肝硬化肝实质的动态对比增强磁共振成像：钆喷酸葡胺与钆贝葡胺的比较
Dynamic-contrast-enhanced magnetic resonance imaging of cirrhotic liver parenchyma: A comparison between gadolinium-diethylenetriamine pentaacetic acid and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid.
作者信息
Lin Chun-Yi, Chang Wei-Chou, Chou Chen-Te, Chen Ran-Chou
机构信息
Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Radiology, National Yang-Ming University Hospital, Yilan, Taiwan, ROC.
Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, ROC.
出版信息
J Chin Med Assoc. 2015 Nov;78(11):666-72. doi: 10.1016/j.jcma.2015.07.005. Epub 2015 Sep 2.
BACKGROUND
The newly developed magnetic-resonance-imaging (MRI) hepatocyte-specific contrast agent, gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA), has different excretion pathways from the conventional MRI contrast agent, gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). In this study, we compare the enhancement effect of the liver and renal parenchyma between these two contrast agents for patients with liver cirrhosis.
METHODS
We retrospectively included 49 consecutive patients with liver cirrhosis who underwent Gd-DTPA- and Gd-EOB-DTPA-enhanced MRIs within 3 months. We measured the signal intensity of the liver and kidney, and calculated the enhancement ratio (ER) in the arterial phase, portal venous phase, and venous phase (VP). We also calculated a delayed phase (DP) when Gd-DTPA was used, and a hepatocyte phase (HP) when Gd-EOB-DTPA was used. The ERs were compared between the two contrast agents. The effect of liver function on the ERs was also evaluated.
RESULTS
The ER of the liver with Gd-EOB-DTPA was significantly higher than with Gd-DTPA in the VP (p = 0.01) and in the HP/DP (p = 0.01). The ER of the kidney in the DP with Gd-DTPA was significantly higher than in the HP with Gd-EOB-DTPA (p < 0.001). The ERs of the liver using Gd-EOB-DTPA for patients with normal serum bilirubin were significantly higher than those with abnormal levels (p = 0.047), but there was no significant difference using Gd-DTPA.
CONCLUSION
The enhancement effect of the liver parenchyma using both MRI contrast agents was not affected by the degree of liver cirrhosis or abnormal liver function. However, it was affected by the serum-bilirubin levels in the Gd-EOB-DTPA-enhanced MRIs. Furthermore, enhancement of the liver was higher when using Gd-EOB-DTPA in the VP, DP, and HP. This knowledge is helpful when performing dynamic MRIs to diagnose focal hepatic lesions in the heterogeneous liver parenchyma.
背景
新开发的磁共振成像（MRI）肝细胞特异性造影剂钆乙氧基苄基二乙三胺五乙酸（Gd-EOB-DTPA）与传统MRI造影剂钆二乙三胺五乙酸（Gd-DTPA）具有不同的排泄途径。在本研究中，我们比较了这两种造影剂对肝硬化患者肝脏和肾实质的增强效果。
方法
我们回顾性纳入了49例连续的肝硬化患者，这些患者在3个月内接受了Gd-DTPA和Gd-EOB-DTPA增强MRI检查。我们测量了肝脏和肾脏的信号强度，并计算了动脉期、门静脉期和静脉期（VP）的增强率（ER）。当使用Gd-DTPA时，我们还计算了延迟期（DP）；当使用Gd-EOB-DTPA时，计算了肝细胞期（HP）。比较了两种造影剂之间的ERs。还评估了肝功能对ERs的影响。
结果
在VP期（p = 0.01）以及HP/DP期（p = 0.01），Gd-EOB-DTPA增强肝脏的ER显著高于Gd-DTPA。使用Gd-DTPA时，DP期肾脏的ER显著高于使用Gd-EOB-DTPA时的HP期（p < 0.001）。血清胆红素正常的患者使用Gd-EOB-DTPA时肝脏的ER显著高于胆红素水平异常的患者（p = 0.047），但使用Gd-DTPA时无显著差异。
结论
两种MRI造影剂对肝实质的增强效果不受肝硬化程度或肝功能异常的影响。然而，在Gd-EOB-DTPA增强MRI中，其受血清胆红素水平的影响。此外，在VP期、DP期和HP期使用Gd-EOB-DTPA时肝脏的增强更高。这一知识在对异质性肝实质中的局灶性肝病变进行动态MRI诊断时很有帮助。
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