统计学意义(P值分别为0.610、0.400、0.410、0.550、0.610、0.620、0.660、0.550,P>0.05),对照组与Child-Pugh B+C组(P值分别为0.017、<0.001、0.013、0.017、0.027、0.030、0.033、0.019,P<0.05)、Child-Pugh A组与Child-Pugh B+C组间差异有统计学意义(P值分别为<0.001、<0.001、0.013、0.013、0.012、0.015、0.015、0.013,P<0.05)。RE_(HBP)、偏度、最小值、第5、10、15、20百分位数及第0.025分位数诊断Child-Pugh B+C级的ROC曲线下面积(area under curve,AUC)分别为0.778、0.816、0.713、0.713、0.715、0.708、0.709及0.713。在所有患者中,RE_(HBP)、偏度与ICG R15无显著性相关(P>0.05),最小值、第5、10、15、20百分位数及第0.025分位数与ICG R15呈负相关(r=-0.274~-0.300,P<0.05);在ICG R15≥10%组中:RE_(HBP)、偏度、第5、10百分位数及第0.025分位数与ICG R15呈负相关(r=-0.390~-0.594,P<0.05);在ICG R15<10%组中:所有参数与ICG R15均无显著性相关(r=-0.027~0.153,P>0.05)。结论Gd-EOB-DTPA增强MRI肝胆期RE_(HBP)及直方图参数在一定程度上能反映肝脏储备功能,直方图参数比RE_(HBP)与ICG R15具有更高的相关性。
Objective:To explore the value of hepatic signal intensity and histogram in hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI in evaluating hepatic reserve function.Materials and Methods:A retrospective analysis of the clinical and imaging data of 87 patients has been conducted in our hospital from January 2014 to June 2019.The patients were classified into three groups according to abnormal liver function,including Child-Pugh grade A(58 cases),Child-Pugh grade B(15 cases)and Child-Pugh grade C(1 case).The patients with normal liver function(13 cases)were used as control group.One-way analysis of variance and pairwise comparison were done to analyze the difference among different liver function groups by using the relative enhancement at hepatobiliary phase(RE_(HBP))and the histogram parameters at hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI.The receiver operating characteristic curve(ROC)was used to evaluate the diagnostic performance of RE_(HBP)and histogram parameters between two groups of Child-Pugh A and Child-Pugh B+C,and Spearman correlation analysis was used to analyze the correlation between RE_(HBP),histogram parameters and indocyanine green retention rate at 15 min(ICG R15).Results:A significant difference of RE_(HBP),skewness,minimum,5th,10th,15th,20th percentile and 0.025th percentile was found among the three groups(P values were<0.001,<0.001,0.015,0.026,0.029,0.034,0.039,0.025,P<0.05).There was no significant difference of those parameters between the normal liver function group and Child-Pugh A group(P values are 0.610,0.400,0.410,0.550,0.610,0.620,0.660,0.550,P>0.05).Significant differences were found between the normal liver function group and Child-Pugh B+C group(P values were 0.017,<0.001,0.013,0.017,0.027,0.030,0.033,0.019,P<0.05)as well as between Child-Pugh A group and Child-Pugh B+C group(P values were<0.001,<0.001,0.013,0.013,0.012,0.015,0.015,0.013,P<0.05).The area under ROC curve(AUC)for RE_(HBP),skewness,minimum,5th,10th,15th,20th percentile and 0.025th quantile were 0.778,0.816,0.713,0.713,0.715,0.708,0.709 and 0.713 respectively for discrimination between Child-Pugh A group and Child-Pugh B+C group.Among all patients,there was no significant correlation between RE_(HBP),skewness and ICG R15(P>0.05).The minimum,5th,10th,15th,20th percentile and 0.025th quantile were negatively correlated with ICG R15(r=-0.274 to-0.300,P<0.05).In the group of ICG R15≥10%,RE_(HBP),skewness,5th,10th percentile and 0.025th percentile were negatively correlated with ICG R15(r=-0.390 to-0.594,P<0.05),while in the group of ICG R15<10%,no significant correlations were found between all parameters and ICG R15(r=-0.027 to 0.153,P>0.05).Conclusions:The RE_(HBP)and histogram parameters at hepatobiliary phase of Gd-EOB-DTPA enhanced MRI may assess the liver reserve function.Compared to RE_(HBP),the histogram parameters have higher correlation with ICG R15.
作者
练玉清
薛星
冯湛
郑燕
陈峰
LIAN Yuqing;XUE Xing;FENG Zhan;ZHENG Yan;CHEN Feng(Department of Radiology,the First Affiliated Hospital of Medical College of Zhejiang University,Hangzhou 310003,China;Department of Hepatobiliary surgery,the First Affiliated Hospital of Medical College of Zhejiang University,Hangzhou 310003,China)
出处
《磁共振成像》
CAS
CSCD
北大核心
2021年第10期36-40,共5页
Chinese Journal of Magnetic Resonance Imaging
基金
浙江省基础公益研究计划项目(编号:LSD19H180003)。
关键词
肝脏储备功能
吲哚菁绿
钆塞酸二钠
直方图
磁共振成像
hepatic reserve function
indocyanine green
gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid
histogram analysis
magnetic resonance imaging
