Gd-BOPTA增强MRI肝功能评估预测术后肝衰的可行性研究
|
摘要
目的探索钆贝葡胺(Gd-BOPTA)增强MRI肝功能评估预测术后肝功能衰竭(肝衰)的效能。方法回顾性分析符合纳入标准的61例患者Gd-BOPTA增强MRI资料,测量肝胆期信噪比(SNR)强化率、对比噪声比(CNR)强化率及预计肝残留率。根据国际肝脏外科学组(ISGLS)标准对患者进行评估,分为肝衰组与无肝衰组。比较预测因素组间差异,分析预测因素与术后肝衰的相关性及预测效能。结果两组间SNR强化率、CNR强化率、预计肝残留率、白蛋白组间差异具有统计学意义(P均<0.05),其中预计肝残留率及白蛋白为独立预测因素(P均<0.05)。由年龄、性别、白蛋白、肝实质强化程度(SNR强化率或CNR强化率)构成预测模型,ROC曲线下面积分别为0.753、0.780,其预测效能优于预计肝残留率。结论 Gd-BOPTA增强MRI肝功能评估模型可能为临床提供一种简便、有效的方法预测术后肝衰。
Objective To explore the efficacy of gadolinium(Gd-BOPTA) in enhancing MRI liver function assessment and predicting postoperative liver failure. Methods A retrospective analysis of 213 cases of Gd-BOPTA enhanced MRI images was performed, of which 61 cases were selected. The hepatobiliary SNR enhancement rate, CNR enhancement rate and estimated liver residual rate were measured. Patients were assessed according to the International Hepatology Surgery Group(ISGLS) criteria and were divided into liver failure group and no liver failure group. The differences between predictive factors, the correlation between predictive factors and postoperative liver failure, and predictive efficacy were compared. Results The SNR enhancement rate, CNR enhancement rate, expected residual rate of liver and albumin group were statistically significant(P<0.05). The residual rate of liver and albumin were predicted to be independent predictors(P<0.05). The predictive model consisted of age, gender, albumin, and liver parenchymal enhancement(SNR enhancement rate or CNR enhancement rate). The area under the ROC curve was 0.753 and 0.780, respectively. The predicted performance was better than the expected liver residual rate. Conclusion The Gd-BOPTA enhanced MRI liver function assessment model may provide a simple and effective method for surgeons to predict postoperative liver failure.
Objective To explore the efficacy of gadolinium(Gd-BOPTA) in enhancing MRI liver function assessment and predicting postoperative liver failure. Methods A retrospective analysis of 213 cases of Gd-BOPTA enhanced MRI images was performed, of which 61 cases were selected. The hepatobiliary SNR enhancement rate, CNR enhancement rate and estimated liver residual rate were measured. Patients were assessed according to the International Hepatology Surgery Group(ISGLS) criteria and were divided into liver failure group and no liver failure group. The differences between predictive factors, the correlation between predictive factors and postoperative liver failure, and predictive efficacy were compared. Results The SNR enhancement rate, CNR enhancement rate, expected residual rate of liver and albumin group were statistically significant(P<0.05). The residual rate of liver and albumin were predicted to be independent predictors(P<0.05). The predictive model consisted of age, gender, albumin, and liver parenchymal enhancement(SNR enhancement rate or CNR enhancement rate). The area under the ROC curve was 0.753 and 0.780, respectively. The predicted performance was better than the expected liver residual rate. Conclusion The Gd-BOPTA enhanced MRI liver function assessment model may provide a simple and effective method for surgeons to predict postoperative liver failure.
引文
1 van Mierlo KM,Schaap FG,Dejong CH,et al. Liver resection for cancer:New developments in prediction,prevention and management of postresectional liver failure[J]. J Hepatol,2016,65:1217-1231.
2 Costa AF,Tremblay St-Germain A,Abdolell M,et al. Can contrast-enhanced MRI with gadoxetic acid predict liver failure and other complications after major hepatic resection?[J]. Clin Radiol,2017,72:598-605.
3 Zhao X,Huang M,Zhu Q,et al. The relationship between liver function and liver parenchymal contrast enhancement on Gd-BOPTA-enhanced MRI imaging in the hepatocyte phase[J]. Magn Reson Imaging,2015,33:768-73.
4 Verloh N,Haimerl M,Zeman F,et al. Assessing liver function by liver enhancement during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MRI at 3 Tesla[J]. Eur Radiol,2014,24:1013-1019.
5 中华医学会放射学分会腹部学组. 磁共振成像对比剂钆贝葡胺肝脏应用专家共识[J]. 中华肝胆外科杂志,2017,23:577-584.
6 Rahbari NN,Garden OJ,Padbury R,et al. Posthepatectomy liver failure:a definition and grading by the international study group of liver surgery (ISGLS)[J]. Surgery,2011,149:713-724.
7 Pulitano C,Crawford M,Joseph D,et al. Preoperative assessment of postoperative liver function:the importance of residual liver volume[J]. J Surg Oncol,2014,110:445-450.
8 庞丽华,龙森森,牟玲,等. 自动、半自动与手动方法肝体积测量准确性的比较:Meta 分析研究[J]. 国际医学放射学杂志,2015,38:313-317.
9 Wibmer A,Prusa AM,Nolz R,et al. Liver failure after major liver resection:risk assessment by using preoperative gadoxetic acid-enhanced 3-T MR imaging[J]. Radiology,2013,269:777-786.
10 Kamiyama T,Nakanishi K,Yokoo H,et al. Perioperative management of hepatic resection toward zero mortality and morbidity:analysis of 793 consecutive cases in a single institution[J]. J Am Coll Surg,2010,211:443-449.
11 龙拥军,卓丽华,王艳菊,等. Gd-BOPTA 增强磁共振成像肝胆期信号反映肝功能关系研究[J]. 实用放射学杂志,2015,31:955-957.
12 Jin YJ,Lee SH,Cho SG,et al. Prediction of postoperative liver failure using gadoxetic acid-enhanced magnetic resonance imaging in patients with hepatocellular carcinoma[J]. J Gastroenterol Hepatol,2016,31:1349-1356.
13 Geisel D,Lüdemann L,Fr?lling V,et al. Imaging-based evaluation of liver function:comparison of 99m Tc-mebrofenin hepatobiliary scintigraphy and Gd-EOB-DTPA-enhanced MRI[J]. Eur Radiol,2015,25:1384-1391.
14 Ringe KI,Boll DT,Husarik DB,et al. Lesion detection and assessment of extrahepatic findings in abdominal MRI using hepatocyte specific contrast agents-comparison of Gd-EOB-DTPA and Gd-BOPTA[J/OL]. BMC Med Imaging,2013,13:10.
2 Costa AF,Tremblay St-Germain A,Abdolell M,et al. Can contrast-enhanced MRI with gadoxetic acid predict liver failure and other complications after major hepatic resection?[J]. Clin Radiol,2017,72:598-605.
3 Zhao X,Huang M,Zhu Q,et al. The relationship between liver function and liver parenchymal contrast enhancement on Gd-BOPTA-enhanced MRI imaging in the hepatocyte phase[J]. Magn Reson Imaging,2015,33:768-73.
4 Verloh N,Haimerl M,Zeman F,et al. Assessing liver function by liver enhancement during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MRI at 3 Tesla[J]. Eur Radiol,2014,24:1013-1019.
5 中华医学会放射学分会腹部学组. 磁共振成像对比剂钆贝葡胺肝脏应用专家共识[J]. 中华肝胆外科杂志,2017,23:577-584.
6 Rahbari NN,Garden OJ,Padbury R,et al. Posthepatectomy liver failure:a definition and grading by the international study group of liver surgery (ISGLS)[J]. Surgery,2011,149:713-724.
7 Pulitano C,Crawford M,Joseph D,et al. Preoperative assessment of postoperative liver function:the importance of residual liver volume[J]. J Surg Oncol,2014,110:445-450.
8 庞丽华,龙森森,牟玲,等. 自动、半自动与手动方法肝体积测量准确性的比较:Meta 分析研究[J]. 国际医学放射学杂志,2015,38:313-317.
9 Wibmer A,Prusa AM,Nolz R,et al. Liver failure after major liver resection:risk assessment by using preoperative gadoxetic acid-enhanced 3-T MR imaging[J]. Radiology,2013,269:777-786.
10 Kamiyama T,Nakanishi K,Yokoo H,et al. Perioperative management of hepatic resection toward zero mortality and morbidity:analysis of 793 consecutive cases in a single institution[J]. J Am Coll Surg,2010,211:443-449.
11 龙拥军,卓丽华,王艳菊,等. Gd-BOPTA 增强磁共振成像肝胆期信号反映肝功能关系研究[J]. 实用放射学杂志,2015,31:955-957.
12 Jin YJ,Lee SH,Cho SG,et al. Prediction of postoperative liver failure using gadoxetic acid-enhanced magnetic resonance imaging in patients with hepatocellular carcinoma[J]. J Gastroenterol Hepatol,2016,31:1349-1356.
13 Geisel D,Lüdemann L,Fr?lling V,et al. Imaging-based evaluation of liver function:comparison of 99m Tc-mebrofenin hepatobiliary scintigraphy and Gd-EOB-DTPA-enhanced MRI[J]. Eur Radiol,2015,25:1384-1391.
14 Ringe KI,Boll DT,Husarik DB,et al. Lesion detection and assessment of extrahepatic findings in abdominal MRI using hepatocyte specific contrast agents-comparison of Gd-EOB-DTPA and Gd-BOPTA[J/OL]. BMC Med Imaging,2013,13:10.