2013-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/660587摘要：肝臟切除手術前，常需要電腦斷層(CT)或磁振造影(MRI)檢查提供病灶的解剖構造等資訊，但另一項重要的評估項目，則是肝臟的剩餘功能(liver reserve)是否足夠，因為這是肝臟手術病人預後的主要因素之一。 現今主要應用的肝功能指標已被沿用多年，例如轉氨酶(AST, ALT)、膽紅素(bilirubin)、白蛋白(albumin)、凝血酶原時間(prothrombin time)、Child-Pugh 肝功能分級等等。其中 ICG (indocyanine green) study為一種動態性的測量方式，由於 ICG於體內完全由肝臟代謝，因此物質在血液中的清除率為一具備肝臟特異性的測量數據。在肝臟切除的術前評估中，ICG檢查也成為大多數外科醫師選擇的常規項目。 卜邁維斯(Gd-EOB-DTPA, Primovist® , Bayer Schering)是一種肝臟特異性的顯影劑，用於磁振造影影像，它具有傳統磁振造影顯影劑(Gd-DTPA)的特性，可由磁振造影檢查提供病灶詳細的解剖構造(位置、大小、局部分期、是否侵犯局部構造)等資訊；同時在代謝的過程中，這種藥物會進入肝臟細胞(hepatocyte)，藉由膽汁分泌排出體外，因此我們可以利用這個特性來分析肝臟細胞的功能和肝臟實質間的組織變化。在這一個單一檢查中，可以同時獲得靜態的肝腫瘤解剖構造和動態的肝功能性資訊，提供臨床醫師多重資訊，配合病理分析，可以得到可靠的、確實完整的資料分析和比較。 使用肝臟特異性顯影劑評估肝臟功能以及肝實質病變是一個很新的研究方向，我們計畫使用此顯影劑與各種不同的生化檢查(包含各項臨床生化檢驗和 ICG 測試)和非侵入式的肝臟纖維化評估工具(超音波彈力影像, ultrasound elastography)做一比較，進一步將與術後病理組織檢查做驗證。 本研究目的是要建立卜邁維斯磁振造影檢查是否能成為肝臟手術前的標準檢查流程，因為它不僅是可以提供最好的局部肝臟病灶的影像，還可以評估術後剩餘的肝臟功能，更進一步去預測肝臟實質病變的嚴重度。<br> Abstract: There are multiple clinical tools to assess the liver function. Traditionally, assessment of liver function and injury is based on static tests, such as serum biochemistry study. Actually, there is no ideal real-time and bedside technique for assessing liver function in critically ill patients. Dynamics tests, such as indocyanine green (ICG) study lidocaine metabolism, are superior to static tests. ICG is a cyanine dye used in medical diagnostics. ICG is exclusively removed by the liver into the bile and does not undergo enterohepatic recirculation. ICG-PDR (Plasma Disappearance Rate) is more sensitive than serum enzyme tests for assessing liver dysfunction and regarded as a valuable tool for the quantitative assessment of liver function. Primovist® (Gd-EOB-DTPA, Gadoxetic acid, Bayer Schering) is a hepatobiliary-specific contrast agent. The EOB moiety of Primovist enables it to be transported into functional hepatocytes and subsequently excreted into the bile. Primovist allows a comprehensive evaluation of the liver with the acquisition of both dynamic and hepatocyte phase images. This provides potential additional information, especially for the hepatocyte function and liver parenchymal change in varying liver diseases. Acoustic radiation force impulse imaging (ARFI) is a method of elasticity imaging that uses impulsive radiation force to remotely excite tissues and measure the shear wave velocity (m/s). Shear wave velocity is known as virtual touch tissue quantification, which is generated by acoustic radiation force, is an objective method for evaluating mechanical tissue properties. According to previous published results, ARFI elastography is a reliable method for predicting fibrosis severity in patients with chronic hepatitis. The purpose of this study is: 1. To evaluate the feasibility of Primovist-enhanced MRI in assessment of liver function, with correlation of biochemistry and ICG studies. 2. To measure the liver fibrosis severity by comparison between Primovist-enhanced MRI and ultrasound elastography 3. To use histopathologic evidence to support and explain the mechanism of Primovist-enhanced MR signal change in varying liver diseases 4. To analyze the functional and volumetric recovery after post-hepatectomy in Primovist-enhanced MR.PrimovistMRIICGAssessment of liver function.