European Radiology:肝功能成像评分在预测HCC切除术后肝功能衰竭方面的价值

2022-08-01 shaosai MedSci原创

肝脏功能成像评分(FLIS)是一项涵盖了肝脏钆塞酸二钠增强MRI三个特征的系统性评分,包括增强质量、胆汁对比剂排泄率和门静脉信号强度的持续性。

肝癌是全球范围内最常见的癌症之一,是癌症相关死亡的第三大原因。肝细胞癌(HCC)占原发性肝癌的70-90%。对于符合条件的HCC患者来说,部分肝切除术仍然是最有效的治疗方法,但部分患者会出现肝功能不足甚至肝衰竭(PHLF)。PHLF是导致HCC患者住院时间延长、费用增加和长期疗效不佳的主要原因。因此,术前准确的预测PHLF有助于风险患者识别并改善其围手术期的管理

塞酸二钠作为一种肝特异性对比剂具有功能性肝细胞摄取并通过膜运输工具排泄到胆管。有研究证明塞酸二钠增强MRI有助于预测部分肝切除术后PHLF的发生率。然而,之前报道的这些应用需要复杂的计算,其成功取决于系统的类型和MRI中使用的场强和序列。肝脏功能成像评分(FLIS)是一项涵盖了肝脏塞酸二钠增强MRI三个特征系统性评分包括增强质量、胆汁对比剂排泄率和门静脉信号强度的持续性。这些研究表明,FLIS与接受肝移植的患者的移植存活率有关,也与晚期慢性肝病患者的发生首次肝功能失调和死亡率有关。同时计算FLIS不需要测量信号强度,也不需要使用特定的软件进行复杂的计算,且与场强和成像系统无关。因此,在常规的临床实践中FLIS更佳容易操作和实现。

近日,发表在European Radiology杂志的一项研究探讨了FLIS预测HCC患者PHLF的能力,为临床快速准确的评估及识别高风险患者并进行个性化方案的制定提供了参考依据。

本项研究纳入了502名接受术前钆塞酸二钠增强MRI的接受HCC切除的患者。使用逻辑回归分析确定了PHLF的术前预测因素。使用受试者工作特性曲线评估FLIS预测PHLF的能力,并将其预测能力与终末期肝病模型(MELD)评分、白蛋白-胆红素(ALBI)评分和吲哚菁绿15分钟保留率(ICG-R15)进行比较。 

在多变量分析中,PHLF与FLIS(OR 0.452,95% CI 0.361至0.568,p < 0.001)和主要切除术(OR 1.898,95% CI 1.057至3.408,p = 0.032)独立相关。与MELD评分(0.557)、ALBI评分(0.609)或ICG-R15(0.605)相比,FLIS与较高的受试者工作特性曲线下面积(0.752)有关(所有P < 0.05)。FLIS≤4的患者接受较大范围切除手术,比FLIS较低的患者接受较小范围切除手术发生PHL的风险高9.4倍。 

 
 两位肝细胞癌(HCC)患者的肝胆图像。A, B 一名43岁的男性,患有直径4.5厘米的HCC(*),肝脏功能成像评分(FLIS)为6分。肝实质的信号强度高于右肾(三角形,2分),门静脉(箭头)相对于肝实质表现出低信号(2分),可见胆汁对比剂排泄到胆管(箭头,2分)。该患者在切除HCC后没有出现肝切除后肝衰竭(PHLF)。C, D 一位58岁的男性,患有直径6.7厘米的HCC(*),FLIS为4。肝脏信号强度与肾脏相似(三角形,得分1),门静脉(箭头)与肝实质等信号(得分1),可见造影剂排泄到胆管(箭头,得分2)。该患者在HCC切除术后出现了PHLF

本研究表明,低FLIS可独立预测接受HCC切除术的患者的PHLF。如果手术范围较大,这种风险会大大增加。FLIS可以实现对适合切除的HCC患者进行术前的常规筛选,将有助于改善患者的围手术期管理并提高患者预后。

原文出处:

Ningbin Luo,Xiangyang Huang,Yinan Ji,et al.A functional liver imaging score for preoperative prediction of liver failure after hepatocellular carcinoma resection.DOI:10.1007/s00330-022-08656-z

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1877602, encodeId=2f8518e76027d, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Fri Dec 16 11:53:56 CST 2022, time=2022-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1944894, encodeId=7cf6194489426, content=<a href='/topic/show?id=948a81192ea' target=_blank style='color:#2F92EE;'>#肝功能衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81192, encryptionId=948a81192ea, topicName=肝功能衰竭)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Sat Nov 19 14:53:56 CST 2022, time=2022-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729691, encodeId=f2c51e2969115, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Thu Mar 16 14:53:56 CST 2023, time=2023-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259570, encodeId=82f012595e0e3, content=<a href='/topic/show?id=2200854517' target=_blank style='color:#2F92EE;'>#HCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8545, encryptionId=2200854517, topicName=HCC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8e4c53, createdName=jiyangfei, createdTime=Wed Aug 03 04:53:56 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366769, encodeId=c6371366e69e3, content=<a href='/topic/show?id=8b4181188f5' target=_blank style='color:#2F92EE;'>#肝功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81188, encryptionId=8b4181188f5, topicName=肝功能)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Wed Aug 03 04:53:56 CST 2022, time=2022-08-03, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1877602, encodeId=2f8518e76027d, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Fri Dec 16 11:53:56 CST 2022, time=2022-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1944894, encodeId=7cf6194489426, content=<a href='/topic/show?id=948a81192ea' target=_blank style='color:#2F92EE;'>#肝功能衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81192, encryptionId=948a81192ea, topicName=肝功能衰竭)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Sat Nov 19 14:53:56 CST 2022, time=2022-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729691, encodeId=f2c51e2969115, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Thu Mar 16 14:53:56 CST 2023, time=2023-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259570, encodeId=82f012595e0e3, content=<a href='/topic/show?id=2200854517' target=_blank style='color:#2F92EE;'>#HCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8545, encryptionId=2200854517, topicName=HCC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8e4c53, createdName=jiyangfei, createdTime=Wed Aug 03 04:53:56 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366769, encodeId=c6371366e69e3, content=<a href='/topic/show?id=8b4181188f5' target=_blank style='color:#2F92EE;'>#肝功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81188, encryptionId=8b4181188f5, topicName=肝功能)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Wed Aug 03 04:53:56 CST 2022, time=2022-08-03, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1877602, encodeId=2f8518e76027d, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Fri Dec 16 11:53:56 CST 2022, time=2022-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1944894, encodeId=7cf6194489426, content=<a href='/topic/show?id=948a81192ea' target=_blank style='color:#2F92EE;'>#肝功能衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81192, encryptionId=948a81192ea, topicName=肝功能衰竭)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Sat Nov 19 14:53:56 CST 2022, time=2022-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729691, encodeId=f2c51e2969115, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Thu Mar 16 14:53:56 CST 2023, time=2023-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259570, encodeId=82f012595e0e3, content=<a href='/topic/show?id=2200854517' target=_blank style='color:#2F92EE;'>#HCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8545, encryptionId=2200854517, topicName=HCC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8e4c53, createdName=jiyangfei, createdTime=Wed Aug 03 04:53:56 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366769, encodeId=c6371366e69e3, content=<a href='/topic/show?id=8b4181188f5' target=_blank style='color:#2F92EE;'>#肝功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81188, encryptionId=8b4181188f5, topicName=肝功能)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Wed Aug 03 04:53:56 CST 2022, time=2022-08-03, status=1, ipAttribution=)]
    2023-03-16 feather89
  4. [GetPortalCommentsPageByObjectIdResponse(id=1877602, encodeId=2f8518e76027d, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Fri Dec 16 11:53:56 CST 2022, time=2022-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1944894, encodeId=7cf6194489426, content=<a href='/topic/show?id=948a81192ea' target=_blank style='color:#2F92EE;'>#肝功能衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81192, encryptionId=948a81192ea, topicName=肝功能衰竭)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Sat Nov 19 14:53:56 CST 2022, time=2022-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729691, encodeId=f2c51e2969115, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Thu Mar 16 14:53:56 CST 2023, time=2023-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259570, encodeId=82f012595e0e3, content=<a href='/topic/show?id=2200854517' target=_blank style='color:#2F92EE;'>#HCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8545, encryptionId=2200854517, topicName=HCC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8e4c53, createdName=jiyangfei, createdTime=Wed Aug 03 04:53:56 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366769, encodeId=c6371366e69e3, content=<a href='/topic/show?id=8b4181188f5' target=_blank style='color:#2F92EE;'>#肝功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81188, encryptionId=8b4181188f5, topicName=肝功能)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Wed Aug 03 04:53:56 CST 2022, time=2022-08-03, status=1, ipAttribution=)]
    2022-08-03 jiyangfei
  5. [GetPortalCommentsPageByObjectIdResponse(id=1877602, encodeId=2f8518e76027d, content=<a href='/topic/show?id=67c5319121e' target=_blank style='color:#2F92EE;'>#切除术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31912, encryptionId=67c5319121e, topicName=切除术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9d8a96, createdName=doctorzheng, createdTime=Fri Dec 16 11:53:56 CST 2022, time=2022-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1944894, encodeId=7cf6194489426, content=<a href='/topic/show?id=948a81192ea' target=_blank style='color:#2F92EE;'>#肝功能衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81192, encryptionId=948a81192ea, topicName=肝功能衰竭)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=49ef408, createdName=hunizi005, createdTime=Sat Nov 19 14:53:56 CST 2022, time=2022-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1729691, encodeId=f2c51e2969115, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Thu Mar 16 14:53:56 CST 2023, time=2023-03-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1259570, encodeId=82f012595e0e3, content=<a href='/topic/show?id=2200854517' target=_blank style='color:#2F92EE;'>#HCC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8545, encryptionId=2200854517, topicName=HCC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8e4c53, createdName=jiyangfei, createdTime=Wed Aug 03 04:53:56 CST 2022, time=2022-08-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366769, encodeId=c6371366e69e3, content=<a href='/topic/show?id=8b4181188f5' target=_blank style='color:#2F92EE;'>#肝功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81188, encryptionId=8b4181188f5, topicName=肝功能)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8942242, createdName=jj000001, createdTime=Wed Aug 03 04:53:56 CST 2022, time=2022-08-03, status=1, ipAttribution=)]

相关资讯

European Radiology:混合型肝细胞胆管癌的LI-RADS M和LI-RADS 4/5风险分层

混合型肝细胞胆管癌(cHCC-CCA)具有复杂的成分及影像学表现,可被归入LI-RADS类别LR-4或LR-5或LR-M。

European Radiology:微波消融与射频消融在包膜下HCC中的应用

热消融术是一种创伤较小的手术,可以作为肝癌患者的替代治疗方案来推荐。

European Radiology:在肝硬化患者中遇到这种肝结节一定要谨慎!

随着钆塞酸增强MRI在肝硬化患者中的应用越来越多,经常会遇到在HBP上显示低信号但没有高强化的结节。

J AM COLL RADIOL:高风险患者对HCC筛查有何自己的“偏爱”?

现阶段,简略MRI(AMRI)作为HCC筛查的替代影像学模式,可提供比US更高的敏感性(w80%)。

European Radiology:究竟哪些肝炎患者需要做EOB-MRI检查?这个血清学指标你一定要知道!

非血管性低信号结节(NHHNs)是通过普美显增强磁共振成像(EOB-MRI)检测出的一类肝脏结节。

European Radiology:钇-90放射栓塞治疗在HCC 中的应用

据统计,HCC是全球肿瘤相关死亡的第三大常见原因。放射性栓塞术中,如嵌入微球的钇-90或钬-166放射性核素可通过肝动脉分支的走行发挥作用。