定量分析钆塞酸二钠增强MRI预测肝纤维化和肝硬化病理分级

doi:10.3969/j.issn.2095-9400.2020.09.006

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摘要目的：通过定量分析钆塞酸二钠（Gd-EOB-DTPA）增强磁共振（MRI）评估和预测肝纤维化和肝硬化的病理分级。方法：所有纳入本实验的55例患者，其中10例病灶周围肝脏组织无肝硬化的作为对照组，10例肝癌病灶周围肝脏组织为肝纤维化的作为肝纤维化组，另外35例肝癌周围组织为肝硬化的作为肝硬化组。所有患者术前均接受Gd-EOB-DTPA增强MRI扫描。定量分析肝癌病灶周围肝脏的平扫期和肝胆特异期信号绝对增强强度（AEV）和对比增强率（CER）。分析信号AEV和CER与不同病变肝脏病理学的相关性。结果：不同病变肝脏的病理分级和信号AEV有相关性（r=-0.526，P＜0.001）；不同病变肝脏的病理分级和CER有相关性（r=-0.741，P＜0.001）。通过对2种信号强度的分析发现不同病变肝脏的病理分级与CER有更显著的负相关性。通过受试者工作曲线的分析发现CER在正常肝脏组织组和肝纤维化组之间最佳截断值为0.76，肝纤维化组和肝硬化组之间的最佳截断值为0.46。结论：CER与不同病变肝脏的病理分级存在比较显著的相关性，并能通过CER的分析评估和预测肝纤维化和肝硬化的病理分级。

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	童洪飞
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	倪仲琳

关键词 ：肝硬化, 钆塞酸二钠, 磁共振成像, 病理分级, 定量分析

Abstract：Objective: To evaluate and predict histological grades of liver fibrosis and cirrhosis by Gd-EOB-DTPA-enhanced MRI. Methods: Totally 55 patients were recruited in this study, of which 10 cases without liver cirrhosis were divided as the control group, 10 cases with liver fibrosis as the liver fibrosis group, 35 cases with liver cirrhosis as the liver cirrhosis group. Gd-EOB-DTPA-enhanced MRI was performed in all 55 patients before surgery. The signal absolute enhancement value (AEV) and contrast enhancement ratio (CER) was analyzed quantitatively in the unenhancement and hepatobiliary phase of background liver. Then we analyzed the correlation among the signal AEV, the CER and histologic grade of liver fibrosis and cirrhosis. Results: The analysis of the correlation between the signal AEV and the histological grades of different diseased hepatic tissue (r=-0.526, P<0.001) and the correlation between CER and the histological grades of different diseased hepatic tissue (r=-0.741, P<0.001). Between the two analyzed methods of signal intensity, we confirmed the more significant negative correlation between signal CER and the histological grades of different diseased hepatic tissue. The cut-off values calculated by receiver operating characteristic curve (ROC curve) were 0.76 between normal hepatic
tissue and liver fibrosis, 0.46 between liver fibrosis and liver cirrhosis, respectively. Conclusion: The more significant negative correlations between CER and the histological grades of different diseased hepatic tissue were confirmed by quantitative analysis of gadoxetic-acid contrast-enhanced MRI and the analysis of CER can evaluate and predict the histological grades of liver fibrosis and cirrhosis.

Key words： liver cirrhosis Gd-EOB-DTPA MRI histological grade quantitative analysis

收稿日期: 2019-09-26

基金资助:浙江省自然科学基金资助项目（LY19H290009）；温州市公益性科技计划项目（Y20160143）。

通讯作者: 倪仲琳，副主任医师，Email：nister@gmail.com。

作者简介: 童洪飞（1979-），男，浙江衢州人，副主任医师，博士。

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https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2020.09.006 或 https://xb.wmu.edu.cn/CN/Y2020/V50/I9/717

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