Department of Radiology, University Hospital Regensburg, Regensburg, Germany.
Eur J Radiol. 2013 Oct;82(10):1710-5. doi: 10.1016/j.ejrad.2013.05.033. Epub 2013 Jun 25.
The purpose of this study was to assess differences in enhancement effects of liver parenchyma between normal and cirrhotic livers on dynamic, Gd-EOB-DTPA enhanced MRI at 3T.
93 patients with normal (n=54) and cirrhotic liver (n=39; Child-Pugh class A, n=18; B, n=16; C, n=5) underwent contrast-enhanced MRI with liver specific contrast media at 3T. T1-weighted volume interpolated breath hold examination (VIBE) sequences with fat suppression were acquired before contrast injection, in the arterial phase (AP), in the late arterial phase (LAP), in the portal venous phase (PVP), and in the hepatobiliary phase (HBP) after 20 min. The relative enhancement (RE) of the signal intensity of the liver parenchyma was calculated for all phases.
Mean RE was significantly different among all evaluated groups in the hepatobiliary phase and with increasing severity of liver cirrhosis, a decreasing, but still significant reduction of RE could be shown. Phase depending changes of RE for each group were observed. In case of non-cirrhotic liver or Child-Pugh Score A cirrhosis mean RE showed a significant increase between AP, LAP, PVP and HBP. For Child-Pugh B+C cirrhosis RE increased until PVP, however, there was no change in case of B cirrhosis (p=0.501) and significantly reduced in case of C cirrhosis (p=0.043) during HBP.
RE of liver parenchyma is negatively affected by increased severity of liver cirrhosis, therefore diagnostic value of HBP could be limited in case of Child Pugh B+C cirrhosis.
本研究旨在评估正常和肝硬化肝脏在 3T 下动态、钆塞酸二钠增强 MRI 中的肝实质增强效果差异。
93 例患者（正常肝 54 例，肝硬化肝 39 例；Child-Pugh 分级 A 18 例，B 16 例，C 5 例）在 3T 行肝脏特异性对比剂增强 MRI。对比剂注射前、动脉期（AP）、晚期动脉期（LAP）、门静脉期（PVP）和 20 分钟后肝胆期（HBP）采集抑脂 T1 加权容积内插呼吸门控检查（VIBE）序列。计算所有相位肝实质信号强度的相对增强（RE）。
在肝胆期，各组间的平均 RE 存在显著差异，且随着肝硬化严重程度的增加，RE 逐渐降低，但仍有显著差异。观察到各亚组间的相位依赖的 RE 变化。在非肝硬化或 Child-Pugh 评分 A 级肝硬化患者中，AP、LAP、PVP 和 HBP 之间的平均 RE 呈显著增加。对于 Child-Pugh B+C 肝硬化，RE 在 PVP 时增加，但在 B 级肝硬化时没有变化（p=0.501），在 C 级肝硬化时显著降低（p=0.043）。
肝硬化严重程度增加会对肝实质的 RE 产生负面影响，因此在 Child-Pugh B+C 肝硬化的情况下，HBP 的诊断价值可能受到限制。
