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钆塞酸二钠增强MRI在肝癌大切除患者中的价值

[The value of Gd-EOB-DTPA-enhanced MRI in patients with major resection of liver cancer].

作者信息

Ye C, Ren S Q, AbuduHaibaier Sadula, Guo X, Yuan M, Yuan C H, Xiu D R

机构信息

Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.

出版信息

Zhonghua Wai Ke Za Zhi. 2020 Oct 1;58(10):765-769. doi: 10.3760/cma.j.cn112139-20200709-00550.

Abstract

To investigate the value of Gd-EOB-DTPA-enhanced MRI in evaluating liver function and predicting the risk of post-hepatoectomy liver failure in patients with major resection of liver cancer. A total number of 212 patients were included from June 2016 to June 2019 at Department of General Surgery, Peking University Third Hospital with a retrospectively collected data.All patients underwent Gd-EOB-DTPA-enhanced MRI for diagnosis and preoperative evaluation of liver function.There were 135 males and 77 females, with age of (63.1±10.3) years old (range: 18 to 86 years old) . Relative enhancement ratio (RER) of the region of interest on Gd-EOB-DTPA-enhanced MRI was acquired by two independent researcher and then conducted the comparison of RER among the patients with or without post-hepatoectomy liver failure (PHLF) .Preoperative evaluation demonstrated that 141 cases infected by hepatitis virus, 128 cases with hepatitis B alone and 11 cases with hepatitis C alone, 2 cases had both of hepatitis B and C, and all patients were grade A judged by Child-Pugh score. The relationship between RER and PHLF was evaluated by Pearson correlation analysis and the diagnostic value of RER in predicting PHLF was test by receiver operating characteristic curve. PHLF occurred in 42 patients according to ISGLS standard. Among them, 31 cases had level A liver failure, 9 cases had level B liver failure and 2 had level C failure. There was a significant correlation between RER and overall level of PHLF and RER was also significantly associated with severe B to C level of PHLF (0.05) .The further receiver operating characteristics curve analysis showed that the diagnostic accuracy of RER on overall PHLF was 0.818 (sensitivity 72.9%, specificity 83.3%, cut-off value 73.5%, 95: 0.75 to 0.887) and on severe PHLF was 0.924 (sensitivity 97.0%, specificity 90.9%, cut-off value: 61.5%, 95: 0.79 to 0.90) . For patients who planned to undergo major resection of liver cancer, preoperative Gd-EOB-DTPA-enhanced MRI can help with the assessment of liver function and predicting the risk for post-hepatectomy liver failure.

摘要

探讨钆塞酸二钠增强磁共振成像(Gd-EOB-DTPA-enhanced MRI)在评估肝癌大切除患者肝功能及预测肝切除术后肝衰竭风险中的价值。回顾性收集2016年6月至2019年6月北京大学第三医院普通外科收治的212例患者的资料。所有患者均行Gd-EOB-DTPA增强MRI检查以进行肝功能诊断及术前评估。其中男性135例,女性77例,年龄(63.1±10.3)岁(范围:18至86岁)。由两名独立研究人员获取Gd-EOB-DTPA增强MRI上感兴趣区域的相对增强率(RER),然后比较肝切除术后肝衰竭(PHLF)患者与未发生PHLF患者的RER。术前评估显示,141例患者感染肝炎病毒,其中单纯乙型肝炎128例,单纯丙型肝炎11例,乙型和丙型肝炎合并感染2例,所有患者Child-Pugh评分均为A级。采用Pearson相关分析评估RER与PHLF的关系,并通过受试者工作特征曲线检验RER预测PHLF的诊断价值。根据国际肝脏外科研究组(ISGLS)标准,42例患者发生PHLF。其中,31例为A级肝衰竭,9例为B级肝衰竭,2例为C级肝衰竭。RER与PHLF总体水平之间存在显著相关性,RER与B级至C级严重PHLF也显著相关(P<0.05)。进一步的受试者工作特征曲线分析显示,RER对总体PHLF的诊断准确性为0.818(敏感性72.9%,特异性83.3%,截断值73.5%,95%可信区间:0.75至0.887),对严重PHLF的诊断准确性为0.924(敏感性97.0%,特异性90.9%,截断值:61.5%,95%可信区间:0.79至0.90)。对于计划行肝癌大切除手术患者,术前Gd-EOB-DTPA增强MRI有助于评估肝功能及预测肝切除术后肝衰竭风险。

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