钆塞酸二钠增强磁共振成像评估慢性乙型肝炎患者肝功能的临床研究-东南大学学报医学版

钆塞酸二钠增强磁共振成像评估慢性乙型肝炎患者肝功能的临床研究

单位：1. 江苏省中医院放射科, 江苏南京 210029;
2. 江苏省中医院感染科, 江苏南京 210029

分类号：R512.620.445.2

出版年·卷·期（页码）：2024·43·第一期（64-71）

摘要：

目的: 研究使用钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像(MRI)评估慢性乙型肝炎(CHB)患者肝功能的可行性。方法: 选取2022年10月1日至2023年12月10日江苏省中医院感染科收治的60例CHB患者进行前瞻性研究,所有患者均行Gd-EOB-DTPA增强MRI检查,计算各期信号强度比(SIR)、对比度增强指数(CEI),并与患者的Child-Pugh分级、肝脏实时剪切波弹性成像(SWE)以及无创肝纤维化模型APRI、FIB-4、GPR相比较。结果: 不同Child-Pugh分级的SWE(P<0.001)、SIR_肝胆期(P=0.005)、CEI_肝胆期(P=0.003)、FIB-4(P<0.001)差异均有统计学意义。不同SWE水平CHB患者的SIR_肝胆期(P=0.031)、CEI_肝胆期(P=0.001)、FIB-4(P<0.001)差异均有统计学意义。低CEI_肝胆期组与中CEI_肝胆期组(P=0.017)、高CEI_肝胆期组(P=0.022)之间的SWE差异有统计学意义,不同水平CEI_肝胆期组间的Child-Pugh分布有差异(P=0.011)。CEI_肝胆期水平与SWE呈负相关(r=-0.3973,P=0.0017),CEI_肝胆期水平诊断Child-Pugh B+C级的曲线下面积(AUC)为0.720,灵敏度为0.818,特异度为0.605。结论: Gd-EOB-DTPA增强MRI可以较好地评估CHB患者的肝功能,CEI_肝胆期水平可以定量地辅助诊断肝功能分级。

Objective: To study the performance of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA) enhanced magnetic resonance imaging(MRI) for assessing liver function in patients with chronic hepatitis B(CHB). Methods: 60 patients with CHB were included in this prospective study from Oct.1,2022 to Dec.10,2023. Gd-EOB-DTPA enhanced MRI was conducted,and then the signal intensity ratio(SIR) and contrast enhancement index(CEI) for each phase were calculated. SIR and CEI were compared with Child-Pugh grading,real-time shear wave elastography(SWE)and non-invasive liver fibrosis models including APRI,FIB-4,GPR. Results: SWE(P<0.001),SIR(P=0.005) and CEI(P=0.003) in the liver biliary phase(HBP),FIB-4(P<0.001) showed statistical differences in different Child-Pugh grades. Statistically significant differences were found in SIR_HBP(P=0.031),CEI_HBP(P=0.001) and FIB-4(P<0.001) of different SWE levels.SWE showed significant differencesbetween the low-level CEI_HBPand the medium-level CEI_HBP(P=0.017) as well as high-level CEI_HBP(P=0.022). Child-Pugh levels showed differences among different CEI_HBP group(P=0.011). A negative correlation was found between CEI_HBPand SWE(r=-0.397 3,P=0.001 7). The area under the curve(AUC) of the CEI_HBP level for Child Pugh B+C grade was 0.720,the sensitivity and specificity were 0.818 and 0.605,respectively.Conclusion: Gd-EOB-DTPA enhanced MRI is an effective method for evaluating liver function in patients with CHB. CEI_HBP couldquantitatively measure liver function.

参考文献：

[1] BAI Q,LI R,HE X,et al.Single-cell landscape of immune cells during the progression from HBV infection to HBV cirrhosis and HBV-associated hepatocellular carcinoma[J].Front Immunol,2023,14:1320414.
[2] OBEAGU E I.Hepatitis B immunization strategies and its associated factors:a narrative review[J].Health Sci Rep,2023,6(12):e1748.
[3] LIU Z,LIN C,MAO X,et al.Changing prevalence of chronic hepatitis B virus infection in China between 1973 and 2021:a systematic literature review and meta-analysis of 3740 studies and 231 million people[J].Gut,2023,72(12):2354-2363.
[4] 姚丽熙,林苏,黄娇凤,等.1990-2030年我国乙型病毒性肝炎相关疾病的疾病负担分析及预测[J].中国血吸虫病防治杂志,2023,35(5):464-475,496.
[5] 尤红,王福生,李太生,等.慢性乙型肝炎防治指南(2022年版)[J].实用肝脏病杂志,2023,26(3):457-478.
[6] GOODWIN M D,DOBSON J E,SIRLIN C B,et al.Diagnostic challenges and pitfalls in MR imaging with hepatocyte-specific contrast agents[J].Radiographics,2011,31(6):1547-1568.
[7] CHOI Y,HUH J,WOO D C,et al.Use of gadoxetate disodium for functional MRI based on its unique molecular mechanism[J].Br J Radiol,2016,89(1058):20150666.
[8] SCALI E P,WALSHE T,TIWARI H A,et al.A pictorial review of hepatobiliary magnetic resonance imaging with hepatocyte-specific contrast agents:uses,findings,and pitfalls of gadoxetate disodium and gadobenate dimeglumine[J].Can Assoc Radiol J,2017,68(3):293-307.
[9] KHOURI C C,VERNUCCIO F,RINI F,et al.Hepatobiliary phase in cirrhotic patients with different model for end-stage liver disease score:comparison of the performance of gadoxetic acid to gadobenate dimeglumine[J].Eur Radiol,2019,29(6):3090-3099.
[10] FU J,WU B,WU H,et al.Accuracy of real-time shear wave elastography in staging hepatic fibrosis:a meta-analysis[J].BMC Med Imaging,2020,20(1):16-25.
[11] MARTONIK D,WANDALOWICZ A,SUPRONOWICZ L,et al.Shear-wave elastography for evaluation of hepatic stiffness in chronic viral hepatitis B and C[J].Clin Exp Hepatol,2023,9(2):179-186.
[12] LIU M T,ZHANG X Q,LU J,et al.Evaluation of liver function using the hepatocyte enhancement fraction based on gadoxetic acid-enhanced MRI in patients with chronic hepatitis B[J].Abdom Radiol(NY),2020,45(10):3129-3135.
[13] AMERNIA B,MOOSAVY S H,BANOOKH F,et al.FIB-4,APRI,and AST/ALT ratio compared to FibroScan for the assessment of hepatic fibrosis in patients with non-alcoholic fatty liver disease in Bandar Abbas,Iran[J].BMC Gastroenterol,2021,21(1):453-460.
[14] 彭晓林,张闽光.非酒精性脂肪肝影像学定性定量检测的研究进展[J].现代医学,2021,49(8):981-985.
[15] METWALLY K,ELSABAAWY M,ABDEL-SAMIEE M,et al.FIB-5 versus FIB-4 index for assessment of hepatic fibrosis in chronic hepatitis B affected patients[J].Clin Exp Hepatol,2020,6(4):335-338.
[16] JIN W,LIN Z,XIN Y,et al.Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio indexfor the prediction of hepatitis B-related fibrosis:a leading meta-analysis[J].BMC Gastroenterol,2012,12:14-22.
[17] LEE G M,KIM Y R,RYU J H,et al.Quantitative measurement of hepatic fibrosis with gadoxetic acid-enhanced magnetic resonance imaging in patients with chronic hepatitis B infection:acomparative study on aspartate aminotransferase to platelet ratio index and fibrosis-4 index[J].Korean J Radiol,2017,18(3):444-451.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录