Wu Jianwei, Li Hui, Lin Yuning, Chen Ziqian, Zhong Qun, Gao Hong, Fu Liyuan, Sandrasegaran Kumar
Department of Radiology, Nanjing Jingdu Hospital, Nanjing, Jiangsu, China.
Abdom Imaging. 2015 Jan;40(1):95-101. doi: 10.1007/s00261-014-0200-3.
To determine if transit time for excretion of gadoxetate into major bile ducts and duodenum correlates with clinical models of hepatocellular function.
This retrospective research was approved by the Institutional Review Board with waiver of informed consent. Search of the radiology database from January 1, 2013 to March 4, 2014 revealed 84 patients with chronic liver disease (65 males, mean age 47 years). Eighteen control subjects with no known liver disease or risk factors were also enrolled for analysis (9 males, mean age 43 years). MRI was performed with hepatobiliary phases at 10, 15, 20, and 25 min after injection of 0.025 mmol/kg of gadoxetate (Primovist, Bayer HealthCare, Shanghai, China). The time of excreted contrast appearing in the biliary tree and in the duodenum was recorded. Linear trend analysis was performed to determine the relationship between excretion time and hepatic function.
The patient cohort was stratified by Child-Pugh classification (A, B, and C with n = 53, 27, and 4, respectively). Arrival of gadoxetate in the gall bladder at 10-min hepatobiliary phase was seen in 87% of control group and 45% of Child-Pugh A group (p = 0.02). There was no difference between these groups for later hepatobiliary phases. The arrival of biliary contrast in the right hepatic duct, common bile duct, and gall bladder were significantly earlier in the Child-Pugh A group compared to the Child-Pugh B/C group at all hepatobiliary phases after 10 min (p < 0.05). Linear trend analysis showed that biliary transit times were significantly delayed with worsening liver function (p = 0.01). There was no difference in entry time of gadoxetate into the duodenum between the normal, Child-Pugh A, and Child-Pugh B/C groups.
The transit time for gadoxetate to appear in extrahepatic duct is a reasonable indicator of liver function, and may be included in radiology reports. The appearance in the duodenum, however, may depend on factors other than liver function, such as the physiology of the gallbladder and sphincter of Oddi.
确定钆塞酸二钠排泄至主要胆管和十二指肠的转运时间是否与肝细胞功能的临床模型相关。
本回顾性研究经机构审查委员会批准，豁免知情同意。检索2013年1月1日至2014年3月4日的放射学数据库，发现84例慢性肝病患者（65例男性，平均年龄47岁）。还纳入了18例无已知肝病或危险因素的对照受试者进行分析（9例男性，平均年龄43岁）。静脉注射0.025 mmol/kg钆塞酸二钠（普美显，拜耳医药保健有限公司，中国上海）后10、15、20和25分钟进行肝胆期MRI检查。记录对比剂出现在胆管树和十二指肠的时间。进行线性趋势分析以确定排泄时间与肝功能之间的关系。
患者队列按Child-Pugh分级分层（A、B和C级，分别为n = 53、27和4）。在10分钟肝胆期，钆塞酸二钠到达胆囊的情况在对照组中为87%，在Child-Pugh A级组中为45%（p = 0.02）。在随后的肝胆期，这些组之间没有差异。在10分钟后的所有肝胆期，Child-Pugh A级组中胆汁对比剂到达右肝管、胆总管和胆囊的时间明显早于Child-Pugh B/C级组（p < 0.05）。线性趋势分析表明，随着肝功能恶化，胆汁转运时间明显延迟（p = 0.01）。正常组、Child-Pugh A级组和Child-Pugh B/C级组之间钆塞酸二钠进入十二指肠的时间没有差异。
钆塞酸二钠出现在肝外胆管的转运时间是肝功能的合理指标，可纳入放射学报告。然而，其出现在十二指肠的情况可能取决于肝功能以外的因素，如胆囊和Oddi括约肌的生理状态。
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