Cui Enming, Long Wansheng, Luo Liangping, Hu Maoqing, Huang Liebin, Chen Xiangmeng
1 Jinan University, Guangzhou, Guangdong, PR China.
2 Department of Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, PR China.
Acta Radiol. 2017 Oct;58(10):1174-1181. doi: 10.1177/0284185116687170. Epub 2017 Jan 16.
Background Insufficient enhancement of liver parenchyma negatively affects diagnostic accuracy of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI). Currently, there is no reliable method for predicting insufficient enhancement during the hepatobiliary phase (HBP) in Gd-EOB-DTPA-enhanced MRI. Purpose To develop a predictor for insufficient enhancement of liver parenchyma during HBP in Gd-EOB-DTPA-enhanced MRI. Material and Methods In order to formulate a HBP enhancement test (HBP-ET), clinical factors associated with relative enhancement ratio (RER) of liver parenchyma were retrospectively determined from the datasets of 156 patients (Development group) who underwent Gd-EOB-DTPA-enhanced MRI between November 2012 and May 2015. The independent clinical factors were identified by Pearson's correlation and multiple stepwise regression analysis; the performance of HBP-ET was compared to Child-Pugh score (CPS), Model for End-stage Liver Disease score (MELD), and total bilirubin (TBIL) using receiver operating characteristic (ROC) curve analysis. The datasets of 52 patients (Validation group), which were examined between June 2015 and Oct 2015, were applied to validate the HBP-ET. Results Six biochemical parameters independently influenced RER and were used to develop HBP-ET. The mean HBP-ET score of patients with insufficient enhancement was significantly higher than that of patients with sufficient enhancement ( P < 0.001) in both the Development and Validation groups. HBP-ET (area under the curve [AUC] = 0.895) had better performance in predicting insufficient enhancement than CPS (AUC = 0.707), MELD (AUC = 0.798), and TBIL (AUC = 0.729). Conclusion The HBP-ET is more accurate than routine indicators in predicting insufficient enhancement during HBP, which is valuable to aid clinical decisions.
肝实质强化不足会对钆塞酸二钠增强磁共振成像（MRI）的诊断准确性产生负面影响。目前，尚无可靠方法预测钆塞酸二钠增强MRI肝胆期（HBP）的强化不足情况。目的：建立一种预测钆塞酸二钠增强MRI中HBP肝实质强化不足的指标。材料与方法：为制定HBP强化试验（HBP-ET），回顾性分析2012年11月至2015年5月期间接受钆塞酸二钠增强MRI检查的156例患者（开发组）数据集中与肝实质相对强化率（RER）相关的临床因素。通过Pearson相关性分析和多元逐步回归分析确定独立临床因素；采用受试者操作特征（ROC）曲线分析比较HBP-ET与Child-Pugh评分（CPS）、终末期肝病模型评分（MELD）和总胆红素（TBIL）的性能。应用2015年6月至10月期间检查的52例患者（验证组）数据集对HBP-ET进行验证。结果：6项生化参数独立影响RER，并用于制定HBP-ET。在开发组和验证组中，强化不足患者的平均HBP-ET评分均显著高于强化充足患者（P < 0.001）。HBP-ET（曲线下面积[AUC] = 0.895）在预测强化不足方面比CPS（AUC = 0.707）、MELD（AUC = 0.798）和TBIL（AUC = 0.729）表现更好。结论：HBP-ET在预测HBP强化不足方面比常规指标更准确，有助于临床决策。
