腹部磁共振在胆道闭锁患儿Kasai术后随访中应用的相关研究

目的 探讨腹部磁共振(MR)检查在胆道闭锁患儿Kasai术后随访中应用的可行性.方法 收集2015年12月至2016年4月于首都医科大学附属北京儿童医院普外科门诊复查,资料完整、自肝生存的胆道闭锁Kasai术后14例,行腹部MR检查.观察MR检查结果所示肝、脾形态学改变;通过公式计算患儿标准肝体积值,与腹部MR检查测量3次所得的患儿平均肝体积值比较,获得平均肝体积值、肝体积比值、肝体积差值,同理获得平均脾体积值、脾体积比值、脾体积差值,及脾/肝体积比值;并收集同期患儿血清AST、血小板计数(PLT),通过公式计算AST与血小板比值(APRI),结合肝硬度测量(LSM)与上述指标进行相关性分析;对患儿合并的腹腔内畸形进行进一步观察.结果 腹部MR观察到,患儿的肝表现为不同程度的肝各叶比例失调(6/14),伴有结节状改变(1/14)等.脾的形态改变主要表现为脾不同程度的增大(14/14).此外腹部MR检查还观察到一些继发于门静脉高压的表现如腹水(2/14),侧枝循环形成(1/14)等.本组脾/肝体积比值、脾体积比值、脾体积差值与LSM值呈线性正相关(r值分别为0.684、0.633和0.579,P值分别为0.007、0.015和0.030),脾/肝体积比值、平均脾体积、脾体积比值、脾体积差值与APRI值呈线性正相关(r值分别为0.764、0.646、0.659和0.796,P值分别为0.001、0.013、0.010和0.001);平均肝体积、肝体积比值、肝体积差值均与LSM值、APRI值无线性相关关系.胆道闭锁患儿合并的腹腔内畸形,脾畸形(4/14),全内脏转位(1/14)亦可通过腹部MR检查进一步观察.结论 通过腹部MR检查可以观察到胆道闭锁患儿Kasai术后肝、脾形态学改变,对肝纤维化水平进行定性评估;通过测量肝、脾体积,可对患儿肝纤维化情况进行定量评估,尤其是脾/肝体积比值,与目前常用的评估肝纤维化的指标LSM值、APRI值呈线性正相关;对胆道闭锁患儿的腹腔内合并畸形进行进一步观察.腹部MR检查可以用于胆道闭锁患儿Kasai术后的随访中.

Application of abdominal magnetic resonance during postoperative follow-ups of biliary atresia patients

Objective To explore the feasibility of applying abdominal magnetic resonance (MR)during the postoperative follow-ups of biliary atresia(BA)patients.Methods A total of 14 BA patients receiving re-examinations during December 2015 to April 2016 were recruited.All abdominal MR images were carefully analyzed.The morphological changes of liver and spleen and associated malformations were examined.Volumes of liver and spleen were measured and compared with standard values.Mean liver volume,ratio of liver volume,difference of liver volume,mean spleen volume,ratio of spleen volume,difference of spleen volume and ratio of spleen volume to liver volume were calculated.Also the results of LSM,AST and ALT were measured at the meantime and APRI values calculated.Their correlations were evaluated.Results Disturbed liver lobe ratio (6/14),nodular-like changes (1/14) and splenomegaly (14/14) was noted on images along with other changes of ascites (2/14) and collateral circulation (1/14).Ratio of spleen volume to liver volume,ratio of spleen volume and difference of spleen volume had statistic correlations with LSM results (r =-0.684,0.633,0.579;P =0.007,0.015,0.030);ratio of spleen volume to liver volume,mean spleen volume,ratio of spleen volume and difference of spleen volume had statistic correlations with APRI (r =0.764,0.646,0.659,0.796;P =0.001,0.013,0.010,0.001);mean liver volume,ratio of liver volume and difference of liver volume had no statistic correlation with LSM results or APRI.Abdominal MR could detect the associated malformations of BA patients.Conclusions Abdominal MR may be used for monitoring the changes of liver and spleen,measure the volume of liver and spleen and analyze the degree of hepatic fibrosis both qualitatively and quantitatively.Associated malformations are detected.It is feasible to apply abdominal MR for following up postoperative BA patients.