肝脏特异性对比剂评价肝功能及肝癌热消融术后的价值研究

发布时间：2018-08-27 17:58

【摘要】：目的:1、探讨肝脏特异性对比剂钆塞酸二钠(GD-EOB-DTPA)增强肝脏MR肝胆期不同肝功能状态摄取对比剂差异,评价不同肝功能状态肝功能。2、GD-EOB-DTPA增强肝脏MR肝胆期评价肝癌经动脉导管化疗栓塞(TACE)术后及肝癌微波固化术后对局部肝功能影响。方法:1、研究对象:回顾性分析50例局灶性病变患者,均行Gd—EOB—DTPA磁共振动态增强扫描,男45例,女5例,年龄25-76岁,平均年龄(54.2±12.8)岁。其中肝硬化患者32例,非肝硬化患者18例。纳入标准:局灶性病变,病灶最大径小于10cm;病例影像及临床生化资料齐全,能获得一般资料及Child—Pugh分级评分所需指标。排除标准:严重运动伪影;肝脏弥漫性占位;严重肾功能不全。2、检查方法:MRI检查采用Siemens Trio Tim 3.0T超导型磁共振扫描仪,体部相控阵线圈,患者取仰卧位,将上腹部置于体部线圈的中央。磁共振扫描序列包括T2WI横断位、T2WI抑脂横断位、T1WI正反相位、扩散加权成像(DWI)、3D扰相容积序列(VIBE)抑脂横断位、VIBE抑脂动态三期增强及延迟20min VIBE抑脂肝胆期。避免呼吸运动伪影,扫描前作屏气训练,扫描时为嘱患者深吸气后屏气。3、肝硬化患者按Child—Pugh分级法行肝功能分级,其中Child—Pugh A级21例,Child—Pugh B级9例,Child—Pugh C级2例。非肝硬化病例中无肝、肾基础疾病,肝、肾功能生化检查正常者作为正常对照组,入组7例。4、分析不同肝功能状态肝胆期肝脏摄取造影剂能力差异;分析肝癌经动脉导管化疗栓塞(TACE)术后及肝癌微波固化术后肝胆期病灶周边肝实质与平均肝实质信号增强程度(IS%)差异。结果:1、正常对照组与Child-Pugh A级、Child—Pugh B级、Child—Pugh C级组间肝实质信号增强程度(IS%)有显著差异(P0.05);2、Child-Pugh A级与Child—Pugh B级、Child—Pugh C级组间肝实质信号增强程度(IS%)有显著差异(P0.05);3、Child—Pugh B级、Child—Pugh C级组增强程度(IS%)无明显差异(P=0.24);4、1例肝癌介入术后病灶及2例肝癌微波固化术后病灶周围肝实质IS%较平均肝实质IS%明显减低,13例病灶灶周肝实质IS%较平均肝实质IS%无明显差异(P=0.37)。结论:1、不同功能状态肝细胞摄取对比剂程度不同,正常对照组、Child-Pugh A级、Child—Pugh B级组随肝功能下降,GD-EOB-DTPA磁共振增强肝胆期肝脏信号增强程度减低。2、GD-EOB-DTPA磁共振增强肝胆期对显示Child—Pugh B级、Child—Pugh C级组肝功能差异不敏感。3、GD-EOB-DTPA磁共振增强肝胆期可以显示肝癌经动脉导管化疗栓塞(TACE)术后及肝癌微波固化术后局部肝功能情况,GD-EOB-DTPA磁共振增强肝胆期可以反映肝细胞功能及全肝功能,亦可反映局部肝功能。目的:与CT增强相比,探讨肝脏特异性对比剂钆赛酸二钠(GD-EOB-DTPA)增强MR在肝癌热消融术后评价的临床价值及优势。方法:1、研究对象:原发性肝癌热消融治疗患者,并具有CT增强及GD-EOB-DTPA磁共振增强随访资料。2、分析原发性肝癌热消融术后患者GD-EOB-DTPA磁共振增强及CT增强影像资料。所有纳入病例均行MR动态增强、延迟20min肝胆期成像及CT动态成像,对比分析GD-EOB-DTPA增强MRI评价肝癌热消融术后复发的优势。结果:1、23例患者中有14例出现肿瘤复发,9例无明显肿瘤复发,复发病灶中8例为单发病灶,6例为多发,总共28个病灶,CT增强检出病灶22个,GD-EOB-DTPA增强MRI共检出病灶29个,其中一例术后诊断为小囊肿,肝胆期均为低信号,2、GD-EOB-DTPA增强MRI与CT增强对病灶诊断敏感性、特异性、阳性预测值、阴性预测值及诊断准确性分别为100%、90%、97%、100%、97%;71%、82%、91%、53%、74%,GD-EOB-DTPA动态MR增强评价肝癌热消融术后复发各预测值均优于CT增强。结论:GD-EOB-DTPA评价肝癌热消融术后复发较CT增强具有明显优势;对显示小病灶、多发病灶具有显著优势。
[Abstract]:Objective: 1. To investigate the difference of liver-specific contrast agent Gd-EOB-DTPA in enhancing liver function at different stages of MR hepatobiliary phase, and to evaluate liver function at different stages of MR hepatobiliary phase. Methods: 1. Subjects: A retrospective analysis of 50 patients with focal lesions, Gd-EOB-DTPA dynamic contrast-enhanced MRI scanning, 45 males, 5 females, age 25-76 years, average age (54.2 + 12.8) years. 32 patients with cirrhosis, 18 patients with non-cirrhosis. Exclusion criteria: severe motion artifacts; diffuse hepatic space occupancy; severe renal insufficiency. 2. Examination methods: MRI scan using Siemens Trio Tim 3.0T superconducting magnetic resonance scanner, body phased array coil, patients take supine position, will be upper abdomen MR scan sequence included T2WI transverse section, T2WI lipid suppression transverse section, T1WI positive and negative phase, diffusion weighted imaging (DWI), 3D perturbation volume sequence (VIBE) lipid suppression transverse section, VIBE dynamic three-phase enhancement and delayed 20 min VIBE lipid suppression hepatobiliary phase. To instruct patients to hold their breath after deep breathing, liver cirrhosis patients were graded according to Child-Pugh grading method, including 21 cases of Child-Pugh A, 9 cases of Child-Pugh B and 2 cases of Child-Pugh C. Non-cirrhosis patients without liver, kidney diseases, normal liver and kidney function biochemical examination were selected as normal control group, and 7.4 cases were divided into two groups. Results: 1. The liver parenchyma of normal control group was different from that of C hild-Pugh A, C hild-Pugh B, C hild-Pugh C groups. Significant difference in signal enhancement (IS%) was found between C hild-Pugh A and C hild-Pugh B, C hild-Pugh C, and C hild-Pugh C groups (P 0.05). 3, C hild-Pugh B and C hild-Pugh C had no significant difference (P = 0.24). 4, 1 case of hepatocellular carcinoma and 2 cases of hepatocellular carcinoma were cured by microwave. The IS% of liver parenchyma around the lesion was significantly lower than the average IS% of liver parenchyma after operation, and the IS% of liver parenchyma around the lesion was not significantly different from the average IS% of liver parenchyma in 13 cases (P = 0.37). Conclusion: 1. The degree of contrast medium uptake by hepatocytes in different functional states was different in normal control group, Child-Pugh A group and Child-Pugh B group. Hepatobiliary phase signal enhancement was decreased. 2. GD-EOB-DTPA enhanced hepatobiliary phase was not sensitive to the difference of hepatic function in Child-Pugh B and Child-Pugh C groups. 3. GD-EOB-DTPA enhanced hepatobiliary phase could show the local hepatic function of hepatocellular carcinoma after transcatheter chemoembolization (TACE) and hepatocellular carcinoma after microwave curing. Objective: To investigate the clinical value and advantages of liver-specific contrast agent disodium gadolinate (GD-EOB-DTPA) in the evaluation of hepatocellular carcinoma after thermal ablation compared with CT enhancement. All patients underwent dynamic contrast-enhanced MR imaging with a 20-minute delay in hepatobiliary phase and dynamic CT imaging, and compared with GD-EOB-DTPA enhanced MRI in the evaluation of hepatocellular carcinoma thermal ablation. Results: Of the 1,23 patients, 14 had recurrence, 9 had no obvious recurrence, 8 had single lesion, 6 had multiple lesions, a total of 28 lesions, 22 lesions were detected by CT enhancement, 29 lesions were detected by GD-EOB-DTPA enhanced MRI, one of which was diagnosed as small cyst, low signal in hepatobiliary phase, 2, GD-EOB. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of enhanced MRI and CT were 100%, 90%, 97%, 100%, 97%, 71%, 82%, 91%, 53%, 74%, respectively. The predictive value of GD-EOB-DTPA dynamic MR enhancement in evaluating the recurrence of hepatocellular carcinoma after thermal ablation was better than that of CT enhancement. It has obvious advantages over CT enhancement, and has a significant advantage in showing small lesions and multiple lesions.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R445.2

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