本文選題：Gd-EOB-DTPA + 普美顯�。� 參考：《蘭州大學》2014年碩士論文

【摘要】：目的：系統(tǒng)評價特異性肝膽對比劑Gd-EOB-DTPA(釓塞酸二鈉)對肝臟惡性腫瘤(肝細胞肝癌,肝轉移癌)的診斷價值。 材料與方法：系統(tǒng)檢索CNKI[2011.1(2011年Gd-EOB-DTPA在國內(nèi)上市)～2013.5]、CBM (2011.1～2013.5)、VIP (2011.1～2013.5)、中華醫(yī)學會數(shù)字化期刊庫(2011.1～2013.5)、PubMed[20041((2004年開始Gd-EOB-DTPA首次在歐洲上市)～2013.5]、Cochrane Library(2012年第1期)、EMbase (2004.1～2013.5)等。并追溯納入研究的參考文獻,依據(jù)QUADAS質量評價標準評價納入研究的質量,采用stata12.0軟件進行Meta分析,分別統(tǒng)計合并的敏感度(Sensitivity, SEN),特異度(Specificity, SPE),陽性似然比(Positive Likelihood Ratio, PLR),陰性似然比(Negative Likelihood Ratio,NLR),診斷比值比(Diagnostic Odds Ratio, dOR), SROC曲線下面積(Areas Under Roc Curve, AUC)等數(shù)據(jù)評價Gd-EOB-DTPA對于肝臟惡性腫瘤的診斷價值。 結果：共納入19篇文獻,分別來自6個國家,共包括1088名患者,2661個結節(jié),Meta分析結果顯示：Gd-EOB-DTPA對肝臟轉移瘤組的合并敏感度為0.93[95%CI (0.88,0.96),特異度為0.91[95%CI (0.83,0.96),陽性似然比為10.66[95%CI (5.49,20.67),陰性似然比為0.075[95%CI (0.04,0.03),診斷OR值為142.530[95%CI (62.080,327.237)],SROC曲線下面積為0.97。Q*值為0.9171。亞組分析的結果表明對于小于10mm的結節(jié)合并敏感度為[0.66(95%CI：0.54-0.79),P=0.038],大于10mm的結節(jié)合并敏感度為[0.94(95%CI：0.90-0.99),P=0.211],兩者之間的P值小于0.001。1.5T磁共振合并敏感度為[0.89(95%CI：0.85-0.94),P0.001].3.OT磁共振敏感度則為[O.99(95%CI：0.98-1.007),P=0.320]。兩者之間的P值0.001；研究對象為歐洲人時合并敏感度為[O.89(95%CI：0.83-0.95),P0.001],當研究對象為亞洲人時合并敏感度為[0.94(95%CI：0.90-0.99),P=0.009],而回顧性研究的合并敏感度則為[0.93(95%CI：0.89-0.96),P0.001]。前瞻性研究的敏感度為0.88。兩者之間P值=0.275。 肝細胞肝癌組合并敏感度為0.92[95%CI(0.89,0.94)](圖2),合并特異度為0.95[95%CI(O.93,0.97)],合并陽性似然比為18.87[95%CI(13.51,26.37)],合并陰性似然比為0.09[95%CI(0.07,0.12)],合并診斷OR值為212.13[95%CI(127.26,353.62)],SROC曲線下面積為0.98[95%CI(0.95,0.99)]。亞組分析的結果表明Gd-EOB-DTPA對于小于10mmm的結節(jié)合并診斷敏感度為[0.70(95%CI：0.52-0.87),P0.001],大于20mm的結節(jié)診斷合并敏感度為[0.98(95%CI：0.96-00),P=0.66],對于大小在1Omm與20mm之間的結節(jié)診斷敏感度為[0.93(95%CI：0.86-1.01),P=0.026]小于10mm結節(jié)與10mm-20mm結節(jié)之間P值為0.008,10mm-20mm結節(jié)與大于20mm結節(jié)之間P值為0.318,小于10mmm結節(jié)與大于20mm結節(jié)之間的P值則為0.002。當研究的對象為亞洲人時其合并敏感度為[0.90(95%CI:0.87-0.92), P=0.455]。當研究對象的為歐洲人時研究敏感度為[0.97(95%CI:0.90-0.99, P=0.237]。兩者之間P值為0.013。前瞻性研究的合并敏感度為[0.95(95%CI:0.91-0.98), P=0.004],回顧性研究的合并敏感度為[0.90(95%CI:0.88-0.93), P=0.004]。兩者之間P值為0.023。而1.5T磁共振合并診斷敏感度為[0.92(95%CI：0.88-0.95),P0.001].3.0T磁共振診斷敏感度則為[0.92(95%CI：0.89-0.95),P=0.602]。兩者之間的P值大于0.99； 結論：(1)Gd-EOB-DTPA對肝臟惡性腫瘤具有明確的診斷效能。(2)對于結節(jié)直徑大于10mm的肝臟惡性腫瘤具有良好的診斷敏感度。(3)使用3.0T磁共振成像系統(tǒng)的肝轉移瘤診斷敏感度較高。但是它仍然是一個新近上市的對比劑,需要更多高質量的研究來進一步證實它的臨床應用價值 目的：全面評價肝功能正常或不正常的患者Gd-EOB-DTPA增強檢查肝細胞期適宜的延遲時間,從而滿足臨床需要。 方法：連續(xù)選取2013年1月-2014年1月懷疑患有肝臟占位性病變行Gd-EOB-DTPA增強檢查的患者45名,在收集三期動態(tài)對比增強圖像的基礎上延遲5、10、20分鐘采集圖像,分別評估每期肝臟、肌肉、結節(jié)信號值及膽總管不同排泄時間的信號變化,計算肝臟／肌肉信號比、對比噪聲比(CNR),信噪比(SNR)；回顧性按Child-Pugh肝功能分級標準分級并分組,與肝細胞期信號變化比較、分析,判定其臨床意義 結果：共31位患者Child-Pugh肝功能分級被分為A級,共有13人肝功能被分為B級,1人肝功能被分為C級。我們根據(jù)肝功能分為肝功能A級組與肝功能B級組來進行研究：(1)肝功能A級組肝實質信號與增強前相比,延遲5分鐘、10分鐘及20分鐘后肝實質增強百分比的中位數(shù)及四分位間距分別為：56.7%(IQR=0.17),57.8%(IQR=0.22)及60.1%(IQR=0.24),延遲10分鐘與延遲20分鐘之間差異不具有統(tǒng)計學意義(P=O.135)；肝功能B級組肝實質信號值與增強前相比,延遲5分鐘、10分鐘及20分鐘后增強百分比的中位數(shù)及四分位間距分別為：54.6%(IQR=0.44),51.3%(IQR=0.47)及52.1(IQR=0.55),延遲10分鐘與延遲20分鐘之間差異不具有統(tǒng)計學意義(P=0.859)。肝功能A級組肝實質強化程度與肝功能B級組延遲10分鐘與延遲20分鐘比較差異沒有統(tǒng)計學意義(P=0.767,P=0.594)。(2)肝細胞肝癌病灶5分鐘與20分鐘CNR值比較差異具有統(tǒng)計學意義(P=0.028)；肝轉移瘤10分鐘與20分鐘比較差別具有統(tǒng)計學意義(P=0.011)。肝臟病灶在肝細胞期沒有顯示出新的強化特點。(3)肝功能A級組延遲10分鐘61.3%膽總管開始顯影,延遲20分鐘90.3%的膽總管顯影。有9.7%的膽總管始終未見顯影。肝功能B級組的患者延遲10分鐘時38.5%的膽總管開始顯影,延遲20分鐘時84.6%膽總管可見顯影,15.4%的膽總管全程未見顯影； 結論：本次研究結合肝實質對Gd-EOB-DTPA的攝取、排泄和病灶增強特征。結果表明,肝功能Child-Pugh分級A級與B級的患者,Gd-EOB-DTPA增強檢查延遲20分鐘肝實質的強化程度與延遲10分鐘沒有明顯統(tǒng)計學差異,同時延遲10分鐘即能夠明確肝臟結節(jié)的性質,故如果觀察重點在于結節(jié)的性質和強化特點時,肝功能Child-Pugh A級或者B級的患者肝細胞期延遲10分鐘檢查即能夠滿足臨床診斷的需要,本研究的結果還需要更多的臨床研究進一步證實。
[Abstract]:Objective : To evaluate the diagnostic value of Gd - EOB - DTPA ( Gd - EOB - DTPA ) ( Gd - EOB - DTPA ) in the diagnosis of hepatic malignant tumor ( hepatocellular carcinoma and hepatic metastases ) .

Materials and Methods : The diagnostic value of Gd - EOB - DTPA in the diagnosis of hepatic malignant tumors was evaluated by using stata12 . 0 software for Meta - analysis , including sensitivity ( SEN ) , specificity ( SPE ) , positive likelihood ratio ( PLR ) , negative likelihood ratio ( NLR ) , diagnostic odds ratio ( PLR ) , negative likelihood ratio ( NLR ) , diagnostic odds ratio ( PLR ) , negative likelihood ratio ( NLR ) , diagnostic odds ratio ( AUC ) and so on .

Results : 19 literatures were included , and the sensitivity of Gd - EOB - DTPA to liver metastasis was 0.93 % 95 % CI ( 0 . 88 , 0.96 ) , specificity was 0 . 91 % 95 % CI ( 0 . 83 , 0 . 96 ) , the specificity was 0 . 91 % 95 % CI ( 0 . 08 , 327 . 237 ) , P = 0 . 089 ( 95 % CI : 0.85 - 0.94 ) , P = 0 .
The sensitivity of the retrospective study was 0 . 93 ( 95 % CI : 0.89 - 0.96 ) , P = 0 . 009 ) , while the sensitivity of the retrospective study was 0 . 93 ( 95 % CI : 0.89 - 0.96 ) , P = 0 . 009 ) , while the sensitivity of the prospective study was 0.88 .

The results showed that the sensitivity of the combination was 0 . 95 % CI : 0 . 95 % CI : 0 . 90 - 0 . 99 , P = 0 .


Conclusion : ( 1 ) Gd - EOB - DTPA has definite diagnostic efficacy on hepatic malignant tumor .

Objective : To evaluate the suitable delay time of Gd - EOB - DTPA in patients with normal or abnormal liver function in order to meet the clinical needs .

Methods : 45 patients with Gd - EOB - DTPA enhanced examination were continuously selected from January 2013 to January 2014 , and the images were collected on the basis of collecting three dynamic contrast enhanced images , and the signal changes of liver , muscle , nodule signal value and different excretion time of common bile duct were assessed , and the ratio of liver / muscle signal ratio , CNR and SNR were calculated .
The clinical significance of the classification and grouping of liver function in the liver and liver cells was reviewed and compared with the changes of liver cell phase signal .

Results : A total of 31 patients were classified into A - grade , with a total of 13 patients with liver function divided into B - grade , 1 - man liver function divided into C - grade .
There was no significant difference ( P = 0.859 ) between 10 minutes and 20 minutes after delayed 5 minutes , 10 minutes and 20 minutes after delayed 5 minutes , 10 minutes and 20 minutes compared with that before enhancement ( P = 0.859 ) . There was no significant difference between the 10 minutes and the delayed 20 minutes ( P = 0.767 , P = 0.594 ) . ( 2 ) There was a significant difference between the five minutes and 20 minutes of the liver cancer lesions ( P = 0.028 ) .
There was no significant difference in liver metastases between 10 minutes and 20 minutes ( P = 0 . 011 ) .


Conclusion : This study combined with liver parenchyma on the uptake , excretion and enhancement of Gd - EOB - DTPA . The results showed that there was no significant difference in the degree of enhancement of liver parenchyma between patients with liver function Child - A grade A and grade B , and that of Gd - EOB - DTPA was delayed for 10 minutes .

【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R735.7;R445.2

【參考文獻】

相關期刊論文 前1條

1 錢海峰;祝躍明;吳曉;李鳳琪;宣浩波;沈健;;增強磁共振成像和擴散加權成像序列對肝轉移瘤檢出價值的比較[J];中國醫(yī)學科學院學報;2012年06期

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本文編號：1889127