Evaluation Of Liver Reserve Function With Gd-EOB-DTPA-enhanced MRI In Patients With Hepatitis B Cirrhosis

Objective To investigate the value of Gd-EOB-DTPA-enhanced MR imaging in assessing the liver reserve function in patients with hepatitis B cirrhosisMethods This study was approved by the institutional review board and informed consent was obtained.To collect patients with hepatitis b cirrhosis and normal liver function without chronic liver disease.A total of 124 patients(84 men,40 women;mean age 54.19±11.25 years)were collected,including hepatitis B cirrhosis patients with Child–Pugh A(CPA)group(n=48),with Child–Pugh B(CPB)group(n=40),with Child–Pugh C(CPC)group(n=15),patients with normal liver function(NLF)without liver cirrhosis(n=21).All patients according to clinical need for Gd-EOB-DTPA enhanced MRI examination,measurement of all cases of plain MR and 20 s,60s,3min,10 min,20 min after the intravenous administration of Gd-EOB-DTPA for each liver segment signal intensity,spleen,erector spinal muscle signal intensity,mean signal intensity of each liver segment as a whole liver signal value,calculate each time point of the whole Liver relative enhancement(RE),Liver signal intensity relative to the spleen(liver to spleen ratio,LSR),Liver signal intensity relative to the Muscle(liver to muscle ratio,LMR),the increasing rate of liver spleen signal ratio(?LSR),the increasing rate of liver muscle signal ratio(?LMR).And measurement of each segment liver relative enhancement(RE),the increasing rate of liver muscle signal ratio(?LMR)at 10 min after administrition of Gd-EOB-DTPA.The serological examination indicators were obtained within one week before and after the imaging examination.Comparison of patients' general information:the gender was compared by the Fisher exact test,the other indexes were compared by the one way ANOVA.Comparison of whole liver: The one way ANOVA was used to compare SI?RE? LSR?LMR??LSR??LMR among four groups at different time.The LSD method was used to compare the differences between the 4 groups.The Spearman rank correlation analysis was used to do correlation analysis.ROC curve was used to analyze the ability of Gd-EOB-DTPA enhanced MRI in the diagnosis of Child-Pugh class ? B.Spearman rank correlation was used to investigate the relationship between the each indexe and Child-Pugh classification.Comparison of different liver segment: The one way ANOVA was used to compare each liver segment between different groups and to compare in the same liver function group between different liver segments.Results(1)The whole liver of SI,LMR,RE,?LMR about NLF group,CPA group with the scanning time increased to delay 10 min showed a rising trend,but CPC group increased to 3min showed a rising trend.The whole liver of LSR about NLF group,CPA group,CPB group showed a rising trend from 25 s to 20 min after Gd-EOB-DTPA administration,but CPC group increased to 3min showed a rising trend.In group NLF,group CPA and group CPB,25 s to delayed 20 min LSR increased gradually.The whole liver of LSR for all patients with scanning time increased to 20 min showed a rising trend.(2)Plain and after Gd-EOB-DTPA administration each time point of the whole liver SI,RE and ? LMR between different groups were statistically significant(P<0.05),at some time point of whole liver LSR,LMR,? LSR were statistically significant.At 10 min,20min differences between any two groups were statistically significant except a small part(P<0.05).Most of the indexes were not statistically different at each scan time point between CPB and CPC group(P>0.05).(3)The corresponding area under the curve(AUC)values of whole liver SI?LMR?RE?? LMR at 10 min diagnose Child-Pugh class ? B were highest,respectively 0.883,0.878,0.857,0.891.The corresponding area under the curve(AUC)values of whole liver LSR??LSR at 20 min diagnose Child-Pugh class ? B were highest,respectively 0.909?0.878.(4)At 10 minutes after Gd-EOB-DTPA administration whole liver SI,LMR,RE,?LMR and Child-Pugh classification showed the highest correlation,r value respectively-0.69,-0.679,-0.627,-0.679,the differences were statistically significant(P<0.001),at 20 minutes whole liver LSR showed the highest correlation,r value respectively-0.721,-0.64.(5)At 10 minutes after Gd-EOB-DTPA administration RE on different liver segments(S1-S8)were significantly different between groups(P<0.001).The RE were significantly different(P<0.05)of different liver segments in NLF,CPA,CPB groups,and there was no significant difference(P>0.05)of CPC group.(6)At 10 minutes after Gd-EOB-DTPA administration ?LMR on different liver segments(S1-S8)were significantly different between groups(P<0.001).The ?LMR were significantly different(P<0.001)of different liver segments in NLF,CPA groups,and there was no significant difference(P>0.05)of CPC and CPB groups.Conclusions Hepatic cell uptake of Gd-EOB-DTPA was significantly affected by liver function,and Gd-EOB-DTPA-enhanced MRI can reflect liver reserve function,and can accurately assess whole liver function and segmental liver function.The liver relative enhancement(RE)and the increasing rate of liver muscle signal ratio(?LMR)were the best evaluation method,and 10 min was the optimal delay time.