Gd-BOPTA在肝脏的临床应用价值课件.ppt

1、钆贝酸 334 mg/ml 葡甲胺 195 mg/ml0.2T1.5T3.0T弛豫率(mM-1s-1)发 现 肝 脏 病 灶 -Lesion Detection 明 确 病 灶 性 质 Lesion Characterization 评 价 疾 病 的 严 重 程度 和 预 后 Severity&Prognosis 肝 脏 储 备 功 能 的 评 估 functional Reserve of liver 胆 道 的 功 能 成 像 functional imaging of biliary treeTransitional Phase TP 直肠癌，肝转移直肠癌，肝转移T2W T1WAP P

2、VPDP-3m HBP-60mAPPVPEPHBPHE50HE300HBP-80m3D-MRCPAP早期AP晚期PVMohajer K,et al.Characterization of Hepatic Adenoma and Focal Nodular Hyperplasia With Gadoxetic Acid.J.Magn.Reson.Imaging 2012;36:686696.T1WT2W30 s3 min1 min80 minl Adenoma(HNF1-inactivated)l FNHT1-APT1-PVP20m（unpaired arterioles）（biliary po

3、larization）RNLGDNEarly-HCCHCCHGDN胆汁分泌微结构的改变T1-IPT1-OPT1-PVPT1-APT1-EPT1-HBP（延迟1个小时）T2WCT穿刺穿刺：62岁女性，肝硬化T1WIEarly-arterialPortal-veinHB-80mHE50T1-APT2T1DWI,b=400T1-PVPT1-40m50岁女性，慢性肝炎T2T1DWI,b=400T1-APT1-PVPT1-40ma-T2Wb-T1Wc-arterial phased-portal venous phasee-hepatobiliary phase Early arterial phase

4、Portal venous phaseHB-80mT2WIT1WIEarly-arterialLate-arterialPortal-veinDelay-phaseHB-20mHB-40mHE80HB-40mLate-arterialPortal-venousHB-40mHB-80mHEx600KUDO M.Multistep human hepatocarcinogenesis:correlation of imaging with pathology.J Gastroenterol 2009,44:112118Gray ZoneRNLGDNHGDNe-HCCWell HCCMod/Poor

5、 HCCMR T2W 信号信号 Vascularity APPVPKupffer细胞数量细胞数量肝细胞功能肝细胞功能低低/等信号等信号 稍高信号稍高信号 富血供富血供 等等/稍高血供稍高血供 等等/稍低密度稍低密度 低密度低密度 正常正常/稍多稍多减少减少正常正常下降下降缺失缺失缺失缺失Gray Zone组织学也难以鉴别组织学也难以鉴别影像学无法鉴别影像学无法鉴别低信号低信号 正常血供正常血供 等密度等密度 正常正常正常正常“The eye sees only what the mind is prepared to comprehend”l Henry Louis Bergson,1859-1941l Nobel Prize for Literature in 1927RNLGDNEarly-HCCHCCHGDNRNLGDNEarly-HCCHCCHGDNlHepatocyte-specific MRIlKupffer cell-specific MRIlDWI-MR lSWIlMR elastographylMRSlNodule characterizationNNNOOOOOOOOOORGd3+男，46岁，先天性胆总管囊肿，胆肠吻合术后3年40m60m90m120m男，42岁，胰头癌胆肠吻合、胰肠吻合术后40m60m90m120m