双能量CT碘定量结合动态对比增强MRI评估肝硬化患者肝脏血流动力学和肝功能临床价值研究*

doi:10.3969/j.issn.1672-5069.2019.05.025

摘要/Abstract

摘要： 目的探讨双能量CT碘定量结合动态对比增强MRI评估肝硬化患者肝脏血流动力学及肝功能的临床价值。方法 2016年6月~2018年6月我院收治的130例乙型肝炎肝硬化患者和同期在我院检查证实肝脏无异常的健康人30例,行动态对比增强MRI和双能CT增强扫描,测量肝实质血流参数峰值（PV）、最大上升斜率（MSI）、最大下降斜率（MSD）、正性增强积分（PEI）和信号增强率（SER）,计算动脉期肝实质碘浓度（Ia）、门静脉期肝实质碘浓度（Ip）、肝动脉碘分数（AIF）和门静脉碘浓度（PVIC）。结果肝硬化组肝实质PV值为（522.1±96.7）,显著低于对照组【（609.2±108.8）,P<0.05】,肝实质PEI值为（200.2±53.3）,显著低于对照组【（241.3±61.5）,P<0.05】;15例CTP C级患者肝实质的PV值为（443.4±57.3）,显著低于89例CTP A级【（587.4±94.5）,P<0.05】,MSI值为（170.1±54.6）,显著低于CTP A级【（310.6±69.5）,P<0.05】,MSD值为（31.9±22.5）,显著低于CTP A级【（67.8±19.6）,P<0.05】,PEI值为（155.6±29.7）,显著低于CTP A级【（236.7±53.4）,P<0.05】,SER值为（109.3±7.5）,显著低于CTP A级【（125.6±13.5）,P<0.05】;26例CTP B级患者Ia值为（0.7±0.2） mgI/ml,C级患者Ia值为（0.8±0.2） mgI/ml,显著高于健康人【（0.5±0.1） mgI/ml,P<0.05】,CTP A级Ip值为（2.2±0.5） mgI/ml,B级为（2.0±0.5） mgI/ml、C级为（1.8±0.3） mgI/ml,显著低于健康人【（2.6±0.6） mgI/ml,P<0.05】,CTP B级AIF值为（31.7±5.0） %、C级为（47.8±8.9） %,显著高于健康人【（21.1±4.3） %,P<0.05】。结论双能量CT碘定量结合动态对比增强MRI检查评估肝硬化患者肝脏血流动力学结果可靠,灌注参数的变化能反映肝功能储备情况。

关键词: 肝硬化, 血流动力学, 双能量CT, 磁共振成像, 灌注参数

Abstract: Objective The purpose of this study was to explore the clinical value of dual-energy CT iodine quantification combined with dynamic contrast-enhanced MRI in evaluating liver hemodynamics and liver functions in patients with hepatitis B-induced liver cirrhosis （LC）. Methods 130 patients with hepatitis B cirrhosis and 30 individuals with normal liver function tests were recruited in our hospital between June 2016 and June 2018. The dynamic contrast-enhanced MRI scan and dual-energy CT enhanced scan were performed and the blood flow parameter peak （PV）,maximum rise slope（MSI）,maximum drop slope （MSD）,positive enhancement integral （PEI） and signal enhancement rate （SER） in the liver parenchyma were measured. The liver iodine concentration （Ia）,portal iodine concentration （Ip）,hepatic artery iodine fraction（AIF）,and portal iodine concentration （PVIC） were also calculated. Results The PV value of liver parenchyma in patients with LC was（522.1±96.7）,significantly lower than [（609.2±108.8）,P<0.05] in the control,and the liver parenchymal PEI value was （200.2±53.3）,significantly lower than [（241.3±61.5）,P<0.05] in the control;the PV value in 15 patients with CTP class C was（443.4±57.3）,significantly lower than [（587.4±94.5）,P<0.05] in 89 patients with CTP class A,the MSI value was（170.1±54.6）,significantly lower than [（310.6±69.5）,P<0.05] in patients with CTP class A,the MSD value was（31.9±22.5）,significantly lower than [（67.8±19.6）,P<0.05] in patients with CTP class A, the PEI value was （155.6±29.7）,significantly lower than [（236.7±53.4）,P<0.05] in patients with CTP class A,and the SER value was （109.3±7.5）,significantly lower than[（125.6±13.5）,P<0.05] in patients with CTP class A;the Ia value in 26 patients with CTP class B was （0.7±0.2） mgI/ml,in class C was （0.8±0.2） mgI/ml,both significantly higher than 【（0.5±0.1） mgI/ml,P<0.05】 in the control,and the Ip value in patients with CTP A was （2.2±0.5） mgI/ml,in patients with class B was （2.0±0.5） mgI/ml,in patients with class C was（1.8±0.3） mgI/ml,all significantly lower than 【（2.6±0.6） mgI/ml,P<0.05】 in the control,and AIF in patients with CTP class B was（31.7±5.0） %,and in those with class C was（47.8±8.9）%,both significantly higher than 【（21.1±4.3） %,P<0.05】 in the control. Conclusion Dual-energy CT iodine quantification combined with dynamic contrast-enhanced MRI is useful in clinical practice,which might help evaluate hepatic hemodynamics in patients with liver cirrhosis.

Key words: Liver cirrhosis, Hemodynamics, Dual energy CT, Magnetic resonance imaging, Perfusion parameters

金良红, 李兴杰, 关红博, 麻少辉. 双能量CT碘定量结合动态对比增强MRI评估肝硬化患者肝脏血流动力学和肝功能临床价值研究*[J]. 实用肝脏病杂志, 2019, 22(5): 712-715.

Jin Lianghong, Li Xingjie, Guan Hongbo, et al. Clinical value of dual-energy CT iodine quantification combined with dynamic contrast-enhanced MRI in evaluating hepatic hemodynamics and liver functions in patients with hepatitis B liver cirrhosis[J]. Journal of Practical Hepatology, 2019, 22(5): 712-715.

参考文献

[1] Campos-Correia D,Cruz J,Matos A P,et al.Magnetic resonance imaging ancillary features used in liver imaging reporting and data system:an illustrative review. World J Radiol,2018,10(2):9-23.
[2] Li Y,Shi G,Wang S,et al.Iodine quantification with dual-energy CT:phantom study and preliminary experience with VX2 residual tumour in rabbits after radiofrequency ablation. Br J Radiol,2013,86(1029):20130143.
[3] Zhang W,Chen H J,Wang Z J,et al.Dynamic contrast enhanced MR imaging for evaluation of angiogenesis of hepatocellular nodules in liver cirrhosis in N-nitrosodiethylamine induced rat model. Eur Radiol,2016,27(5):1-9.
[4] 徐晓莉,隋昕,钟巍等. 双能量CT碘图定量参数联合CT征象建模在诊断肺癌病理亚型中的价值.中华放射学杂志,2018,52(11):823-828.
[5] Thian Y L,Riddell A M,Koh D M.Liver-specific agents for contrast-enhanced MRI:role in oncological imaging. Cancer Imaging,2013,13(4):567-579.
[6] Mileto A,Marin D,Alfarocordoba M,et al.Iodine quantification to distinguish clear cell from papillary renal cell carcinoma at dual-energy multidetector CT:a multireader diagnostic performance study. Radiology,2014,273(3):813-820.
[7] Nilsson H,Blomqvist L,Douglas L,et al.Gd-EOB-DTPA-enhanced MRI for the assessment of liver function and volume in liver cirrhosis. Brit J Radiol,2013,86(1026):315-331.
[8] Sebastian F,Stefan K,Stefan S,et al.Performance of today's dual energy CT and future multi energy CT in virtual non-contrast imaging and in iodine quantification:A simulation study. Med Phys,2015,42(7):4349.
[9] 谢婷婷,石桥,张嘉瑜等. 采用双能量CT碘定量法研究肝硬化患者脾脏血流动力学变化.中国CT和MRI杂志,2017,15(5):78-80.
[10] Smith A D,Branch C R,Zand K,et al.Liver surface nodularity quantification from routine CT images as a biomarker for detection and evaluation of cirrhosis. Radiology,2016,280(3):771-781.
[11] Ascenti G,Mileto A,Krauss B,et al.Distinguishing enhancing from nonenhancing renal masses with dual-source dual-energy CT:iodine quantification versus standard enhancement measurements. Eur Radiol,2013,23(8):2288-2295.
[12] Saito K,Ledsam J,Sourbron S,et al.Measuring hepatic functional reserve using low temporal resolution Gd-EOB-DTPA dynamic contrast-enhanced MRI:a preliminary study comparing galactosyl human serum albumin scintigraphy with indocyanine green retention. Eur Radiol,2014,24(1):112-119.
[13] Lee S,Choi D,Jeong W K,et al.Frequency,CT findings,and fate of multiple infarcted regenerative nodules in liver cirrhosis after variceal bleeding or septic shock. Abdom Imaging,2015,40(4):835-842.
[14] Baxa J,Vondráková A,Matouáková T,et al.Dual-phase dual-energy CT in patients with lung cancer:assessment of the additional value of iodine quantification in lymph node therapy response. Eur Radiol,2014,24(8):1981-1988.
[15] Brodsky E K,Bultman E M,Johnson K M,et al.High-spatial and high-temporal resolution dynamic contrast-enhanced perfusion imaging of the liver with time-resolved three-dimensional radial MRI. Magn Reson Med,2014,71(3):934-941.