T2WI信号强度及钆贝葡胺增强MRI肝胆期参数评估肝硬化患者肝功能的价值

doi:10.3969/j.issn.1004-583X.2025.03.010

摘要/Abstract

摘要：

目的本研究旨在探讨T₂WI信号强度及钆贝葡胺(gadobenate dimeglumine,Gd-BOPTA)肝胆期参数与肝功能分级的相关性,并分别分析它们单独和联合诊断肝功能的价值。方法回顾性收集我院2019年6月-2024年9月行T₂WI及Gd-BOPTA 增强 MRI检查的肝硬化患者57例。在肝门层面,分别在T₂WI、平扫及肝胆期90 min MRI图像上,于肝左叶、肝右前叶及右后叶各放置大小相同感兴趣区域。测量T₂WI信号强度值(T₂WI signal intensity,SI_T2)、T₁WI信号强度值(T₁WI signal intensity,SI_平扫)及肝胆期信号强度(hepatobiliary phase signal intensity,SI_肝胆期), 计算得到相对增强度(relative enhancement,RE)。比较不同Child-Pugh分级间各参数的差异;探讨各参数与Child-Pugh分级间的相关性;分析各有意义参数单独及联合诊断Child-Pugh B+C级的效能,同时比较各诊断效能间的差异性。结果不同Child-Pugh分级间的SI_T2、SI_肝胆期及RE差异均具有统计学意义(P<0.05)。SI_T2与Child-Pugh分级呈正相关(r=0.408,P=0.002);SI_肝胆期及RE均与Child-Pugh分级呈负相关(r=-0.365、-0.376,P=0.005、0.004);而SI_平扫与Child-Pugh分级不具有相关性(P=0.753);SI_T2、SI_肝胆期、RE及三者联合诊断Child-Pugh B+C组的AUC分别为0.715、0.707、0.757及0.846。SI_T2+SI_肝胆期+RE的AUC高于SI_肝胆期,差异有统计学意义(P<0.05)。结论 SI_T2、Gd-BOPTA肝胆期参数SI_肝胆期及RE与肝硬化患者肝功能分级相关,各自诊断肝功能分级有一定价值,三者联合诊断能拥有更高的效能。

关键词: 肝硬化, T₂WI, 钆贝葡胺, 肝胆期, 肝功能

Abstract:

Objective To investigate the correlation of T2-weighted imaging (T₂WI) signal intensity and gadobenate dimeglumine (Gd-BOPTA) hepatobiliary phase (HBP) parameters with liver function grade, and to analyze their value in the diagnosis of liver function alone and combination. Methods A total of 57 cirrhosis patients who underwent enhanced magnetic resonance imaging (MRI) on T₂WI and Gd-BOPTA from June 2019 to September 2024 were retrospectively collected. At the hilar level, the region of interest (ROI) with the same size was placed on the left, right anterior and right posterior lobes of the liver on T₂WI, plain scan and 90-min MRI images of the hepatobiliary phase. The signal intensity of T₂WI (SI_T2), T₁WI (SIplain scan) and hepatobiliary phase (SI_HBP) were measured, and relative enhancement (RE) was calculated. The parameters in cirrhosis patients possessing different Child-Pugh grades were compared. The correlation between the parameters and Child-Pugh grades was discussed. The diagnostic efficacy of Child-Pugh grade B+C was analyzed, and the difference between the diagnostic efficacy was compared. Results There were significant differences in SI_T2, SI_HBP and RE among cirrhosis patients with different Child-Pugh grades (P<0.05). SI_T2 was positively correlated with Child-Pugh classification (r=0.408, P=0.002). SI_HBP and RE were negatively correlated with Child-Pugh grade (r=-0.365,-0.376, P=0.005, 0.004). However, there was no correlation between SI plain scan and the Child-Pugh grade (P=0.753). The area under the curve (AUC) of SI_T2, SI_HBP, RE and their combination in diagnosing Child-Pugh B+C cirrhosis was 0.715, 0.707, 0.757 and 0.846, respectively. The AUC of SI_T2+SI_HBP +RE was significantly larger than that of SI_HBP (P<0.05). Conclusion SI_T2, Gd-BOPTA HBP parameters SI_HBP and RE are related to liver function grading in cirrhosis patients. Each possess a certain value in diagnosing liver function grading, and their combination reaches a higher efficiency.

Key words: liver cirrhosis, T₂WI, gadobenate dimeglumine, hepatobiliary phase, liver function

中图分类号:

R575.2

林涛, 杜涛明, 李亚, 冯钰玲, 宋惠贞, 俞琴. T₂WI信号强度及钆贝葡胺增强MRI肝胆期参数评估肝硬化患者肝功能的价值[J]. 临床荟萃, 2025, 40(3): 251-256.

Lin Tao, Du Taoming, Li Ya, Feng Yuling, Song Huizhen, Yu Qin. Value of T₂WI signal intensity and gadobemeglumine enhanced MRI hepatobiliary phase parameters in evaluating liver function of cirrhosis patients[J]. Clinical Focus, 2025, 40(3): 251-256.

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https://lchc.magtechjournal.com/CN/Y2025/V40/I3/251

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参考文献 20

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组别	例数	BMI (kg/m²)	性别[例(%)]		年龄 (岁)	乙型肝炎背景[例(%)]		AST[例(%)]		ALT[例(%)]		GGT[例(%)]
组别	例数	BMI (kg/m²)	男	女	年龄 (岁)	有	无	≤40 U/L	>40 U/L	≤50 U/L	>50 U/L	≤60 U/L	>60 U/L
A组	20	23.25±2.52	15(75.0)	5(25.0)	59.10±13.09	10(50.0)	10(50.0)	5(25.0)	15(75.0)	10(50.0)	10(50.0)	6(30.0)	14(70.0)
B组	22	25.54±4.26	19(86.4)	3(13.6)	58.23±12.01	14(63.6)	8(36.4)	5(22.7)	17(77.3)	13(59.1)	9(40.9)	5(22.7)	17(77.3)
C组	15	24.98±4.27	11(73.3)	4(26.7)	64.67±11.08	9(60.0)	6(40.0)	5(33.3)	10(66.7)	8(53.3)	7(46.7)	3(20.0)	12(80.0)
统计值		t=2.063	χ²=1.200		t=1.379	χ²=0.836		χ²=0.545		χ²=0.358		χ²=0.528
P值		0.137	0.549		0.260	0.658		0.762		0.836		0.768

组别	例数	BMI (kg/m²)	性别[例(%)]		年龄 (岁)	乙型肝炎背景[例(%)]		AST[例(%)]		ALT[例(%)]		GGT[例(%)]
组别	例数	BMI (kg/m²)	男	女	年龄 (岁)	有	无	≤40 U/L	>40 U/L	≤50 U/L	>50 U/L	≤60 U/L	>60 U/L
A组	20	23.25±2.52	15(75.0)	5(25.0)	59.10±13.09	10(50.0)	10(50.0)	5(25.0)	15(75.0)	10(50.0)	10(50.0)	6(30.0)	14(70.0)
B组	22	25.54±4.26	19(86.4)	3(13.6)	58.23±12.01	14(63.6)	8(36.4)	5(22.7)	17(77.3)	13(59.1)	9(40.9)	5(22.7)	17(77.3)
C组	15	24.98±4.27	11(73.3)	4(26.7)	64.67±11.08	9(60.0)	6(40.0)	5(33.3)	10(66.7)	8(53.3)	7(46.7)	3(20.0)	12(80.0)
统计值		t=2.063	χ²=1.200		t=1.379	χ²=0.836		χ²=0.545		χ²=0.358		χ²=0.528
P值		0.137	0.549		0.260	0.658		0.762		0.836		0.768

观察者	SI_T2(×10²)	SI_肝胆期(×10²)	SI_平扫(×10²)
观察者1	1.02±0.29	2.95±0.57	1.80±0.37
观察者2	1.19±0.30	3.23±0.53	1.97±0.34
ICC值	0.830	0.920	0.900

观察者	SI_T2(×10²)	SI_肝胆期(×10²)	SI_平扫(×10²)
观察者1	1.02±0.29	2.95±0.57	1.80±0.37
观察者2	1.19±0.30	3.23±0.53	1.97±0.34
ICC值	0.830	0.920	0.900

组别	例数	SI_T2 (×10²)	SI_平扫 (×10²)	SI_肝胆期 (×10²)	RE
A组	20	1.05±0.23	1.94±0.35	3.49±0.56	0.82±0.27
B组	22	1.18±0.24	2.03±0.27	3.16±0.48^*	0.57±0.24^*
C组	15	1.39±0.36^*#	1.97±0.34	2.99±0.53^*#	0.57±0.21^*#
F值		6.680	0.490	4.730	6.960
P值		0.003	0.616	0.013	0.002

T₂WI信号强度及钆贝葡胺增强MRI肝胆期参数评估肝硬化患者肝功能的价值

Value of T₂WI signal intensity and gadobemeglumine enhanced MRI hepatobiliary phase parameters in evaluating liver function of cirrhosis patients

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参数	AUC	95%CI		界值	敏感度	特异度
参数	AUC	下限	上限	界值	敏感度	特异度
SI_T2(×10²)	0.715	0.580	0.827	1.07	0.810	0.600
SI_肝胆期(×10²)	0.707	0.571	0.820	3.25	0.676	0.700
RE	0.757	0.625	0.861	0.69	0.811	0.700
SI_T2+SI_肝胆期+RE	0.846	0.726	0.928	0.64	0.784	0.800

参数	AUC差值	Z值	P值
SI_T2与SI_肝胆期	0.008	0.071	0.944
SI_T2与RE	0.042	0.435	0.664
SI_T2与SI_T2+SI_肝胆期+RE	0.131	1.848	0.065
SI_肝胆期与RE	0.050	0.625	0.532
SI_肝胆期与SI_T2+SI_肝胆期+RE	0.139	2.313	0.021
RE与SI_T2+SI_肝胆期+RE	0.089	1.852	0.064

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