大鼠诱发性肝硬化和肝癌的CT灌注成像研究

CT Perfusion Imaging of Inductive Cirrhosis and Hepatocellular Carcinoma in Rats: An Experimental Study

目的探讨肝癌演化过程中，肝脏血液动力学的变化规律。材料与方法2—3月龄的雄性Wistar大鼠105只，随机分成4组：A、B、A1、B1。A组为肝硬化组（35只）；B组为肝癌组（60只）；A1为A的对照组（5只）；B1为B的对照组（5只）。A、B两组大鼠分别用浓度为100ppm的二乙基亚硝胺（DENA）水溶液诱导12周和20周。A1、B1两组大鼠则常规饲养。以0．6ml的对比剂和0．2ml／s的注射流率对这4组大鼠进行肝脏CT灌注成像，测量全肝的灌注参数并与病理进行对照。结果肝硬化组、肝癌组的肝动脉灌注量（HAP）、肝动脉灌注指数（HPI）分别为（57．7±14．3）ml·min^-1·100ml^-1、（65．3±16．8）ml·min^-1·100ml^-1和（61．4±8．8）％、（71．3±10．0）％，均明显高于各自的对照组（F值分别为7．96、11．03、31．67、45．54，P值均〈0．01），而门静脉灌注量（PVP）分别为（35．9±9．7）ml·min^-1·100ml^-1、（26．9±14．3）ml·min^-1·100ml^-1，低于相应的对照组（F值分别为27．47、23．30，P值均〈0．01）。肝硬化组与肝癌组的HAP无统计学差异（F=1．55，P〉0．05），但后者的PVP更低（F=3．94，P〈0．05），HPI更高（F=7．20，P〈0．01）。2个对照组的各项灌注参数差异均无统计学意义。结论在从正常肝脏到肝硬化最后发展成肝癌的过程中，肝脏的HAP和HPI逐渐升高，而PVP则逐渐降低。

Objective To investigate the hemodynamic changes of liver during hepatocellular carcinoma evolution. Materials and Methods 105 male Wistar rats of 2-3 months old were randomly divided into four groups：A, B, A1 and B1. A was cirrhosis group （35 rats）. B was hepatocellular carcinoma group （60 rats）. A1 was the control group of A （5 rats）. B1 was the control group of B （5 rats）. Group A and group B were induced with 100ppm diethylnitrosamine （DENA） water solution for 12 weeks and 20 weeks respectively. Group A1 and group B1 were fed normally. Hepatic CT perfusion imaging was performed with 0.6ml of contrast medium and 0.2ml/s of injection rate, Perfusion parameters of the whole liver were measured and compared with pathologic results. Results In cirrhosis group and hepatocellular carcinoma group, respectively, hepatic arterial perfusion （HAP） was （57.7 ± 14. 3） ml. min-ml·min^-1·100ml^-1 and （65.3 ± 16. 8）ml·min^-1·100ml^-1, hepatic perfusion index （HPI） was （ 61.4 ± 8.8 ） % and （ 71.3 ± 10.0） %. Both parameters were higher in cirrosis group and hepatocellular carcinoma group as compared with those of their control groups （ F values were 7, 96,11.03, 31.67,45.54 respectively, P 〈 0. 01 ）. Portal venous perfusion （PVP） in cirrosis group and hepatocellular carcinoma group was （35.9 ± 9.7 ） ml·min^-1·100ml^-1and （26.9 ± 14.3 ） ml·min^-1·100ml^-1 respectively, lower than those of their control groups （F values were 27.47 and 23.30 ,P 〈 0.01 ）. HAP showed no significant difference between cirrhosis group and hepatocellular carcinoma group （ F = 1.55, P 〉 0.05 ）. But PVP in hepatocellular carcinoma group was lower （ F = 3.94, P 〈0.05 ） and HPI was higher（ F = 7.20 ,P 〈 0.01 ）. No significant difference was found in each perfusion parameter of the two control groups. Conclusion HAP and HPI of the whole liver increased gradually while PVP decreased from normal liver to cirrhosis and at last lead to hepatocellular carcinoma.