Wu Wen-Pei, Chen Ran-Chou, Lee Chih-Wei, Chen Yao-Li, Lee Kwo-Whei, Wu Hwa-Koon, Chou Chen-Te
Department of Radiology, Lukang Christian Hospital, Chang-Hua, Taiwan, ROC; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan, ROC.
Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan, ROC; Department of Radiology, Heping Fuyou Branch, Taipei City Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2015 Dec;78(12):726-31. doi: 10.1016/j.jcma.2015.06.019. Epub 2015 Oct 4.
Gadoxetic acid is one of the hepatobiliary-specific agents and so can be used for contrast-enhanced magnetic resonance cholangiography (CE-MRC). The aim of our study was to compare the performance of CE-MRC with that of T2-weighted magnetic resonance cholangiography (T2W-MRC), and also to ascertain the effectiveness of both modalities combined for visualizing anatomic structures of the biliary tree in patients with liver cirrhosis.
Fifty-six patients underwent CE-MRC and T2W-MRC imaging. In the CE-MRC studies, hepatobiliary phase images were acquired 20 minutes after contrast injection. Two radiologists first evaluated the T2W-MRC and CE-MRC images separately in random order, and then they reviewed both images together 8 weeks later. The readers graded the quality of visualization of each biliary duct and the entire biliary tree (overall rating) using a five-point scale. Images with a grade of 3 or 4 were considered to provide sufficient visualization for clinical application, and those with a grade of 2 or less were considered to provide insufficient visualization. Laboratory data, Child-Pugh classification, and model for end-stage liver disease score were also recorded.
The overall rating of T2W-MRC was significantly higher than that of CE-MRC (p < 0.001), although combined T2W/CE-MRC provided better visualization of biliary segments than T2W-MRC alone (p = 0.025). There were no significant differences between liver function and the overall rating of CE-MRC.
CE-MRC is not superior to conventional T2W-MRC with respect to biliary visualization in patients with liver cirrhosis. However, a combination of T2W-MRC and CE-MRC provides significantly better visualization of biliary structures than T2W-MRC alone.
钆塞酸二钠是一种肝胆特异性造影剂，可用于磁共振胰胆管造影（CE-MRC）。本研究旨在比较CE-MRC与T2加权磁共振胰胆管造影（T2W-MRC）的成像效果，并确定两种方法联合使用对肝硬化患者胆管树解剖结构的可视化效果。
56例患者接受了CE-MRC和T2W-MRC检查。在CE-MRC检查中，注射造影剂20分钟后采集肝胆期图像。两名放射科医生首先以随机顺序分别评估T2W-MRC和CE-MRC图像，然后在8周后一起复查这两种图像。阅片者使用五点量表对每条胆管和整个胆管树的可视化质量（总体评分）进行分级。评分3或4级的图像被认为可为临床应用提供足够的可视化效果，评分2级或以下的图像被认为可视化效果不足。还记录了实验室数据、Child-Pugh分级和终末期肝病模型评分。
T2W-MRC的总体评分显著高于CE-MRC（p<0.001），尽管T2W/CE-MRC联合检查比单独的T2W-MRC能更好地显示胆管节段（p=0.025）。肝功能与CE-MRC的总体评分之间无显著差异。
在肝硬化患者的胆管可视化方面，CE-MRC并不优于传统的T2W-MRC。然而，T2W-MRC和CE-MRC联合使用比单独使用T2W-MRC能显著更好地显示胆管结构。
