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MRI钆对比剂:环状 螯合物和链状螯合 物在乳腺纤维腺瘤 增强效能的对比研 究

作者:李建鹏 郑晓林 邹玉坚 方学文 刘碧华 范宪淼 张坤林

所属单位:广东省东莞市人民医院放射科 (广东 东莞 523059)

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摘要

目的 对比研究MRI钆对比剂:钆 特酸葡胺,钆喷酸葡胺(马根维显)、钆双 胺、钆喷酸双葡甲胺(康臣)对乳腺纤维腺 瘤增强效能。方法 收集本院经病理确诊 的120例乳腺纤维腺瘤的MRI资料,随机 分为4组,每组30例,钆对比剂分别使用 钆特酸葡胺、马根维显、钆双胺、钆喷 酸双葡甲胺。MRI动态增强采用快速小角 度激发三维成像(Flash-3D)抑脂T1WI序 列。记录各个病例每个时期的MRI SI值, 并算出最大对比增强率(MCER)。SI值比 较采用单因素方差分析,MRCE比较采用 Kruskal-Walls检验,得出P值,以P<0.05 认为差异有统计学意义。统计使用对比剂 后的药物不良反应。结果 使用钆特酸葡 胺纤维腺瘤的TIC曲线持续上升型26例, 上升平台型4例。使用马根维显纤维腺瘤 的TIC曲线持续上升型24例,上升平台型6 例。使用钆双胺纤维腺瘤的TIC曲线持续 上升型28例,上升平台型2例。使用钆喷 酸双葡甲胺纤维腺瘤的TIC曲线持续上升 型28例,上升平台型2例。经过统计学分 析,各组病灶的长径、短径、起始SI值、 终末SI值、MRCE、SNR、CNR差别均无统计 学意义。120例患者均未出现药物不良反 应。结论 钆特酸葡胺的分子类型是大环 状,马根维显、钆双胺、钆喷酸双葡甲胺 的分子类型是线性,基于分子结构方面考 虑,钆特酸葡胺要优于其余三种钆造影 剂。通过本研究,对于乳腺纤维腺瘤的 MRI动态增强,钆特酸葡胺、马根维显、 钆双胺、钆喷酸双葡甲胺在增强效能方面 无明显差异,均未出现药物不良反应。

Objective Comparative study of MRI gadolinium contrast agent enhancement efficacy: gadoterate meglumine(cyclic chelate), gadopentetate(chain chelate), gadodiamide(chain chelate), gadopentetate dimeglumine (chain chelate) in breast fibroadenoma. Methods Collected 120 cases MRI datas of breast fibroadenoma confirmed by pathology, were randomly divided into 4 groups, each group of 30 cases, gadolinium contrast agent were used gadoterate meglumine, gadopentetate, gadodiamide or gadopentetate dimeglumine. MRI dynamic enhancement using fast small angle excitation three-dimensional imaging lipid-suppressing T1WI sequence. The MRI signal strength values of each case were recorded and the maximum contrast enhancement rate (MCER) was calculated. SI values were compared using single factor analysis of variance, MRCE comparison using Kruskal-Walls test. The adverse effects of contrast agents were recorded. Results The group of used gadoterate meglumine, TIC curve includes 26 cases of inflow type and 4 cases of ascending platform type. The group of used gadopentetate, the types of TIC curves were 24 cases of inflow type and 6 cases of ascending platform type. The group of used gadoterate meglumine, TIC curve includes 28 cases of inflow type and 2 cases of ascending platform type. The group of used gadopentetate , the types of TIC curves were 28 cases of inflow type and 2 cases of ascending platform type. After statistical analysis, the difference in each group of the length and short diameter of tumor, the initial SI value, the end SI value, the MRCE, the SNR and CNR were not statistically significant. No adverse reactions occurred in 120 patients. Conclusion The molecular type of gadoterate meglumine is cyclic, and the molecular type of gadopentetate, gadodiamide, and gadopentetate dimeglumine is linear. Based on the molecular structure, gadoterate meglumine is superior to the other three kinds of gadolinium contrast agents. In this study, there was no significant difference in enhancement performance between those four kinds gadolinium contrast agents, and no adverse reactions occurred.

【关键词】磁共振成像;钆对比剂;乳腺 纤维腺瘤;动态增强

【中图分类号】R737.9

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2018.06.009

前言

MRI动态增强检查(Dynamic contrast-enhanced magnetic resonance mammography,CE-MRM)是影像对病变检测、评估、分期及 预后评价的重要手段。由于钆对比剂中Gd3+具有多个不成对电子,能 够使邻近质子的T1弛豫时间缩短,临床通过静脉注射含钆对比剂来缩 短T1弛豫时间来提高组织的信噪比(SNR)。随着MRI对比剂的广泛应 用,其安全性逐渐受到关注,研究表明分子结构为环状钆的螯合物稳 定性较钆的链状螯合物稳定性高,在体内的重金属的析出率减低。为 了了解不同钆螯合物对比剂的增强效能,本研究随机选取经病理确诊 的120例乳腺纤维腺瘤,使用相同的MRI设备及检查序列,对钆特酸葡 胺、钆喷酸葡胺(马根维显)、钆双胺(欧乃影)、钆喷酸双葡甲胺四种 对比剂动态增强的MRI信号强度进行比较。