肝移植相关性肾功能衰竭的临床观察及处理

肾功能衰竭是原位肝移植术后常见而严重的并发症,是影响患者预后的重要因素。选择我院2004年9月至2005年4月间原位肝移植手术患者132例,其中35例在术后早期发生肾功能衰竭,现将肝移植术后早期肾功能衰竭的治疗体会报告如下。1对象和方法1.1对象132例,男117例,女15例;年龄26~72岁,平均43.6岁。原发病中慢性乙型重症肝炎26例,肝炎后肝硬化57例,肝硬化合并肝癌46例,肝豆状核变性2例,原发性胆汁性肝硬化1例。术前已有肾功能损害者2例。本组资料按Rimola等提出的标准进行诊断:对于术前肾功能正常者,术后血肌酐(Cr)≥132 umol/L和(或)血尿素氮(U…     

甲状腺疾病患者血清纤维连结蛋白的测定及临床意义

对6种甲状腺疾病患者血清纤维连结蛋白(FN)进行测定。观察对象中健康人59名(女35名,男24名),年龄17～69岁(平均37.5岁),各类甲状腺疾病患者240例(男96例,女144例),年龄16～70岁(平均39.5岁)。观察项目除血清     

肝移植术后胆系并发症的T管造影表现

目的 探讨肝移植术后胆系并发症的T管造影表现及其意义。资料与方法 搜集52例肝移植术后T管造影病例中发生胆系并发症的患者24例，其中男20例，女4例，年龄21～64岁。所有病例均行T管造影，并将X线表现与肝穿刺病理所见对照。结果并发症发生率为46．1％(24／52)。T管造影表现：(1)9例早期胆汁淤积症，T管造影无胆管梗阻，但肝内胆树稀疏，分支细，有时呈“垂柳状”外观；(2)10例胆总管吻合口胆瘘，表现为吻合口对比剂外漏，形成不规则状阴影；(3)5例胆管吻合口狭窄，表现为胆总管吻合口的不规则形充盈缺损，对比剂经吻合口排人远段胆管困难；(4)5例胆管内结石／胆泥形成，表现为胆管内充盈缺损；(5)6例胆管炎，肝内胆管细小，走行僵硬，胆管炎严重者可表现为胆管近肝门段狭窄、远段扩张的独特外观；(6)3例肝外胆管吻合后过长，长度超过13cm。肝移植术后胆管并发症的患者T管造影表现可同时出现上述征象1～4种。结论 T管造影可以明确肝移植术后的胆管并发症，对肝移植术后胆系的评价具有重要的价值，是肝移植术后常规检查手段之一。     

甲状腺片抑制试验对临床诊断的探讨

我室自1988年3月～1988年6月对20例吸~(131)Ⅰ率增高者测定了甲状腺片抑制试验,并结合血清总T_3、T_4测定及临床检查将结果进行了初步分析,现报告如下: 资料与方法 20例受检查均系我院门诊病人测定吸~(131)Ⅰ率增高者,其中男8例,女12例,年龄11～66岁,平     

原位肝移植经典非转流术式对血流动力学影响及麻醉处理

肝移植是治疗终末期肝病的有效方法,但因手术创伤大及终末期肝病本身的病理变化,手术对患者全身各系统干扰明显,尤其采用经典非转流术式的患者,在无肝期及新肝期可发生较大的血流动力学变化。我院自2002年4月～2004年12月行成人原位肝移植术317例,其中216例采用经典非静脉-静脉转流术式,现报告如下。1对象和方法1.1对象216例终末期肝病患者,年龄25～72岁,男184例,女32例,其中急慢性重症肝炎48例,肝炎后肝硬化62例,酒精性肝硬化2例,胆汁淤积性肝硬化5例,肝豆状核变性2例,肝癌90例,丙型肝炎肝硬化4例,行二次肝移植手术3例。1.2麻醉与监测均用…     

家族性甲状腺髓样癌9例

甲状腺髓样癌是中等恶性程度的内分泌肿瘤 ,占全部甲状腺癌的 3%～ 10 % [1,2 ] 。 196 3～ 2 0 0 0年 ,我院及浙江省肿瘤医院共收治家族性甲状腺髓样癌 9例 ,占同期甲状腺髓样癌的 17 3%。1　临床资料1 1　一般情况　为三个家族两代人共 9例 :母与子、母与三女、母与二子。男 3例 ,女 6例 ;年龄 9～4 0岁 ,平均 2 5岁 ;病程 7ｄ～ 15年。均以颈部无痛性肿块就医 ,无腹泻、面部潮红、多汗、怕热及阵发性血压升高等症状。血清钙正常 8例。伴原发性甲状旁腺增生 1例 ,术前血清钙为 2 6ｍｍｏｌ/Ｌ ,术后血清钙及降钙素均正常。1 2　手术方式…     

消化道恶性肿瘤患者空腹血糖、胰岛素、乳酸和服糖后血糖变化及临床意义

笔者以50例消化道恶性肿瘤患者为研究对象,测定空腹血糖、空腹胰岛素、空腹乳酸和服糖后2h血糖含量,以及稳态模式评估法胰岛素抵抗指数,探讨糖代谢紊乱的特点及其可能机制,为临床营养治疗提供实验依据。1对象和方法1.1对象选取2001年5月～2004年3月我院收治的住院消化道恶性肿瘤患者50例,男30例,女20例,平均年龄61岁,其中胃癌25例,肝癌15例,结肠癌10例。所有患者临床和病理诊断明确,无糖尿病史。正常对照组为门诊体检健康人50例,男32例,女18例,平均年龄50岁,无糖尿病史。两组在年龄、性别上无可比性。1.2测定方法血糖采用葡萄糖氧化酶动力法…     

肝移植32例围术期酸碱及血钾水平变化分析

电解质紊乱是肝移植患者常见并发症之一,处理不当可影响预后。近期,我们回顾分析了我院2003年1月-2009年6月,肝移植32例围术期血钾水平及术中酸碱变化情况。现报告如下。1临床资料1.1一般情况肝移植32例中,男31例,女1例;年龄29～67岁,平均47.7岁。其中肝硬化17例,肝癌     

螺旋CT增强三期扫描诊断小肝癌的价值

早期肝癌的手术切除率高,晚期肝癌将错过最佳手术时机,因而预后极差[1]。提高肝癌特别是小肝癌(Small hepato-cellular carcinoma,SHCC)的早期检出率是肝癌患者及时治疗或延长生存期的关键。笔者研究分析36例SHCC(瘤体直径≤3 cm)在螺旋CT增强三期扫描图像上的特征性表现,为提高SHCC的检出率和定性准确性提供经验和依据。1对象和方法1.1对象2000年1月~2004年12月经术前穿刺及术后病理证实为SHCC 36例的螺旋CT增强三期扫描图像,男30例,女6例;年龄31~70岁,36例小肝癌患者中有肝硬化病者34例,约占94.44%。1.2方法应用美国GE Prospeed…     

癌症及肝硬化疾病血清锌、铜、铁、镁的测定分析

<正> 微量元素与人类的健康相关,它与癌症的关系是当前十分引人注目的重要课题。根据流行病学,公共卫生学调查以及实验和临床观察研究,证实了微量元素与肿瘤的发生、发展及治疗有密切的关系。本文对我院1990年3月至1991年2月治疗的71例癌症患者及肝硬化患者作了锌、铜、铁、镁以及锌铜比值的测定和分析,现报告如下: 对象与方法 对象:1肝癌组:18例,男16例,女2例均年龄55.1岁。 2肝硬化组:19例,男14例,女5例,平均年龄56.4岁。 3胃癌组:19例,男17例、女2例,平均年龄60.7岁.     

T1, T2, and relative proton density at 0.35 T for spleen, liver, adipose tissue, and vertebral body: normal values

An MRI installation (Magnetom, Siemens, software version B1 of NUMARIS) working at 0.35 T was used to estimate T1, T2, and relative proton density in the spleen, liver, adipose tissue, and vertebral body in 14 healthy volunteers. Two double-echo sequences were applied for all subjects: TR = 500 ms, TE1 = 35 and TE2 = 70 ms; and TR = 1600 ms, TE1 = 35 and TE2 = 70 ms. The images were sampled in regions of interest and appropriate relaxation expressions fitted to the ROI data yielding relaxation parameters and relative proton densities. Relaxation expressions, included in standard software (Siemens), were compared to more elaborate functions, developed in parallel to this study. The latter were found more appropriate, especially for high T1 values, and gave the following mean values for the four tissues (estimated uncertainty of mean in parentheses) T1 (ms) 915(36), 428(5), 261(7), and 501(11); T2 (ms) 79.7(8.8), 51.0(0.2), 59.8(1.0), and 64.7(0.8); and corresponding relative proton density (rho, arbitrary units) 2088(136), 2182(10), 2915(49), and 2136(21). The uncertainty in the values was estimated in the fitting procedure and does not include systematic errors. The relative noise in the ROIs was about 9% and the reproducibility of the ROI mean values about 8%.     

Focal liver lesions: SPIO-, gadolinium-, and ferucarbotran-enhanced dynamic T1-weighted and delayed T2-weighted MR imaging in rabbits

PURPOSE: To compare a superparamagnetic iron oxide (SPIO), VSOP-C184, with a gadopentetate dimeglumine with regard to signal-enhancing effects on T1-weighted dynamic magnetic resonance (MR) images and with another SPIO contrast medium with regard to signal-reducing effects on delayed T2-weighted MR images. MATERIALS AND METHODS: All experiments were approved by the responsible Animal Care Committee. Twenty rabbits (five for each contrast agent and dose) implanted with VX-2 carcinoma were imaged at 1.5 T. VSOP-C184 at 0.015 and 0.025 mmol Fe/kg was compared with gadopentetate dimeglumine at 0.15 mmol Gd/kg and ferucarbotran at 0.015 mmol Fe/kg. The imaging protocol comprised a T1-weighted dynamic gradient-echo (GRE) MR before injection and at 6-second intervals for up to 42 seconds after injection and a T2-weighted turbo spin-echo MR before and 5 minutes after injection. Images were evaluated quantitatively, and contrast media were compared by using nonparametric analysis of variance. RESULTS: At dynamic T1-weighted GRE MR imaging with 0.015-mmol Fe/kg VSOP-C184, 0.025-mmol Fe/kg VSOP-C184, gadopentetate dimeglumine, and ferucarbotran, the median peak contrast-to-noise ratio (CNR) was 20.7 (25th percentile, 16.3; 75th percentile, 22.6), 24.2 (25th percentile, 19.3; 75th percentile, 28.5), 16.4 (25th percentile, 13.7; 75th percentile, 20.3), and 14.0 (25th percentile, 11.4; 75th percentile, 16.8), respectively. Both doses of VSOP-C184 yielded significantly higher CNR (P < .05) than the other two agents. At T2-weighted turbo spin-echo imaging with 0.015-mmol Fe/kg VSOP-C184, 0.025-mmol Fe/kg VSOP-C184, gadopentetate dimeglumine, and ferucarbotran, the median CNR was 15.0 (25th percentile, 13.4; 75th percentile, 21.3), 15.7 (25th percentile, 14.5; 75th percentile, 19.8), 11.3 (25th percentile, 8.2; 75th percentile, 12.2), and 15.7 (25th percentile, 12.5; 75th percentile, 22.4), respectively. There was no significant difference between VSOP-C184 and ferucarbotran; both had a significantly higher CNR than did gadopentetate dimeglumine. CONCLUSION: VSOP-C184 produces higher liver-to-tumor contrast at dynamic T1-weighted imaging than does gadopentetate dimeglumine; at delayed T2-weighted imaging, the contrast is comparable to that achieved with ferucarbotran.     

Conspicuity of liver hemangiomas: short tau inversion recovery, T1, and T2 imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid

PURPOSE: To compare conspicuity of liver hemangiomas on STIR, T1-weighted, and T2-weighted magnetic resonance (MR) images before and after administration of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) (hepatocellular contrast agent), using contrast-to-noise ratios (CNRs). MATERIALS AND METHODS: Thirteen hemangiomas were imaged using breath-hold gradient echo (GRE) T1, fat-saturated turbo spin echo (TSE)-T2, and short tau inversion recovery (STIR) sequences. Background noise and signal-to-noise ratios (SNRs) for liver and hemangioma, along with CNR for normal liver and hemangioma, were measured on each sequence before and after administration of Gd-EOB-DTPA. Hemangioma conspicuity was also evaluated qualitatively. RESULTS: After Gd-EOB-DTPA administration, the quantitative liver SNR decreased 54% on STIR, increased 45% on T1-weighted images, and increased 14.5% on TSE-T2-weighted images. The CNR for liver and hemangioma increased 50% on STIR images (P < 0.0001), increased 46% on T1-weighted imaging (P = 0.0033), and increased 22% on TSE-T2-weighted MR imaging (MRI) (P = 0.0083). After contrast, the CNR for TSE-T2 images was greater than those for both the T1 and STIR images (P < 0.0001 for both). Qualitatively, signal change was visually apparent in the liver on T1 and STIR, but not on T2 images or in the hemangiomas on any sequence. CONCLUSION: Despite the statistically significant T1 and STIR increase in CNR, liver hemangiomas were most conspicuous on TSE-T2 images after Gd-EOB-DTPA. This pilot study with hemangiomas highlights the newly recognized potential benefit of TSE-T2 imaging with hepatocellular contrast.     

Quantitative and qualitative comparison of 3.0T and 1.5T MR imaging of the liver in patients with diffuse parenchymal liver disease

Purpose

The purpose of our study was to compare signal characteristics and image qualities of MR imaging at 3.0 T and 1.5 T in patients with diffuse parenchymal liver disease.

Materials and methods

25 consecutive patients with diffuse parenchymal liver disease underwent abdominal MR imaging at both 3.0 T and 1.5 T within a 6-month interval. A retrospective study was conducted to obtain quantitative and qualitative data from both 3.0 T and 1.5 T MRI. Quantitative image analysis was performed by measuring the signal-to-noise ratios (SNRs) and the contrast-to-noise ratios (CNRs) by the Students t-test. Qualitative image analysis was assessed by grading each sequence on a 3- and 4-point scale, regarding the presence of artifacts and image quality, respectively. Statistical analysis consisted of the Wilcoxon signed-rank test.

Results

the mean SNRs and CNRs of the liver parenchyma and the portal vein were significantly higher at 3.0 T than at 1.5 T on portal and equilibrium phases of volumetric interpolated breath-hold examination (VIBE) images (P < 0.05). The mean SNRs were significantly higher at 3.0 T than at 1.5 T on T1-weighted spoiled gradient echo (SGE) images (P < 0.05). However, there were no significantly differences on T2-weighted short-inversion-time inversion recovery (STIR) images. Overall image qualities of the 1.5 T non-contrast T1- and T2-weighted sequences were significantly better than 3.0 T (P < 0.01). In contrast, overall image quality of the 3.0 T post-gadolinium VIBE sequence was significantly better than 1.5 T (P < 0.01).

Conclusions

MR imaging of post-gadolinium VIBE sequence at 3.0 T has quantitative and qualitative advantages of evaluating for diffuse parenchymal liver disease.     

Focal liver disease: comparison of dynamic contrast-enhanced CT and T2-weighted fat-suppressed, FLASH, and dynamic gadolinium-enhanced MR imaging at 1.5 T.

Dynamic contrast medium-enhanced computed tomography (CT), T2-weighted fat-suppressed spin-echo (T2FS) magnetic resonance (MR) imaging, and breath-hold T1-weighted fast low-angle shot (FLASH) MR imaging before and after dynamic gadopentetate dimeglumine injection were compared in 73 patients with clinically suspected liver disease. Observer confidence for presence of focal lesions was determined by using receiver operating characteristic analysis. For all MR images, hepatic lesion-liver signal-to-noise ratios were evaluated qualitatively. and resolution and presence of artifacts were evaluated qualitatively. Lesion detection was greatest with T2FS (n = 272) and enhanced FLASH (n = 244) and was statistically greater with both of these than with CT (n = 220) and FLASH (n = 219) (P less than .03). Correct lesion characterization was greatest with enhanced FLASH (n = 236) (P less than .01), followed by CT (n = 199), FLASH (n = 164), and T2FS (n = 144). Enhanced FLASH was particularly successful in characterization of 5-mm- to 1.5-cm-diameter lesions as cystic or solid.     

Intra-individual comparison of image contrast in SPIO-enhanced liver MRI at 1.5T and 3.0T

The purpose of the study was to examine if the higher susceptibility at 3.0 Tesla (T) compared to 1.5 T will affect the contrast in MR imaging of the liver after application of superparamagnetic iron oxide particles (SPIO). The study was approved by our institutional review board and informed consent was obtained. Seventeen healthy volunteers were examined in a prospective, intra-individual comparative study within one day on a 1.5 T and a 3.0 T MRI system. T2 weighted TSE sequences were acquired after bolus injection of a SPIO contrast agent. Image contrast and signal to noise ratio (SNR) were compared between the field strengths. Image contrast was calculated between the liver tissue and the kidneys / spleen / muscles and fluids. The students’T-test was used for statistical analysis. No influence of the higher field strength could be observed on image contrast except for the liver / muscle contrast. This was due to a distinct SNR increase of the muscle tissue at 3.0 T as a result of their relaxation properties. The higher susceptibility at 3.0 T compared to 1.5 T does not translate into a stronger signal attenuation of the SPIO enhanced liver parenchyma.     

In vivo blood T1 measurements at 1.5 T, 3 T,and 7 T

The longitudinal relaxation time of blood is a crucial parameter for quantification of cerebral blood flow by arterial spin labeling and is one of the main determinants of the signal‐to‐noise ratio of the resulting perfusion maps. Whereas at low and medium magnetic field strengths (B₀), its in vivo value is well established; at ultra‐high field, this is still uncertain. In this study, longitudinal relaxation time of blood in the sagittal sinus was measured at 1.5 T, 3 T, and 7 T. A nonselective inversion pulse preceding a Look‐Locker echo planar imaging sequence was performed to obtain the inversion recovery curve of venous blood. The results showed that longitudinal relaxation time of blood at 7 T was ～ 2.1 s which translates to an anticipated 33% gain in the signal‐to‐noise ratio in arterial spin labeling experiments due to T₁ relaxation alone compared with 3 T. In addition, the linear relationship between longitudinal relaxation time of blood and B₀ was confirmed. Magn Reson Med, 70:1082–1086, 2013. © 2012 Wiley Periodicals, Inc.