Gd-EOB-DTPA增强MRI联合剪切波弹性成像对肝硬化并发食管胃静脉曲张破裂出血风险的预测价值

Predictive value of Gd-EOB-DTPA-enhanced MRI combined with shear wave elastography for the risk of ruptured esophagogastric variceal bleeding complicated by cirrhosis

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摘要目的探讨肝脏Gd-EOB-DTPA增强MRI联合剪切波弹性成像对临床显著门静脉高压(clinically significant portal hypertension,CSPH)及食管胃静脉曲张出血(esophagogastric variceal bleeding,EVB)风险的预测价值.方法选取我院行肝脏Gd-EOB-DTPA增强MRI检查、剪切波弹性成像并行HVPG测定的32例患者的资料.Pearson相关分析门静脉、脾静脉管径、肝脾体积、肝胆期相对强化程度(relative enhancement,RE)值、肝硬度值(liver stiffness,LS)等参数与HVPG的相关性.对易出血组(HVPG＞12 mmHg)进行二元logistic回归建立联合诊断模型(RE20mnin与肝硬度值)并检验拟合度,绘制单一诊断指标及联合诊断指标的受试者工作特征曲线(ROC),计算曲线下面积(AUC).结果患者存在CSPH,相关性分析结果显示门静脉管径、脾脏体积、LS均呈正相关(r=0.375、0.591、0.749,P＜0.05),与RE10min、RE20min呈负相关性(r=-0.453、-0.548,P＜0.01),与肝脏体积、脾静脉无相关性(r=0.032、0.287,P＞0.05).门静脉管径、脾体积、RE10min、RE20min、LS、联合诊断模型(RE20min与肝脏硬度)的AUC值分别为0.806,0.813,0.759,0.721,0.881,0.883.结论肝脏Gd-EOB-DTPA增强MRI相关参数与HVPG密切相关,有助于CSPH的诊断.在CSPH患者中,对肝脏硬度明显增高、肝胆期相对强化程度明显降低的患者应进行早期干预,以降低食管胃静脉曲张破裂出血风险.RE20min联合肝硬度值较单一因素有更好的敏感性和特异性,但有待进一步模型优化.