Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Invest Radiol. 2012 Nov;47(11):649-55. doi: 10.1097/RLI.0b013e3182652fb9.
The aim of this study was to evaluate the serial signal changes in hepatobiliary enhancement on gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid or gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging and its correlation with clinical parameters.
Under institutional review board approval, Gd-EOB-DTPA-enhanced magnetic resonance imaging was performed in 77 subjects (21 healthy volunteers and 56 biopsy-proven chronic hepatitis patients), and the signal intensities of the liver and common hepatic ducts (CHD) were measured every 2 minutes up to 50 minutes postcontrast. The associations among hepatic and CHD signals, physiological and hematological variables, histological activity index, and Metavir scores were analyzed with Pearson correlation and multiple linear stepwise regressions. The predictive ability of contrast enhancement index (CEI) of the liver with histological activity index and fibrosis scores at different time points were studied using nonparametric receiver operating characteristic curves.
Among the clinical parameters, body weight and body mass index had the highest negative correlation with hepatobiliary enhancement between 2 and 50 minutes postcontrast (P < 0.001). Multiple regressions showed that creatinine level, body weight, and body mass index were independent predictors for both mean hepatic and CHD signal intensity (P < 0.05). Patients with more severe fibrosis or moderate necrosis tended to have lower CEIs than other patients were. The predictive ability of CEI for the best differentiation between no fibrosis and any fibrosis (F ≥ 1) was at 10 minutes postcontrast (area under the receiver operating characteristic curve, 0.797).
Delayed hepatobiliary enhancement with Gd-EOB-DTPA could be possibly used for staging liver fibrosis. Contrast enhancement index of the liver at 10 minutes is useful for differentiating between no fibrosis and any degree of fibrosis in chronic hepatitis patients.
本研究旨在评估钆塞酸二钠（Gd-EOB-DTPA）增强磁共振成像（MRI）肝胆期的连续信号变化及其与临床参数的相关性。
本研究经机构审查委员会批准，对 77 例患者（21 名健康志愿者和 56 名经活检证实的慢性肝炎患者）进行了 Gd-EOB-DTPA 增强 MRI 检查，并在注射对比剂后每 2 分钟测量肝脏和肝内胆管（CHD）的信号强度，直到 50 分钟。采用 Pearson 相关分析和多元线性逐步回归分析肝和 CHD 信号与生理、血液学变量、组织学活动指数和 Metavir 评分之间的关系。采用非参数接收器操作特性曲线研究不同时间点肝对比增强指数（CEI）与组织学活动指数和纤维化评分的预测能力。
在临床参数中，体重和体重指数与注射对比剂后 2 至 50 分钟的肝胆增强具有最高的负相关性（P<0.001）。多元回归显示，肌酐水平、体重和体重指数是肝和 CHD 平均信号强度的独立预测因子（P<0.05）。纤维化程度较重或坏死程度中等的患者的 CEI 低于其他患者。CEI 在 10 分钟时对无纤维化和任何纤维化（F≥1）的最佳鉴别能力最佳（受试者工作特征曲线下面积，0.797）。
Gd-EOB-DTPA 延迟肝胆增强可能用于分期肝纤维化。肝的 CEI 在 10 分钟时可用于鉴别慢性肝炎患者是否存在纤维化以及纤维化程度。
