摘要
目的：探讨肝硬化病人钆塞酸二钠胆道成像（CE-MRC）的价值。方法：53例肝硬化病人和18例正常成人行磁共振钆塞酸二钠动态增强肝胆期胆道成像，评价肝胆期5、10、15、20和25 min胆道图像质量，分析胆总管信号强度与血清总胆红素水平、白蛋白水平和凝血酶原时间的关系，比较CE-MRC和磁共振胰胆道成像（MRCP）的差异。结果：正常成人延迟15 min胆道大部分已经显影，肝硬化病人显影延迟，Child-Pugh B级和C级明显。延迟25 min胆总管信号强度在正常人群与Child-Pugh A级之间无显著差异（P=0.570），与Child-Pugh B级之间（P=0.002）以及Child-Pugh A级、B级之间有显著差异（P=0.000）。在肝硬化病人，胆总管信号强度与凝血酶原时间相关系数为-0.57，CE-MRC和MRCP分别显示了79%和32%的胆囊管（χ2=23.891，P=0.000），二级分支胆管、左右肝管、胆总管的显示率无显著差异（P＞0.05）。结论：肝硬化病人注射钆塞酸二钠后25 min行胆道成像较合适，肝脏功能影响胆道显影时间和信号强度，CE-MRC在显示胆囊管方面较MRCP更有优势，两者结合能够对胆道结构和功能进行有效评价。
Abstract
Objective: To discuss the value of contrast-enhanced magnetic resonance cholangiography(CE-MRC) using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA) in patients with liver cirrhosis. Methods: The dynamic scan and CE-MRC in hepatobiliary phase were performed in 53 patients with liver cirrhosis and 18 normal adults, the image quality of CE-MRC at 5, 10, 15, 20 and 25 minutes in hepatobiliary phase were evaluated, the relationship between signal intensity of common bile ducts and serum total bilirubin level, albumin level and prothrombim time were analyzed. The differences between CE-MRC and MRCP were compared. Results: CE-MRC allowed the visualization of most parts of biliary duct at 15 minutes after administration of Gd-EOB-DTPA in normal adults. The visualization of biliary ducts were delayed in patients with liver cirrohsis, especially in cases with Child-Pugh B and C. There were no differences of signal intensity of common bile ducts at 25 minutes delayed between the normal adults and patients with Child-Pugh A(P=0.570), while there were differences between normal adults and Child-Pugh B(P=0.002), between Child-Pugh A and Child-Pugh B(P=0.000). In patients with liver cirrhosis, the correlation coefficient between signal intensity of common bile ducts and prothrombin time was -0.57, CE-MRC and MRCP showed 79% and 32% of the cystic ducts respectively(χ2=23.891, P=0.000) and had the similar ability for displaying the second order division ducts, bilateral hepatic ducts and common bile ducts(P＞0.05). Conclusion: It was suitable that CE-MRC were performed at 25 minutes after contrast administration in patients with liver cirrhosis. The liver funcion affected the time of visualization and signal intensity of bile ducts, CE-MRC had the advantage for detecting the cystic ducts than MRCP. CE-MRC combined with MRCP allowed evaluation for structure and function of biliary system effectively.
关键词
肝硬化 /
胰胆管造影术 /
磁共振
Key words
Liver cirrhosis /
Cholangiopancreatography /
magnetic resonance
金腊梅;吴建伟;瞿献莉;高 红;张 艳;卢光明.
钆塞酸二钠在肝硬化病人胆道成像中的应用价值[J]. 中国临床医学影像杂志. 2013, 24(10): 701-705
JIN La-mei;WU Jian-wei;QU Xian-li;GAO Hong;ZHANG Yan;LU Guang-ming.
The value of CE-MRC using Gd-EOB-DTPA in patients with liver cirrhosis[J]. Journal of China Clinic Medical Imaging. 2013, 24(10): 701-705
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