切换至 "中华医学电子期刊资源库"

中华消化病与影像杂志(电子版) ›› 2022, Vol. 12 ›› Issue (04) : 204 -209. doi: 10.3877/cma.j.issn.2095-2015.2022.04.003

论著

钆塞酸二钠增强磁共振成像肝胆期对比剂摄取相关参数评估药物性肝损伤的价值
王笑笑1, 胡景卉1, 刘金韵2, 陈俊飞2, 黄京城2, 罗先富3,()   
  1. 1. 225001 江苏扬州,苏北人民医院影像科
    2. 116011 辽宁大连,大连医科大学扬州临床医学院
    3. 225001 江苏扬州,苏北人民医院影像科;116011 辽宁大连,大连医科大学扬州临床医学院
  • 收稿日期:2021-12-01 出版日期:2022-08-01
  • 通信作者: 罗先富

Value of contrast agent uptake related parameters of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging in evaluating the severity of drug induced liver injury in hepatobiliary phase

Xiaoxiao Wang1, Jinghui Hu1, Jinyun Liu2, Junfei Chen2, Jingcheng Huang2, Xianfu Luo3,()   

  1. 1. Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou 225001, China
    2. Yangzhou Clinical Medical College, Dalian Medical University, Dalian 116011, China
    3. Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou 225001, China; Yangzhou Clinical Medical College, Dalian Medical University, Dalian 116011, China
  • Received:2021-12-01 Published:2022-08-01
  • Corresponding author: Xianfu Luo
引用本文:

王笑笑, 胡景卉, 刘金韵, 陈俊飞, 黄京城, 罗先富. 钆塞酸二钠增强磁共振成像肝胆期对比剂摄取相关参数评估药物性肝损伤的价值[J/OL]. 中华消化病与影像杂志(电子版), 2022, 12(04): 204-209.

Xiaoxiao Wang, Jinghui Hu, Jinyun Liu, Junfei Chen, Jingcheng Huang, Xianfu Luo. Value of contrast agent uptake related parameters of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced magnetic resonance imaging in evaluating the severity of drug induced liver injury in hepatobiliary phase[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2022, 12(04): 204-209.

目的

探讨钆塞酸二钠(Gd-EOB-DTPA)增强磁共振成像(MRI)肝胆期对比剂摄取相关参数评估药物性肝损伤(DILI)患者肝损伤程度的价值。

方法

选择2020年1月至2021年6月扬州大学附属苏北人民医院收治的55例DILI患者,其中轻症DILI组29例,重症DILI组26例。选择同期30例肝功能正常患者(非DILI组)作为对照。回顾性分析患者Gd-EOB-DTPA增强MRI图像,测量增强前及增强后肝胆期肝脏、门静脉与脾脏信号强度,计算肝脏相对强化程度(RE)、肝脏相对于门静脉强化程度比(LPC)、肝脏相对于脾脏强化程度比(LSC),同时评价功能性肝脏影像评分(FLIS)。比较非DILI组、轻症DILI组、重症DILI组患者各参数差异。采用Pearson相关分析Gd-EOB-DTPA增强MRI肝胆期对比剂摄取相关参数与肝功能指标的相关性。绘制受试者操作特征(ROC)曲线分析Gd-EOB-DTPA增强MRI肝胆期对比剂摄取相关参数鉴别轻症DILI组与重症DILI组的效能。

结果

DILI组患者RE、LPC、LSC均低于非DILI组患者,且随着肝损伤程度的加重而降低,且差异均有统计学意义(P均<0.05)。RE、LPC与DILI患者总胆红素水平呈中度负相关(r=-0.53、-0.51,P<0.05),与DILI患者总蛋白水平呈中度正相关(r=0.54、0.53,P<0.05)。ROC曲线显示,RE、LPC、LSC、FLIS区分轻症DILI组与重症DILI组患者的曲线下面积(AUC)分别为0.74、0.81、0.74、0.78。

结论

Gd-EOB-DTPA增强MRI肝胆期对比剂摄取相关参数可评估DILI患者肝损伤程度,为临床定量评估DILI严重程度提供了新的辅助方法。

Objective

To investigate the value of parameters obtained from gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) uptake in hepatobiliary phase of enhanced magnetic resonance imaging (MRI) for evaluating the severity of drug induced liver injury.

Methods

A total of 55 patients with drug induced liver injury admitted to North Jiangsu People's Hospital from January 2020 to June 2021 were selected, including 29 patients in the mild group and 26 patients in the severe group. Thirty patients with normal liver function were selected as control group. Gd-EOB-DTPA enhanced MRI images of patients were retrospectively analyzed. The signal intensity of liver, portal vein and spleen before enhancement and in hepatobiliary phase were measured, and the liver relative enhancement (RE), the enhancement degree of liver relative to portal vein (LPC), and the ratio of liver to spleen (LSC) were calculated. Functional liver imaging score (FLIS) was also performed. The parameters of the control group, mild drug-induced liver injury group and severe drug-induced liver injury group were compared. Pearson correlation analysis was used to analyze the correlation between hepatobiliary phase parameters and liver injury biochemical indexes in enhanced MRI. Receiver operating characteristic (ROC) curves were drawn to analyze the efficacy of different parameters in differentiating the mild and severe liver injury group.

Results

The parameters of RE, LPC and LSC in patients with drug induced liver injury were lower than those in the control group, and the parameters decreased gradually with the aggravation of liver injury, with statistically significant differences (all P<0.05). RE and LPC were moderately negatively correlated with the level of total bilirubin (r=-0.53, -0.51, P<0.05) and moderately positively correlated with the level of total protein (r=0.54, 0.53, P<0.05) in patients with drug induced liver injury. The areas under the ROC curve of RE, LPC, LSC, LFIS for distinguishing the mild and severe drug induced liver injury groups were 0.74, 0.81, 0.74, 0.78 respectively.

Conclusion

The parameters related to Gd-EOB-DTPA enhanced MRI in hepatobiliary phase can evaluate the severity of drug induced liver injury, providing a new auxiliary method for clinical quantitative assessment of drug induced liver injury severity.

图1 DILI患者Gd-EOB-DTPA增强MRI图像。图A为平扫期,白色、红色、黄色圆圈分别代表肝脏各段、门静脉及脾脏ROI位置;图B为肝胆期,白色、红色、黄色圆圈分别代表对照平扫期画取的ROI位置
表1 DILI组与非DILI组患者一般临床资料比较
表2 轻症DILI组与重症DILI组患者一般临床资料及影像学特征比较
表3 DILI组与非DILI组患者Gd-EOB-DTPA增强MRI肝胆期摄取参数比较(±s
表4 不同程度DILI组与非DILI组患者Gd-EOB-DTPA增强MRI肝胆期摄取参数比较(±s
图2 非DILI组(A)、轻症DILI组(B)、重症DILI组(C)患者注射Gd-EOB-DTPA增强20 min肝胆期肝实质信号强度依次降低,门静脉信号强度依次增加
表5 不同程度DILI组患者FILS评分比较(例)
表6 Gd-EOB-DTPA增强MRI肝胆期对比剂摄取参数与DILI患者实验室指标的相关性
图3 Gd-EOB-DTPA增强MRI肝胆期摄取参数鉴别诊断轻症DILI组与重症DILI组的ROC曲线
1
Shen T, Liu Y, Shang J, et al. Incidence and Etiology of Drug-Induced Liver Injury in Mainland China [J]. Gastroenterology, 2019, 156(8): 2230.e11-2241.e11.
2
杨雪,涂荣芳,杨晋辉. 药物性肝损伤的研究进展 [J]. 临床肝胆病杂志, 2020, 36(3): 509-513.
3
Yoon J, Lee J, Kang H, et al. Quantitative Assessment of Liver Function by Using Gadoxetic Acid-enhanced MRI: Hepatocyte Uptake Ratio [J]. Radiology, 2019, 290(1): 125-133.
4
Yang M, Zhang Y, Zhao W, et al. Evaluation of liver function using liver parenchyma,spleen and portal vein signal intensities during the hepatobiliary phase in Gd-EOB-DTPA-enhanced MRI [J]. BMC Med Imaging, 2020, 20(1): 119.
5
毕新军,张学琴,陆健, 等. 钆塞酸二钠增强MR T1 mapping成像对肝功能的定量评估价值 [J]. 临床放射学杂志, 2020, 39(10): 1992-1996.
6
Chalasani NP, Maddur H, Russo MW, et al. ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury [J]. Am J Gastroenterol, 2021, 116(5): 878-898.
7
Poetter-Lang S, Bastati N, Messner A, et al. Quantification of liver function using gadoxetic acid-enhanced MRI [J]. Abdom Radiol (NY), 2020, 45(11): 3532-3544.
8
李莉,唐鹤菡,刘洋洋, 等. Gd-EOB-DTPA增强MRI定量评估肝脏储备功能的可行性研究 [J]. 放射学实践, 2016, 31(1): 19-25.
9
毕新军,张学琴,陆健, 等. 钆塞酸二钠增强MRI肝细胞摄取定量参数评估肝功能 [J]. 放射学实践, 2021, 36(4): 514-519.
10
Joo J, Lee M. Recent Advances in the Imaging Diagnosis of Hepatocellular Carcinoma: Value of Gadoxetic Acid-Enhanced MRI [J]. Liver cancer, 2016, 5(1): 67-87.
11
Li T, An J, Xu J, et al. Overview of organic anion transporters and organic anion transporter polypeptides and their roles in the liver [J]. World J Clin Cases, 2019, 7(23): 3915-3933.
12
Alam K, Crowe A, Wang X, et al. Regulation of Organic Anion Transporting Polypeptides (OATP) 1B1-and OATP1B3-Mediated Transport: An Updated Review in the Context of OATP-Mediated Drug-Drug Interactions [J]. Int J Mol Sci, 2018, 19(3): 855.
13
卫李,李云芳,刘明明, 等. 药物性肝损伤临床分型与影像特点的相关性分析 [J]. 北京医学, 2018, 40(10): 927-931.
14
Lee S, Choi D, Jeong K. Hepatic enhancement of Gd-EOB-DTPA-enhanced 3 Tesla MR imaging: Assessing severity of liver cirrhosis [J]. J Magn Reson Imaging, 2016, 44(5): 1339-1345.
15
Zhang W, Wang X, Miao Y, et al. Liver function correlates with liver-to-portal vein contrast ratio during the hepatobiliary phase with Gd-EOB-DTPA-enhanced MR at 3 Tesla [J]. Abdom Radiol (NY), 2018, 43(9): 2262-2269.
16
汪小,张卫国,冯婷婷, 等. 采用钆塞酸二钠增强MRI肝胆期门静脉信号强度评价肝脏功能的临床价值 [J]. 中华放射学杂志, 2018, 52(2): 108-112.
17
Bastati N, Beer L, Mandorfer M, et al. Does the functional liver imaging score derived from gadoxetic acid-enhanced MRI predict outcomes in chronic liver disease [J]. Radiology, 2020, 294(1): 98-107.
18
王晨,王志聪,丁莺, 等. Gd-EOB-DTPA增强磁共振肝胆特异期肝实质强化程度与临床化验指标相关性的研究 [J]. 临床放射学杂志, 2018, 37(1): 66-69.
[1] 项文静, 徐燕, 茹彤, 郑明明, 顾燕, 戴晨燕, 朱湘玉, 严陈晨. 神经学超声检查在产前诊断胼胝体异常中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(05): 470-476.
[2] 谢峰, 伍玉晗, 赵胜, 杨小红, 王玉波, 石珍, 范建华, 章敏. 产前超声和MRI诊断胎儿硬脑膜窦畸形的联合应用[J/OL]. 中华医学超声杂志(电子版), 2024, 21(03): 275-280.
[3] 刘晨鹭, 刘洁, 张帆, 严彩英, 陈倩, 陈双庆. 增强MRI 影像组学特征生境分析在预测乳腺癌HER-2 表达状态中的应用[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 339-345.
[4] 庄若语, 杭明辉, 李文华, 张霆, 侯炜. 膝骨关节炎半定量磁共振评分研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 545-552.
[5] 吴少敏, 张世豪, 刘炳光, 李婵, 尹嘉敏, 郑昌业, 黄素然. 胎儿巨大蛛网膜囊肿并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 390-397.
[6] 王莉, 曹蕾, 王亚丹, 张伟. Krabbe病1例临床分析并文献复习[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 339-345.
[7] 陈海香, 王元银, 蒋盼. 冠突过长患者的临床表现及磁共振影像学分析[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(03): 169-174.
[8] 谢丽春, 欧庆芬, 张秋萍, 叶升. 简化和标准肝脏MRI方案在结直肠癌肝转移患者随访中的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 434-437.
[9] 刘明辉, 葛方明. MRI 对腹股沟疝修补术后患者早期并发症的评估价值研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 579-583.
[10] 臧书芹, 陈巧玲, 江思源, 朱晓明, 沈浮, 王颢, 张卫, 邵成伟. 基于直肠高分辨MRI的直肠侧系膜分析及其临床价值的研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(04): 312-320.
[11] 吴浩凡, 刘元豪, 张锋敏, 张现中, 朱金浩, 黄嘉莹, 刘忠臣, 丁良福, 庄成乐. 基于术前MRI的盆底解剖参数对超低位直肠癌精准功能保肛手术时间的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(03): 209-216.
[12] 张立俊, 孙存杰, 胡春峰, 孟冲, 张辉. MSCT、DCE-MRI 评估术前胃癌TNM 分期的准确性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 519-523.
[13] 姜超, 夏旭东, 王功夏, 何向宇, 王海彬, 李媛. 磁共振DWI及其ADC对乳腺导管原位癌伴微浸润腋窝淋巴结转移的诊断价值[J/OL]. 中华介入放射学电子杂志, 2024, 12(03): 234-243.
[14] 关计添, 尤克增, 耿义群, 孙树宜, 赖凌峰, 沈智威, 张晓磊, 周腾, 黄淮栋, 杨琳, 程焱, 吴烁华, 赵芝泓, 庄彩玉, 吴仁华. 质子磁共振波谱对急性肝损伤兔肝脏脂质与葡萄糖代谢评估价值的研究[J/OL]. 中华诊断学电子杂志, 2024, 12(03): 160-165.
[15] 金安松, 邹玉松, 刘玖涛, 薛凤麟, 庞爱兰. 孤立性颅内浆细胞瘤一例及相关文献复习[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 495-500.
阅读次数
全文


摘要