双源CT灌注成像在活体肝移植后对移植肝的评价作用

The role of DSCT perfusion imaging in evaluating transplanted livers after living donor liver transplantation

目的探讨双源CT灌注成像在活体肝移植后对移植肝的评价作用。方法招募解放军总医院第三医学中心2013-06至2018-11进行活体肝移植术后1个月经超声及CTA检查肝动脉无狭窄患者25例;术后3个月患者61例,其中肝动脉无狭窄25例,轻度狭窄13例,中度狭窄12例,重度狭窄11例;同时收集同时期因怀疑有肝脏肿瘤行CT灌注扫描,后经临床及影像证实无肿瘤的患者(25例)作为对照组。上述所有研究对象均行双源CT全肝灌注成像检查并测量肝动脉灌注量(hepatic artery perfusion,HAP)、门静脉灌注量(portal vein perfusion,PVP)、肝总灌注量(total liver perfusion,TLP)及肝动脉灌注指数(hepatic perfusion index,HPI)。同时补充检测肝动脉狭窄人群的谷丙转氨酶(alanine transaminase,ALT)。结果与对照组人群[(0.28±0.13)ml/(min·ml)]相比,肝移植术后1个月无肝动脉狭窄人群HAP[(0.36±0.17)ml/(min·ml)]显著增高(P<0.05),术后3个月中度及重度肝动脉狭窄人群HAP显著降低[(0.12±0.09)ml/(min·ml),(0.06±0.03)ml/(min·ml),P<0.05]。中度及重度肝动脉狭窄人群HPI较对照组显著降低(0.07±0.05、0.03±0.02 vs.0.23±0.16,P<0.05)。重度肝动脉狭窄人群PVP较对照组显著升高[(1.81±0.36)ml/(min·ml)vs.(1.23±0.62)ml/(min·ml),P<0.05]。在肝动脉狭窄患者中,ALT对数与HAP对数成线性相关。结论双源CT能对活体肝移植患者术后的移植肝进行血流灌注评价,能够为临床提供更为精准的信息,提高患者后续治疗的准确性。

Objective To explore the role of dual-source CT perfusion imaging in evaluating liver transplantation after living donor liver transplantation(LDLT).Methods Twenty-five patients without hepatic artery stenosis according to ultrasound and CTA examination one month after LDLT were enrolled between June 2013 and November 2018.Another 61 patients were selected three months after surgery,including 25 patients without hepatic artery stenosis,13 with mild stenosis,12 with moderate stenosis,and 11 with severe stenosis.Another 25 patients who received CT perfusion scanning in the same period because they were suspected of liver tumor but confirmed otherwise by clinical examination and imaging were collected as the control group.All these subjects underwent the examination of dual-source CT perfusion imaging of the whole liver.Hepatic artery perfusion(HAP),portal vein perfusion(PVP),total liver perfusion(TLP),and hepatic perfusion index(HPI)were measured.Simultaneously,the level of alanine transaminase(ALT)of patients with hepatic artery stenosis was detected.Results HAP of patients without hepatic artery stenosis one month after liver transplantation[(0.36±0.17)ml/(min·ml)]was significantly higher than in the control group(0.28±0.13)(P<0.05).HAP of patients with moderate and severe hepatic artery stenosis was significantly lower[(0.12±0.09)ml/(min·ml),(0.06±0.03)ml/(min·ml),P<0.05].HPI of patients with moderate and severe hepatic artery stenosis was significantly lower than that of patients in the control group(0.07±0.05,0.03±0.02 vs.0.23±0.16,P<0.05).PVP of patients with severe hepatic artery stenosis was significantly higher than that of patients in the control group[(1.81±0.36)ml/(min·ml) vs.(1.23±0.62)ml/(min·ml),P<0.05].In patients with hepatic artery stenosis,the logarithm of ALT was linearly correlated with that of HAP.Conclusions Dual-source CT can be used to evaluate the blood perfusion of the transplanted liver of patients after LDLT,provide more accurate information for clinical application,and improve the accuracy of subsequent treatment of patients.