MSCT灌注成像在肝脏病变中的临床应用研究

Clinical application with MSCT perfusion imaging in liver diseases

目的探讨MSCT灌注成像在肝脏病变诊断中和鉴别诊断的临床应用价值。方法对46例经临床及病理证实的肝脏疾病患者行MSCT肝脏灌注成像，其中16例原发性肝癌，8例肝脏转移癌。9例肝脓肿，7例肝血管瘤。6例肝硬化，并选取15例正常肝组织作为对照组。采用CT电影技术对病变中心层面（同时包括第一肝门区能清楚显示门静脉主干及其分支）进行四层同层灌注扫描，应用GE perfusion 3．0软件分别计算肝血流最（HBF）、肝血容壁（HBV）、平均通过时间（MTT）、毛细血管表面通透性（PS）、肝动脉灌注分数（HAF）、对比剂到达时间（IRF TO）。结果正常组织与良恶性病变组织的HBF、HBV、HAF、IRF TO函数值差异有统计学意义，正常组织与良性病变组织比较HBF、HBV、HAF差异有统计学意义。正常组织与恶性病变组织比较HBF、HBV、PS、HAF、IRF TO差异有统计学意义。而良性病变与恶性病变组织比较仅MTT差异有统计学意义；恶性病变组织中原发性肝癌与转移癌比较各参数值差异无统计学意义；原发性肝癌与肝硬化比较HBF、HBV差异有统计学意义；良性病变组织肝脓肿与肝血管瘤比较各参数值差异无统计学意义。结论MSCT灌注成像可定量评价正常肝组织、病变肝组织的血流动力学状态、肝动脉供血比例，在组织代谢功能方面为肝脏病变的诊断和鉴别诊断提供了一种新手段，但对肝脏良恶性病变的鉴别诊断是否有帮助尚需进一步研究。

Objective To explore the clinical value of MSCT perfusion imaging in the diagnosis and differentiation of liver diseases. Methods MSCT perfusion imaging as performed in 46 patients who were verified by chnic and pathology （inchlding 16 hepatoceUular carcinoma, 8 metastases, 9 acute abscesses,7 hepatic hemangiomas and 6 liver cirrhoses）, 15 normo-cases were chosed as control subjects. Plain scan was performed firstly in order to localize central slices of lesions, then imaging of four and identical slices in central slices of hepatic tumors were performed by CT cine producing 396 slices reconstruction images. These images were performed perfusion analysis by GE perfusion 3.0 software package. The perfusion images and parameters such as hepatic blood flow （HBF）,hyperemic blood volume （HBV）,mean transit time （MTT）, PS,HAF and IRF TO were worked out with liver tumor mode. Results The differences of HBF, HBV, HAF and IRF TO between the normal tissues and the lesion tissues were statistically significant. Compared with normal tissues,HBF,HBV,HAF in benign lesions and HBF,HBV,PS,HAF,IRF TO in malignant lesions were statistically significant. MTr was the only difference between malignant lesions and benign lesions. While the differences between hepatocellular carcinoma and metastasis in the malignant lesions trod the differences between hemangioma and abscess in the benign lesions were not statistical. The differences of HBF and HBV between hepatocellular carcinoma and liver cirrhoses were statistically significant. Conclusion MSCT perfusion imaging can appraise quantitively normal liver tissue,the hemodynamic status and hepatic artery ratio of normal and liver tissue lesions, it can be served as a usefid method provided for the differentiation diagnosis in liver diseases in the aspect of tissue melabolism, but the differentiation with MSCT perfusion imaging between benign and malignant diseases should be validated by a larger series of study after following.