Laboratory of Imaging Biomarkers, Center of Research on Inflammation, UMR 1149 Inserm - University Paris Diderot, Sorbonne Paris Cité, Paris, France
Université de Lyon, CREATIS; CNRS UMR 5220; Inserm U1206; INSA-Lyon; Université Lyon 1; Villeurbanne, France.
Clin Sci (Lond). 2018 Apr 16;132(7):813-824. doi: 10.1042/CS20171131.
The purpose of the present study was to develop and perform initial validation of dynamic MRI enhanced with gadoxetic acid as hepatobiliary contrast agent to quantify hepatic perfusion and hepatocyte function in patients with chronic liver disease. Free-breathing, dynamic gadoxetic acid-enhanced MRI was performed at 3.0 T using a 3D time-resolved angiography sequence with stochastic trajectories during 38 min. A dual-input three-compartment model was developed to derive hepatic perfusion and hepatocyte function parameters. Method feasibility was assessed in 23 patients with biopsy-proven chronic liver disease. Parameter analysis could be performed in 21 patients (91%). The hepatocyte function parameters were more discriminant than the perfusion parameters to differentiate between patients with minimal fibrosis (METAVIR F0-F1), intermediate fibrosis (F2-F3) and cirrhosis (F4). The areas under the receiver operating characteristic curves (ROCs) to diagnose significant fibrosis (METAVIR F ≥ 2) were: 0.95 (95% CI: 0.87-1; <0.001) for biliary efflux, 0.88 (95% CI: 0.73-1; <0.01) for sinusoidal backflux, 0.81 (95% CI: 0.61-1; <0.05) for hepatocyte uptake fraction and 0.75 (95% CI: 0.54-1; <0.05) for hepatic perfusion index (HPI), respectively. These initial results in patients with chronic liver diseases show that simultaneous quantification of hepatic perfusion and hepatocyte function is feasible with free breathing dynamic gadoxetic acid-enhanced MRI. Hepatocyte function parameters may be relevant to assess liver fibrosis severity.
本研究旨在开发并初步验证钆塞酸增强磁共振动态成像作为肝胆对比剂，以定量评估慢性肝病患者的肝脏灌注和肝细胞功能。在 3.0T 磁共振扫描仪上使用三维时间分辨血管造影序列进行自由呼吸、钆塞酸增强磁共振动态成像，在 38 分钟内采集数据。采用双输入三房室模型来推导肝脏灌注和肝细胞功能参数。在 23 例经活检证实的慢性肝病患者中评估了方法的可行性。21 例（91%）患者可进行参数分析。肝细胞功能参数比灌注参数更能区分轻度纤维化（METAVIR F0-F1）、中度纤维化（F2-F3）和肝硬化（F4）患者。用于诊断显著纤维化（METAVIR F ≥ 2）的受试者工作特征曲线（ROC）下面积（AUC）分别为：胆汁流出（biliary efflux）为 0.95（95%可信区间：0.87-1；<0.001），窦后回流（sinusoidal backflux）为 0.88（95%可信区间：0.73-1；<0.01），肝细胞摄取分数（hepatocyte uptake fraction）为 0.81（95%可信区间：0.61-1；<0.05），肝灌注指数（hepatic perfusion index，HPI）为 0.75（95%可信区间：0.54-1；<0.05）。这些初步结果显示，自由呼吸动态钆塞酸增强磁共振成像可同时定量评估肝脏灌注和肝细胞功能。肝细胞功能参数可能与评估肝纤维化严重程度有关。
