Advances in the evaluation of hepatic function by magnetic resonance imaging
Received date: 2023-01-11
Online published: 2023-08-31
肝功能储备在肝脏疾病在术前评估中意义重大。早先，由于技术限制，很少有研究探索磁共振成像（magnatic resonance imaging, MRI)在肝脏功能储备定量中的应用；近年来MRI不断发展和完善，在成像方式、造影材料、定量参数等多个方向获得进展，产生了多种用于定量肝功能的新技术、新应用。MRI弹性成像技术可以反映生物力学特征，通过振动波在肝内传播速率等参数，可以得到肝脏微结构与功能的信息；肝胆细胞特异性对比剂增强MRI可以被肝细胞特异性摄取，从而显示肝细胞的功能情况，并在MRI图像上直观地显示出肝脏的功能分布；T1弛豫时间成像以及扩散加权成像等技术则能够反映大分子成分与水扩散等局部微环境特点，并通过这些特征定量肝功能。此外，诸如三维断层弹性成像以及结合T1 mapping定量的肝胆细胞特异性对比剂增强MRI等最新技术进展进一步提高了这些检查定量评估肝功能的效能。与临床常用的生化指标、Child-Pugh评分以及吲哚菁绿试验等肝功能定量方法相比，影像学检查虽仍然受制于成本高、操作困难等因素，但其提供的的肝功能储备空间分布信息可协助肝脏术前规划，从而更好地预测术后不良事件，提高患者的生存概率。所以，影像学技术在肝功能定量中有着很好的发展前景。
关键词： 肝功能储备; 磁共振成像; 弹性成像; 肝胆细胞特异性对比剂
陈乾, 林慧敏, 严福华 . 磁共振成像评估肝功能储备的研究进展[J]. 诊断学理论与实践, 2023 , 22(02) : 190 -196 . DOI: 10.16150/j.1671-2870.2023.02.014
Quantitative assessment of liver function reserve is crucial for preoperative evaluation of patients with liver diseases. The use of magnetic resonance imaging (MRI) for quantitative assessment of liver function reserve has been limited by technical challenges for a long time; recently, MRI has developed and improved in various aspects, such as imaging methods, contrast agents, quantitative parameters, etc., leading to new techniques and applications for liver function quantification. Magnetic resonance elastography (MRE) can measure the biomechanical properties of liver tissue, and provide information on liver microstructure and function based on parameters such as vibration wave propagation speed in the liver; hepatobiliary-specific contrast-enhanced MRI can visualize the hepatocyte uptake and biliary excretion of contrast agent, thus revealing the functional distribution of the liver; T1ρ and diffusion-weighted imaging (DWI) can capture the local microenvironment features such as macromolecular components and water diffusion, and quantify liver function using these characteristics. Moreover, the latest technological advances such as three-dimensional shear wave elastography (3D-SWE) and hepatobiliary-specific contrast-enhanced MRI combined with T1 mapping quantification have further enhanced the performance of these examinations in liver function quantification. Compared with the commonly used clinical methods for liver function assessment, such as biochemical indicators, Child-Pugh score and indocyanine green test, the advantage of imaging techniques is that they can offer spatial distribution information of liver function reserve that is not available from clinical methods, providing new tools for preoperative evaluation of liver function reserve. This is expected to bridge the gap of current clinical examinations, assist in preoperative planning of liver surgery, and has promising development prospects.
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