钆贝酸葡甲胺与钆喷替酸葡甲胺在肝脏MRI增强扫描中的应用与评价

目的对钆贝酸葡甲胺（Gd—BOPTA）与钆喷替酸葡甲胺（Gd—DTPA）在肝脏MRI增强扫描中的安全性、耐受性及诊断性疗效进行临床研究与评价。方法经超声或CT检查怀疑为肝脏原发肿瘤或转移瘤而要求行MR检查的患者共42例。先进行MR平扫,然后随机经静脉注射Gd—BOPTA或Gd—DTPA中任1种试验药物,剂量0．1mmol／kg。在开始注射对比剂后15～45s、1～2min、2～3min、4～5min和8min时,进行早期动态增强T1FFE扫描;给药后40～120min,进行T1FFE和T1SE延迟扫描。将每一病例的全部影像资料分为3组：给药前与给药后早期成像组、给药前与给药后延迟成像组、给药前与给药后早期＋延迟成像组;并对每组资料从4个方面进行配对判读：（1）肝脏病变信号的增强程度;（2）检出或排除肝脏病变的准确性;（3）对病变内部形态的评估;（4）显示病变特点的可信度。将判读结果分别进行组内及组间比较,最后进行放射学应用价值评估。结果在Gd—DTPA组内,给药后早期成像组的增强效果明显优于给药前与给药后延迟成像组,差异有统计学意义（P〈0．01）。给药前与给药后延迟成像组内,Gd-BOPTA组优于Gd．DTPA组,两组间差异有统计学意义（P〈0．05）。Gd—BOPTA组与Gd—DTPA组分别有72．7％和70．0％的病例在用药后图像质量得到显著改善,两组间差异无统计学意义。结论Gd-DTPA给药后早期的增强效果明显优于延迟期;Gd—BOPTA给药后早期的增强效果与Gd—DTPA相仿,而延迟期明显优于Gd-DTPA。

Evaluation of Gd-BOPTA and Gd-DTPA in contrast-enhanced MR imaging of the liver

OBJECTIVE: To evaluate the safety, tolerance and efficacy of Gd-BOPTA and Gd-DTPA in contrast-enhanced MR imaging of the liver. METHODS: Forty-two patients having been suspected of suffering from primary liver tumor or hepatic metastasis by ultrasonography (US) or CT received Gd-BOPTA or Gd-DTPA in contrast-enhanced MRI examination pre- and post-contrast MRI. T(1)- and T(2)-weighted spin-echo, and T(1)-weighted gradient-echo images were acquired before injection. Dynamic T(1)-weighted gradient-echo images were obtained at 15 - 45 s, 1 - 2, 2 - 3, 4 - 5 and 8 min, respectively, after intravenous injection of Gd-BOPTA or Gd-DTPA at the same dose of 0.1 mmol/kg, and delayed T(1)-weighted spin-echo and gradient-echo images were acquired at 40 - 120 minutes after injection. All the images were assessed in three matched pairs including pre-contrast images vs. early post-contrast images; pre-contrast images vs. delayed post-contrast images; and pre-contrast images vs. early and delayed post-contrast images. The assessment was made in terms of 4 aspects including improved conspicuousness and/or delineation of liver lesions, improved confidence in lesion detection or exclusion, improved assessment of lesion internal morphology, and improved confidence in lesion characterization. The results of assessments were statistically compared inside every group or between two groups, and the radiological utility of contrast enhancement was also evaluated at the end of the study. RESULTS: 1. There were significant differences between pre-contrast images vs. early post-contrast images and pre-contrast images vs. delayed post-contrast images inside the Gd-DTPA group, and the early post-contrast images were superior to delayed images. 2. There were significant differences between the two groups in terms of pre-contrast images vs. delayed post-contrast images, and Gd-BOPTA was superior to Gd-DTPA. 3. The quality of post-contrast images were improved obviously with a rate of 72.7% for Gd-BOPTA and 70.0% for Gd-DTPA, respectively, but without significant difference. CONCLUSION: The early post-contrast phase of Gd-DTPA-enhanced MR imaging is superior to delayed phase. The effects of Gd-BOPTA and Gd-DTPA in early post-contrast imaging are comparable, but Gd-BOPTA is significantly superior to Gd-DTPA in delayed post-contrast imaging.