钆塞酸二钠增强MRI对肝功能评估价值的血清学对照研究

目的通过钆塞酸二钠(Gd-EOB-DTPA)增强MRI与肝脏功能分级及肝脏血清学指标的对照研究,探讨EOB-MRI对于肝脏功能的预测及评估预测价值。材料与方法 Philips 3.0 T磁共振扫描仪行Gd-EOB-DTPA MRI增强扫描共98例,测量、计算得到相对增强率(relative enhancement ratio,rER),并在EOB检查前后1周内行各项血清学检查,计算Child-Pugh分数得到相关分级。单因素方差分析进行正常组与不同Child-Pugh分级病例组之间rER值的差异性分析,采用直线回归分析进行rER值与各种血清学检查结果之间的相关性。P0.05为差异有统计学意义。结果正常组及不同Child-Pugh分级病例组之间rER值具有差异性,P0.05,正常组与不同Child-Pugh分级病例组的rER值的均数分别为2.281±0.275、2.092±0.474、1.824±0.246、1.711±0.433。不同组之间的两两分析,正常组与Child-Pugh B级、正常组与Child-Pugh C级、Child-Pugh A级与Child-Pugh B级之间差异具有统计学意义,P0.05。直线回归分析:rER值与血清总胆红素、谷草转氨酶、谷丙转氨酶、凝血酶原时间、凝血酶原活度、血清前白蛋白、胆碱酯酶均具有相关性,P0.05;其余各项P0.05,无统计学意义。结论 EOB-MRI增强扫描所得的rER值可用于区别不同肝功能程度,且对于轻度及中度肝损害具有鉴别意义;在血清学检查中,与凝血酶原活度和血清前白蛋白最为密切。

The clinical study on the Gd-EOB-DTPA-enhanced MR imaging for analysis of liver function and comparison with serologic results

Objective: To investigate the clinical significance of Gd-EOB-DTPA to predict and evaluate the liver function. Materials and Methods: Gd-EOB-DTPA-enhanced MR images of 98 patients were conducted on a 3.0 Tesla MRI. The values of relative enhancement ratio (rER) and Child-Pugh scores were calculated. Serologic testing was obtained within 7 days before and after MRI. The comparison between different Child-Pugh groups was accomplished by One-Way ANOVA. Spearman rank correlation was applied to analyze the relationship between the rER values and serologic results. Results:The results showed statistical differences among rER values of different Child-Pugh groups and normal group (P<0.05). The mean values are respectively 2.281±0.275, 2.092±0.474,1.824±0.246, 1.711±0.433. Comparative analysis between every two groups was applied and the results showed that normal and Child-Pugh B, normal and Child-Pugh C, Child-Pugh A and Child-Pugh B indicated statistical significance. The linear regression analysis showed that P value between rERs and values of TBIL, ALT, AST, PT, PTA, PA, ChE were less than 0.05, which was significant statistically. Conclusions: The rER values of EOBMRI could be used to evaluate liver function and to identify mild, moderate liver damage significantly. It got the most intimate relation with prothrombin activity and prealbumin.