【摘要】：目的:1、探討肝臟特異性對比劑釓塞酸二鈉(GD-EOB-DTPA)增強(qiáng)肝臟MR肝膽期不同肝功能狀態(tài)攝取對比劑差異,評價(jià)不同肝功能狀態(tài)肝功能。2、GD-EOB-DTPA增強(qiáng)肝臟MR肝膽期評價(jià)肝癌經(jīng)動(dòng)脈導(dǎo)管化療栓塞(TACE)術(shù)后及肝癌微波固化術(shù)后對局部肝功能影響。方法:1、研究對象:回顧性分析50例局灶性病變患者,均行Gd—EOB—DTPA磁共振動(dòng)態(tài)增強(qiáng)掃描,男45例,女5例,年齡25-76歲,平均年齡(54.2±12.8)歲。其中肝硬化患者32例,非肝硬化患者18例。納入標(biāo)準(zhǔn):局灶性病變,病灶最大徑小于10cm;病例影像及臨床生化資料齊全,能獲得一般資料及Child—Pugh分級評分所需指標(biāo)。排除標(biāo)準(zhǔn):嚴(yán)重運(yùn)動(dòng)偽影;肝臟彌漫性占位;嚴(yán)重腎功能不全。2、檢查方法:MRI檢查采用Siemens Trio Tim 3.0T超導(dǎo)型磁共振掃描儀,體部相控陣線圈,患者取仰臥位,將上腹部置于體部線圈的中央。磁共振掃描序列包括T2WI橫斷位、T2WI抑脂橫斷位、T1WI正反相位、擴(kuò)散加權(quán)成像(DWI)、3D擾相容積序列(VIBE)抑脂橫斷位、VIBE抑脂動(dòng)態(tài)三期增強(qiáng)及延遲20min VIBE抑脂肝膽期。避免呼吸運(yùn)動(dòng)偽影,掃描前作屏氣訓(xùn)練,掃描時(shí)為囑患者深吸氣后屏氣。3、肝硬化患者按Child—Pugh分級法行肝功能分級,其中Child—Pugh A級21例,Child—Pugh B級9例,Child—Pugh C級2例。非肝硬化病例中無肝、腎基礎(chǔ)疾病,肝、腎功能生化檢查正常者作為正常對照組,入組7例。4、分析不同肝功能狀態(tài)肝膽期肝臟攝取造影劑能力差異;分析肝癌經(jīng)動(dòng)脈導(dǎo)管化療栓塞(TACE)術(shù)后及肝癌微波固化術(shù)后肝膽期病灶周邊肝實(shí)質(zhì)與平均肝實(shí)質(zhì)信號增強(qiáng)程度(IS%)差異。結(jié)果:1、正常對照組與Child-Pugh A級、Child—Pugh B級、Child—Pugh C級組間肝實(shí)質(zhì)信號增強(qiáng)程度(IS%)有顯著差異(P0.05);2、Child-Pugh A級與Child—Pugh B級、Child—Pugh C級組間肝實(shí)質(zhì)信號增強(qiáng)程度(IS%)有顯著差異(P0.05);3、Child—Pugh B級、Child—Pugh C級組增強(qiáng)程度(IS%)無明顯差異(P=0.24);4、1例肝癌介入術(shù)后病灶及2例肝癌微波固化術(shù)后病灶周圍肝實(shí)質(zhì)IS%較平均肝實(shí)質(zhì)IS%明顯減低,13例病灶灶周肝實(shí)質(zhì)IS%較平均肝實(shí)質(zhì)IS%無明顯差異(P=0.37)。結(jié)論:1、不同功能狀態(tài)肝細(xì)胞攝取對比劑程度不同,正常對照組、Child-Pugh A級、Child—Pugh B級組隨肝功能下降,GD-EOB-DTPA磁共振增強(qiáng)肝膽期肝臟信號增強(qiáng)程度減低。2、GD-EOB-DTPA磁共振增強(qiáng)肝膽期對顯示Child—Pugh B級、Child—Pugh C級組肝功能差異不敏感。3、GD-EOB-DTPA磁共振增強(qiáng)肝膽期可以顯示肝癌經(jīng)動(dòng)脈導(dǎo)管化療栓塞(TACE)術(shù)后及肝癌微波固化術(shù)后局部肝功能情況,GD-EOB-DTPA磁共振增強(qiáng)肝膽期可以反映肝細(xì)胞功能及全肝功能,亦可反映局部肝功能。目的:與CT增強(qiáng)相比,探討肝臟特異性對比劑釓賽酸二鈉(GD-EOB-DTPA)增強(qiáng)MR在肝癌熱消融術(shù)后評價(jià)的臨床價(jià)值及優(yōu)勢。方法:1、研究對象:原發(fā)性肝癌熱消融治療患者,并具有CT增強(qiáng)及GD-EOB-DTPA磁共振增強(qiáng)隨訪資料。2、分析原發(fā)性肝癌熱消融術(shù)后患者GD-EOB-DTPA磁共振增強(qiáng)及CT增強(qiáng)影像資料。所有納入病例均行MR動(dòng)態(tài)增強(qiáng)、延遲20min肝膽期成像及CT動(dòng)態(tài)成像,對比分析GD-EOB-DTPA增強(qiáng)MRI評價(jià)肝癌熱消融術(shù)后復(fù)發(fā)的優(yōu)勢。結(jié)果:1、23例患者中有14例出現(xiàn)腫瘤復(fù)發(fā),9例無明顯腫瘤復(fù)發(fā),復(fù)發(fā)病灶中8例為單發(fā)病灶,6例為多發(fā),總共28個(gè)病灶,CT增強(qiáng)檢出病灶22個(gè),GD-EOB-DTPA增強(qiáng)MRI共檢出病灶29個(gè),其中一例術(shù)后診斷為小囊腫,肝膽期均為低信號,2、GD-EOB-DTPA增強(qiáng)MRI與CT增強(qiáng)對病灶診斷敏感性、特異性、陽性預(yù)測值、陰性預(yù)測值及診斷準(zhǔn)確性分別為100%、90%、97%、100%、97%;71%、82%、91%、53%、74%,GD-EOB-DTPA動(dòng)態(tài)MR增強(qiáng)評價(jià)肝癌熱消融術(shù)后復(fù)發(fā)各預(yù)測值均優(yōu)于CT增強(qiáng)。結(jié)論:GD-EOB-DTPA評價(jià)肝癌熱消融術(shù)后復(fù)發(fā)較CT增強(qiáng)具有明顯優(yōu)勢;對顯示小病灶、多發(fā)病灶具有顯著優(yōu)勢。
[Abstract]:Objective: 1. To investigate the difference of liver-specific contrast agent Gd-EOB-DTPA in enhancing liver function at different stages of MR hepatobiliary phase, and to evaluate liver function at different stages of MR hepatobiliary phase. Methods: 1. Subjects: A retrospective analysis of 50 patients with focal lesions, Gd-EOB-DTPA dynamic contrast-enhanced MRI scanning, 45 males, 5 females, age 25-76 years, average age (54.2 + 12.8) years. 32 patients with cirrhosis, 18 patients with non-cirrhosis. Exclusion criteria: severe motion artifacts; diffuse hepatic space occupancy; severe renal insufficiency. 2. Examination methods: MRI scan using Siemens Trio Tim 3.0T superconducting magnetic resonance scanner, body phased array coil, patients take supine position, will be upper abdomen MR scan sequence included T2WI transverse section, T2WI lipid suppression transverse section, T1WI positive and negative phase, diffusion weighted imaging (DWI), 3D perturbation volume sequence (VIBE) lipid suppression transverse section, VIBE dynamic three-phase enhancement and delayed 20 min VIBE lipid suppression hepatobiliary phase. To instruct patients to hold their breath after deep breathing, liver cirrhosis patients were graded according to Child-Pugh grading method, including 21 cases of Child-Pugh A, 9 cases of Child-Pugh B and 2 cases of Child-Pugh C. Non-cirrhosis patients without liver, kidney diseases, normal liver and kidney function biochemical examination were selected as normal control group, and 7.4 cases were divided into two groups. Results: 1. The liver parenchyma of normal control group was different from that of C hild-Pugh A, C hild-Pugh B, C hild-Pugh C groups. Significant difference in signal enhancement (IS%) was found between C hild-Pugh A and C hild-Pugh B, C hild-Pugh C, and C hild-Pugh C groups (P 0.05). 3, C hild-Pugh B and C hild-Pugh C had no significant difference (P = 0.24). 4, 1 case of hepatocellular carcinoma and 2 cases of hepatocellular carcinoma were cured by microwave. The IS% of liver parenchyma around the lesion was significantly lower than the average IS% of liver parenchyma after operation, and the IS% of liver parenchyma around the lesion was not significantly different from the average IS% of liver parenchyma in 13 cases (P = 0.37). Conclusion: 1. The degree of contrast medium uptake by hepatocytes in different functional states was different in normal control group, Child-Pugh A group and Child-Pugh B group. Hepatobiliary phase signal enhancement was decreased. 2. GD-EOB-DTPA enhanced hepatobiliary phase was not sensitive to the difference of hepatic function in Child-Pugh B and Child-Pugh C groups. 3. GD-EOB-DTPA enhanced hepatobiliary phase could show the local hepatic function of hepatocellular carcinoma after transcatheter chemoembolization (TACE) and hepatocellular carcinoma after microwave curing. Objective: To investigate the clinical value and advantages of liver-specific contrast agent disodium gadolinate (GD-EOB-DTPA) in the evaluation of hepatocellular carcinoma after thermal ablation compared with CT enhancement. All patients underwent dynamic contrast-enhanced MR imaging with a 20-minute delay in hepatobiliary phase and dynamic CT imaging, and compared with GD-EOB-DTPA enhanced MRI in the evaluation of hepatocellular carcinoma thermal ablation. Results: Of the 1,23 patients, 14 had recurrence, 9 had no obvious recurrence, 8 had single lesion, 6 had multiple lesions, a total of 28 lesions, 22 lesions were detected by CT enhancement, 29 lesions were detected by GD-EOB-DTPA enhanced MRI, one of which was diagnosed as small cyst, low signal in hepatobiliary phase, 2, GD-EOB. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of enhanced MRI and CT were 100%, 90%, 97%, 100%, 97%, 71%, 82%, 91%, 53%, 74%, respectively. The predictive value of GD-EOB-DTPA dynamic MR enhancement in evaluating the recurrence of hepatocellular carcinoma after thermal ablation was better than that of CT enhancement. It has obvious advantages over CT enhancement, and has a significant advantage in showing small lesions and multiple lesions.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7;R445.2

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