摘要:
目的 探讨利用肝脏Gd-EOB-DTPA增强磁共振成像,术前定量测定肝功能体积,评估肝细胞癌患者肝功能储备的可行性.方法 本项前瞻性研究共纳入了23位肝细胞癌病例,所有患者术前均行Gd-EOB-DTPA增强磁共振及吲哚靛青绿检查(ICG).肝实质T1值(T1pre、T1pos)及体积(LV)分别在增强前T1map、肝胆期增强后的T1map及肝胆特异期图像上测定.根据术前多学科会诊讨论的切除方案,分别运用这三个序列在工作站进行模拟手术切除,计算模拟切除后剩余肝实质的T1值(rT1pre、rT1pos)及肝体积(rLV).用于评估肝功能储备的功能性参数的计算公式分别为T1减低率(△T1=(T1pre-T1pos)/T1pre)、功能性肝体积(FV=LV×△T1)、功能性肝体积/体重(FV/W)、增强后T1值/体积(T1pos/LV)等.运用Spearman 相关性检验来检测MRI功能性参数与ICG-R15的相关性,同时计算剩余肝实质的功能参数来预测术后的肝功能情况.结果 术前Gd-EOB-DTPA增强MRI测定的功能性参数FV、FV/W、T1pos/LV均值分别为879.93、14.24、0.18和ICG-R15具有显著的相关性(rho=-0.552、-0.486、-0.579;P=0.006、0.019、0.004),其中 T1pos/LV 相关性最高.剩余肝实质的功能性参数均值分别为 rLV=805.89 ml, rFV=546.24,rFV/W=9.13,T1pos/LV=0.29.术后1周患者的Child-Pugh评分为5~8分(A级18例,B级4例),其中1例术后出现感染及肝功能衰竭.结论 肝脏 Gd-EOB-DTPA 增强磁共振的功能性肝体积测定是术前肝功能储备的定量评估的理想方法.%Objective Our aim of the study is to determine the feasibility of functional liver volume for quantitative liver function reserve analysis in patients with hepatocellular carcinoma by preoperative Gd-EOB-DTPA enhanced magnetic resonance imaging(MRI). Methods This prospective study included 23 patients with HCC who underwent Gd-EOB-DTPA enhanced MRI including volumetric T1mapping and indocyanine green(ICG)tests before surgery. Based on HCC standard resection approach, virtual resection protocol was performed on the work station. For each patient, the mean liver T1relaxation time in precontrast (T1pre)and HBP images(T1pos)were measured respectively. The liver volume excluded tumor tissue(LV)in HBP, and possible remnant liver volume after surgery(rLV)were also measured respectively. The △T1[(T1pos-T1pre)/T1pre], functional liver volume (FV=LV*△T1)and functional liver volume to weight ratio(FV/W), liver T1in HBP to volume ratio(T1pos/LV)were calculated. The correlation between functional liver volume quantitative parameters(FV, FV/W, T1pos/LV)and ICG retention(ICG-R15)were investigated by using Spearman correlation analysis. Remnant functional liver volume(rFV=rLV×△T1), remnant functional liver volume to weight ratio(rFV/W)and remnant liver T1in HBP to volume ratio(rT1pos/LV)were calculated to predict the postoperative liver function.Results The functional liver volume parameters FV,FV/W and T1pos/LV(mean value:879.93,14.24,0.18,respectively) were significantly correlated with ICG-R15(rho=-0.552, -0.486, -0.579; P=0.006, 0.019, 0.004). T1/LV had the highest correlation with ICG-R15 among all the MRI functional quantitative parameter, while the FV/W showed a low correlation with ICG-R15. The mean of rLV, rFV, rFV/W, rT1/LV calculated using virtual resection protocol were 805.89 ml and 546.24, 9.13, 0.29, respectively. Based on Gd-EOB-DTPA liver function reserve analysis, all the patients received standard resection success-fully for HCC.Child score one week after surgery were ranged from 5 to 8(Child A:n=18,Child B:n=4),except 1 patient suffered from serve hepatic insufficiency. Conclusion It is feasible to quantitative liver function reserve in patients with HCC before surgery by functional liver volume assessment in Gd-EOB-DTPA MRI combined with volumetric T1mapping.