钆塞酸二钠增强MRI在预测肝癌和肝硬化病理分级及评估肝功能中的应用

发布时间：2018-05-23 13:03

本文选题：钆塞酸二钠 + 磁共振　；参考：《南方医科大学》2017年博士论文

【摘要】：肝纤维化和肝硬化在我国的发病率非常高,随着病情的进展,肝纤维化可以向肝硬化发展,最终演变为肝细胞肝癌(hepatocellular carcinoma HCC)。目前对肝纤维化和肝硬化的评估主要依靠肝穿刺组织的病理检查,HCC病理结果需依靠术后检查,肝穿刺有一定的缺点。因此需寻找一种无损伤的检查方法来预测肝纤维化、肝硬化和HCC的病理学分级,并且能精确评估肝功能的情况。因此本实验进行了以下方面的研究:(1)分析Gd-EOB-DTPA增强MRI预测HCC的病理学分级;(2)分析大鼠Gd-EOB-DTPA增强MRI预测肝硬化的病理学分级;(3)分析Gd-EOB-DTPA增强MRI与不同病变程度肝脏的病理学相关性;(4)Gd-EOB-DTPA 增强 MRI 在评估功能性肝体积(functional liver volume,FLV)与肝功能Child-Pugh分级相关性中的作用。方法:1.分析Gd-EOB-DTPA增强MRI癌灶信号绝对增强强度(absolute enhancement value,AEV)和对比增强率(contrast enhancement ratio,CER),及癌灶对肝脏的对比增强率(CERtl,CERtumor to liver)与病理分级的相关性。2.分析大鼠肝脏Gd-EOB-DTPA增强MRI的AEV和CER。根据Laennec分级系统对肝硬化进行分级。分析AEV和CER与肝硬化病理分级的相关性。3.定量分析Gd-EOB-DTPA增强MRI癌灶周围肝脏的AEV和CER。分析AEV和CER与不同病变程度肝脏病理分级的相关性。4.计算肝段的CER和解剖性肝体积(anatomical liver volume,ALV)。利用Ⅰvol×ⅠCER+Ⅱvol×ⅡCER+……+Ⅷvol×ⅧCER.计算 FLV。分析 ALV 和 FLV 与肝功能Child-Pugh分级的相关性。结果:1.CERtl与肝癌的分化程度有最显著的负相关性。ROC曲线中,CERd在肝癌分化程度Ⅰ和Ⅱ级,Ⅱ和Ⅲ级,Ⅲ和Ⅳ级间的临界值为分别为0.535,0.40,0.295。CERtl与病理分级的一致性检验的kappa值为0.62。2.肝硬化的病理分级和CER之间存在更显著的负相关。肝硬化病理分级之间的差异性通过ROC曲线下面积来分析。轻和中度肝硬化,中和重度肝硬化之间的CER临界值分别为0.535和0.335。CER和病理分级之间的一致性检验,kappa 值为 0.73。3.不同病变肝脏的病理分级与CER有最显著的负相关性。通过ROC曲线的分析,正常肝脏和肝纤维化,肝纤维化和肝硬化间的CER临界值分别为0.76和0.46。分析CER和不同病变程度肝脏病理分级之间的一致性检验,kappa值为0.41。在轻和中度肝硬化组,中和重度肝硬化之间CER临界值分别为0.425和0.325。分析CER和肝硬化病理分级之间的一致性检验,kappa值为0.60。4.肝功能Child-Pugh分级与ALV的相关性(r =-0.792,p0.001);肝功能Child-Pugh 分级与 FLV 的相关性(r=-0.911,p0.001)。FLV 与肝功能 Child-Pugh分级有更显著的负相关性。结论:1.CERtl与HCC的分化程度之间有比较显著的相关性。分析Gd-EOB-DTPA增强MRI可以预测病理分级。2.CER与肝硬化的病理分级存在比较显著的相关性,CER在区别不同病变程度肝脏病理学分级的能力较差,但可以预测肝硬化的病理分级。3.结合CER和ALV计算肝脏的FLV实现区域性肝功能的整合,较ALV能更好的反映肝脏的功能。项目创新性:1.定量分析Gd-EOB-DTPA增强MRI,创新性的使用公式CER=SIth-SItu/SIlh-SIlu 预测 HCC 的病理学分级。2.创新性的利用定量分析钆塞酸二钠增强MRI,并通过计算CER预测肝硬化的病理学分级。3.创新性的结合Gd-EOB-DTPA增强MRI和ALV计算肝脏的FLV,并实现区域性肝功能的计算和整合。
[Abstract]:The incidence of liver fibrosis and cirrhosis in our country is very high. With the progress of the disease, liver fibrosis can develop to liver cirrhosis and eventually become liver cell liver cancer (hepatocellular carcinoma HCC). The evaluation of liver fibrosis and liver cirrhosis depends mainly on the pathological examination of liver puncture tissue, and the pathological results of HCC need to be checked by postoperative examination, Liver puncture has some shortcomings. Therefore, it is necessary to find a noninvasive method to predict the pathological grading of liver fibrosis, liver cirrhosis and HCC, and to evaluate the liver function accurately. Therefore, the following studies have been carried out in this experiment: (1) analysis of the pathological grade of Gd-EOB-DTPA enhanced MRI prediction of HCC; (2) analysis of Gd-EOB-DTPA in rat The histopathological classification of liver cirrhosis was predicted by enhanced MRI; (3) the pathological correlation between Gd-EOB-DTPA enhanced MRI and the liver of different pathological changes was analyzed; (4) the role of Gd-EOB-DTPA enhanced MRI in evaluating the correlation between functional hepatic volume (functional liver volume, FLV) and liver function Child-Pugh classification. Method: 1. analysis Gd-EOB-DTPA enhanced MRI cancer Absolute enhancement value (AEV) and contrast enhancement (contrast enhancement ratio, CER), and the correlation of the contrast enhancement of the liver (CERtl, CERtumor to liver) and pathological grading. Analysis of the correlation between AEV and CER and the pathological classification of liver cirrhosis by.3. quantitative analysis of the AEV and CER. analysis of the liver surrounding the MRI carcinoma and the correlation between AEV and CER and the pathological grade of liver with different pathological changes;.4. for the CER and anatomical liver volume of the liver segment. The correlation between ALV and FLV and liver function Child-Pugh classification was calculated by FLV.. Results: the degree of differentiation between 1.CERtl and liver cancer was the most significant negative correlation.ROC curve. CERd was in the degree of differentiation of liver cancer I and II, grade II and grade III, and the critical value between grade III and grade IV was the consistency of 0.535,0.40,0.295.CERtl and pathological grading, respectively. The kappa value of the test was a more significant negative correlation between the pathological grades of 0.62.2. cirrhosis and CER. The difference between the pathological grades of liver cirrhosis was analyzed under the ROC curve. The critical value of CER between mild and moderate cirrhosis, and severe cirrhosis was 0.535 and 0.335.CER, and the consistency test between pathological grades, kappa The pathological grading of the liver of 0.73.3. with different lesions was the most significant negative correlation with CER. Through the analysis of the ROC curve, the critical values of normal liver and liver fibrosis, liver fibrosis and liver cirrhosis were 0.76 and 0.46., respectively, and the consistency test between CER and the pathological grade of different pathological changes, the kappa value was 0.41. in light and middle. The critical value of CER between the liver cirrhosis and the severe cirrhosis was 0.425 and 0.325., respectively, for the consistency test between CER and the pathological grading of liver cirrhosis. The kappa value was the correlation between the 0.60.4. liver function Child-Pugh grading and ALV (R =-0.792, p0.001); the correlation between the liver function Child-Pugh classification and FLV, and the liver function Ild-Pugh classification has a more significant negative correlation. Conclusion: there is a significant correlation between the differentiation degree of 1.CERtl and HCC. The analysis of Gd-EOB-DTPA enhanced MRI can predict a significant correlation between pathological grade.2.CER and the pathological grading of liver cirrhosis, and CER is less capable of differentiating the pathological grade of liver from different pathological changes, but it can be less effective. To predict the pathological grade.3. of liver cirrhosis combined with CER and ALV to calculate the integration of liver function in the liver, which can better reflect the liver function than ALV. Project innovation: 1. quantitative analysis of Gd-EOB-DTPA enhanced MRI, innovative use formula CER=SIth-SItu/SIlh-SIlu to predict the innovative utilization of HCC's pathological grade.2.. The MRI was enhanced by the analysis of two sodium gadolinium acid, and the pathological grading of liver cirrhosis was calculated by CER to predict the MRI and ALV to calculate the FLV of the liver, and to realize the calculation and integration of the regional liver function.
【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R735.7;R575.2

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