比較Gadolinium與Ferucarbotran顯影磁振造影在肝臟腫瘤之表現

Comparison of Gadolinium-enhanced and Ferucarbotran-enhanced MR Imaging of Hepatic Tumors

王宗成(Tsung-Chen Wang) ； 陳潤秋(Ran-Chou Chen) ； 黃愛嬌(Ai-Chiao Hwang) ； 賴建成(Chien-Cheng Lai) ； 劉益瑞(Yi-Jui Liu)

《北市醫學雜誌》 4卷3期 (2007/03) Pp. 205-211

https://doi.org/10.6200/TCMJ.2007.4.3.01

摘要

Super paramagnetic iron oxide (SPIO)超順磁性氧化鐵顯影劑在MR運用中，其強化的原理和方式，與傳統的T1顯影劑釓螯合物(Gadolinium GD-DTPA)完全不相同，兩者在臨床應用上是可以互相補充和印證的，本篇主要是介紹運用磁振造影不同的參數，比較傳統GDDTPA和新型超順磁性氧化鐵造影劑Super paramagnetic iron oxide(SPIO, Ferucarbotran)在肝臟腫瘤的診斷價值。一般而言，肝臟腫瘤患者接受Ferucarbotran MRI檢查的掃描序列主要為T2W/TSE(T2Weight/Turbo Spin Echo)、T2W/SPIR/TSE(T2Weight/Spectral saturation Inversion Recovery/Turbo Spin Echo)、T1W/SE(T1 Weight/Spin Echo)、T1W/SPIR/SE、T2W/FEE-EPI(T2 Weight/Gradient Echo-Echo Planar Imaging)，Ferucarbotran同時具有T1及T2的效能，與傳統Gd-DTPA以T1序列為顯影後主要掃描序列不同。在肝腫瘤的表徵方面，注射Gd-DTPA顯影劑後，肝臟信號在T1序列明顯增強，肝臟腫瘤隨種類不同，有的增強，有的不變或變弱，而Ferucarbotran 顯影之肝臟信號則在T1及T2序列均有變化，其中又以T2序列最為顯著，且其變化為訊號下降，至於肝腫瘤的信號在T2序列下降幅度並不顯著，在T1序列方面，肝臟及腫瘤之信號變化類似Gd-DTPA，只是訊號變化之強度不如Gd-DTPA。簡而言之，SPIO主要為T2序列變化，而Gd-DTPA 主要為T1序列變化，兩者對肝腫瘤均有良好之診斷價值，且可互相補強，藉以提升MR 的肝腫瘤之偵測及診斷率。

關鍵字

超順磁性氧化鐵 ； 磁振造影成像 ； 肝腫瘤

並列摘要

Super paramagnetic iron oxide (SPIO) contrast medium is a tissue-specific MRI contrast agent taken up by the reticuloendothelial system. The T2 value of tissue decreases due to the susceptibility effect of the super paramagnetic agent. For this article, we reviewed the imaging manifestations of Gd-DTPAenhanced MR imaging and SPIO (Ferucarbotran)-enhanced MR imaging. For SPIO-enhanced MR imaging, T2W/TSE (T2 weight/Turbo Spin Echo), T2W/SPIR/TSE (T2 Weight/Spectral Saturation Inversion Recovery/Turbo Spin Echo), T1W/SE (T1 Weight/Spin Echo), T1W/SPIR/SE, and T2W/FFEEPI (T2 Weight/ Gradient Echo-Echo Planar Imaging) were used. Ferucarbotran, a new SPIO, showed both T1 and T2 effects. In the liver, ferucarbotran is ingested by kupffer cells, decreasing the T2 value of the liver, as kupffer cells are reduced or absent in hepatic neoplasms. Changes in the contrast between neoplasm and surrounding liver parenchyma in T2-weighted MR images were especially notable in T2W/TSE, T2/TSE/SPIR and T2W/FFE sequences. For Gd-DTPA-enhanced MR imaging, the hepatic neoplasm was enhanced in T1-weighted images. The major sequences used for post-contrast study are T1W/FFE-dynamic sequences. All of the T2-weighted sequences were not used in post Gd-DTPA MR images.

並列關鍵字

super paramagnetic iron oxide SPIO ； ferucarbotran ； magnetic resonance imaging MRI ； hepatic lesion