动态钆塞酸增强 MRI 与 Tc-美罗芬酸肝胆闪烁成像 SPECT 定量评估肝功能的比较。

Comparison between dynamic gadoxetate-enhanced MRI and Tc-mebrofenin hepatobiliary scintigraphy with SPECT for quantitative assessment of liver function.

机构信息

Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Quantitative Imaging Group, Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands.

出版信息

Eur Radiol. 2019 Sep;29(9):5063-5072. doi: 10.1007/s00330-019-06029-7. Epub 2019 Feb 22.

OBJECTIVES

To compare Gd-EOB-DTPA dynamic hepatocyte-specific contrast-enhanced MRI (DHCE-MRI) with Tc-mebrofenin hepatobiliary scintigraphy (HBS) as quantitative liver function tests for the preoperative assessment of patients undergoing liver resection.

METHODS

Patients undergoing liver surgery and preoperative assessment of future remnant liver (FRL) function using Tc-mebrofenin HBS were included. Patients underwent DHCE-MRI. Total liver uptake function was calculated for both modalities: mebrofenin uptake rate (MUR) and Ki respectively. The FRL was delineated with both SPECT-CT and MRI to calculate the functional share. Blood samples were taken to assess biochemical liver parameters.

RESULTS

A total of 20 patients were included. The HBS-derived MUR and the DHCE-MRI-derived mean Ki correlated strongly for both total and FRL function (Pearson r = 0.70, p = 0.001 and r = 0.89, p < 0.001 respectively). There was a strong agreement between the functional share determined with both modalities (ICC = 0.944, 95% CI 0.863-0.978, n = 20). There was a significant negative correlation between liver aminotransferases and bilirubin for both MUR and Ki.

CONCLUSIONS

Assessment of liver function with DHCE-MRI is comparable with that of Tc-mebrofenin HBS and has the potential to be combined with diagnostic MRI imaging. This can therefore provide a one-stop-shop modality for the preoperative assessment of patients undergoing liver surgery.

KEY POINTS

• Quantitative assessment of liver function using hepatobiliary scintigraphy is performed in the preoperative assessment of patients undergoing liver surgery in order to prevent posthepatectomy liver failure. • Gd-EOB-DTPA dynamic hepatocyte-specific contrast-enhanced MRI (DHCE-MRI) is an emerging method to quantify liver function and can serve as a potential alternative to hepatobiliary scintigraphy. • Assessment of liver function with dynamic gadoxetate-enhanced MRI is comparable with that of hepatobiliary scintigraphy and has the potential to be combined with diagnostic MRI imaging.

目的

比较钆塞酸二钠动态肝细胞特异性对比增强磁共振成像（DHCE-MRI）与 Tc-美罗芬宁肝胆闪烁扫描（HBS）作为定量肝功能检查，用于评估行肝切除术的患者。

方法

纳入接受 Tc-美罗芬宁 HBS 行术前肝储备功能评估的行肝切除术的患者。患者均行 DHCE-MRI。两种方法均计算总肝摄取功能：美罗芬宁摄取率（MUR）和 Ki。SPECT-CT 和 MRI 均用于勾画肝储备功能（FRL），以计算功能份额。采集血样以评估生化肝功能参数。

结果

共纳入 20 例患者。HBS 衍生的 MUR 与 DHCE-MRI 衍生的平均 Ki 与总肝和 FRL 功能均呈强相关性（Pearson r=0.70，p=0.001 和 r=0.89，p<0.001）。两种方法确定的功能份额具有很强的一致性（ICC=0.944，95%CI 0.863-0.978，n=20）。MUR 和 Ki 均与肝转氨酶和胆红素呈显著负相关。