肝纤维化CT灌注成像与实验室指标及穿刺病理的随访研究

Follow-up Study on Liver Fibrosis Patients using CT Perfusion,Laboratory Markers and Biopsy

目的:探讨肝CT灌注扫描对评价肝脏纤维化程度的价值。方法:对18例慢性乙肝患者采用病毒性肝炎防治方案进行治疗,疗程6个月,分别于治疗前后检测患者血清纤维化指标,同时经皮肝穿刺活检观察肝脏组织病理学变化,并进行肝血流CT灌注扫描,应用去卷积算法计算肝组织平均通过时间(MTT)和表面通透性(PS)值。结果:18例患者中1例患者失访,2例患者未能完成第2次CT扫描。15例患者在治疗后,肝血流CT灌注参数(MTT和PS)均有明显增加(t=2.806、P=0.014;t=2.646、P=0.019);同时患者血清纤维化指标(透明质酸、层粘连蛋白、Ⅲ型前胶原肽和Ⅳ型胶原)有所下降(t=2.372,P=0.033;t=3.381,P=0.004;t=2.686,P=0.018;t=2.738,P=0.016);经皮肝穿刺活检病理学检查显示肝纤维化程度评分有所降低(t=3.110,P=0.008)。结论:肝脏CT灌注参数在肝纤维化治疗前后有明显改变,CT灌注成像对评价肝脏纤维化程度有重要价值。

Objective：To study the possibility of hepatic CT perfusion parameters might reflect the severity of liver fibrosis in patients with chronic hepatitis B. Methods： 18 patients with hepatic fibrosis proven by biopsy and being treated with a 6-month therapeutic regimen for the disease entered this study. Serum markers of hepatic fibrosis, including hyaluronic acid （HA） ,laminin （LN） ,aminoterminal propeptide of type Ⅲ procollagen （PⅢ P） and Ⅳ collagen （CⅣ） were respectively examined before and after the treatment. Meanwhile, the pre- and post-treatment histopathological changes of livers were observed and evaluated according to the percutaneous liver biopsy findings. CT Liver perfusion scan was performed on a GE Lightspeed scanner. The mean transit time （MTT） and permeability of surface （PS） of the livers were measured using the convolution techniques. Results：The follow-up failed in 1 of the 18 patients and the second time hepatic CT perfusion scan had not been performed in the other 2 patients. In the remaining 15 patients,the hemodynamic parameters of MTT and PS improved remarkably after treatment in contrast to those before treatment. At the same time, the serum markers of hepatic fibrosis markers including HA, LN, P Ⅲ P and C Ⅳ decreased significantly （t = 2. 372, P = 0. 033 ; t = 3.381, P = 0. 004 ; t = 2. 686,P=0. 018;t=2. 738,P= 0. 016,respectively） in the 15 patients with chronic hepatitis B. The scores of hepatic fi- brosis in accordance with the pathological findings from percutaneous liver biopsy reduced at a certain extent （t = 1. 110, P= 0. 008） as well. Conclusion：Changes of CT perfusion parameters were remarkable before and after relative treatment in patients with hepatic fibrosis, therefore,CT perfusion scanning could be used as a valuable imaging modality in the evaluation of the severity of liver fibrosis in patients with chronic hepatitis B.