肝肺综合征的CT表现及临床意义

CT Findings and Clinical Significance in Hepatopulmonary Syndrome

目的 :探讨肝肺综合征 (hepatopulmonarysyndrome ,HPS)的CT表现及临床意义。材料和方法 :对 3 9例经临床、实验室和影像学检查证实为失代偿期肝硬化 (decompensationcirrhosis ,DCC)并发HPS ,40例正常对照组的CT扫描结果以及 2例DCC并发HPS的肺动脉DSA结果进行分析。观察 :右肺底最大肺纹理的直径 ;右肺底平均密度 ;右下肺末梢肺纹理延伸至胸膜面的发生率。结果 :右肺底最大肺纹理的直径 ,病例组 ( 0 .44± 0 .0 9mm)高于对照组 ( 0 .3 1± 0 .0 8mm ,P <0 .0 1) ;病例组右肺底平均密度 ( -671.4± 92 .4Hu)大于对照组 ( -710 .1± 5 4.7Hu ,P <0 .0 5 ) ;右下肺末梢肺纹理延伸至胸膜面的发生率病例组 ( 89.7% )远大于对照组 ( 12 .5 % ,P <0 .0 1)。结论 :DCC之CT表现有下肺纹理明显增粗、密度明显增高和末梢肺纹理明显延伸至胸膜面时 ,提示有HPS的CT证据。

Purpose: To explore CT changes and clinical significance of hepatopulmonary syndrome(HPS). Materials and Methods: We analysed CT data of 39 patients with DCC complicated HPS proved by clinic,laboratory and imaging examinations and 40 age-matched control subjects,and DSA data in pulmonary arteries of 2 patients with DCC complicated HPS. We measured in right base of lung as follow: (1)diameter of the most great lung-marking,(2)mean density and(3)incidence of lung-marking extend to pleura. Results: In patients with HPS (0.44±0.09mm), the peripheral pulmonary vasculature was significantly dilated compared with that in control subjects(0.44±0.09mm, 0.31±0.08mm;u=6.5, P< 0.01). In mean density there were a significant difference(u=2.26, 0.05>P>0.01)between HPS group(-671.4±92.4Hu) and control group (-710.1±54.7Hu).In frequency of lung-marking extend to pleura HPS group was significantly higher than that control group(89.7%, 12.5%; u=6.89, P<0.01). Conclusion: In patients with DCC significantly dilated peripheral pulmonary vasculature, increasing density of pulmonary base and finding of lung-marking extend to pleura are CT evidences of complicated HPS.