肝脏、脾脏密度改变对慢性肝纤维化、早期肝硬化的诊断价值

The diagnostic value of hepatic and splenic density for chronic hepatic fibrosis and early cirrhosis

目的:探讨不同程度肝纤维化肝、脾密度的变化特点及其临床应用价值。方法:对经肝穿刺病理活检确诊的肝纤维化S1期12例、S2期14例、S3期9例、S4期/早期肝硬化13例、典型肝硬化16例以及20例正常组行上腹部16层螺旋CT平扫和增强扫描,于CT平扫图像上分别测量肝脏、脾脏密度及肝/脾CT值比值,将上述参数值与病理学分期作对照研究和统计学分析。结果:随着肝纤维化、肝硬化程度的加重,肝脏各叶的密度及肝平均密度均呈先降低后增高的趋势,其中S4期/早期肝硬化组肝脏各叶及平均密度最低。各组之间脾脏密度的比较均无差异。肝/脾CT值比值先降低后增高;S4期的肝/脾CT值比值最低(1.08±0.07),且与各组比较均有统计学差异。结论:肝脏密度和肝/脾CT值比值的测定对于早期肝硬化的诊断有一定帮助,但是其临床应用价值是有限的,不能简单的通过肝、脾密度的测量来诊断肝纤维化或早期肝硬化。

Objective：To investigate the feature of hepatic and splenic density change in chronic hepatic fibrosis,and explore its clinical application value.Methods：Plain and tri-stage enhance CT scan of epigast was performed in 84 participants,including 48 patients with hepatic fibrosis which divided into Si（12/48）,S2（14/48）,S3（9/48）and S4 （13/48）confirmed by liver pathologic biopsy,16 patients with typical cirrhosis,and 20 healthy subjects as control group.Hepatic and splenic density were measured on image of plain scan respectively,density ratios of liver/spleen was calculated in comparison with histopathologic stage.Results：The density of hepatic lobes and total liver trended to decreased at S1-4（S4 was minimun）but increased slightly than S4 at typical cirrhosis.The density of spleen had no significant difference among all groups.The density ratios of liver/spleen at S4 was minimum（1.08±0.07）and had statistical difference with other groups.Conclusion：The measurement of hepatic density and CT value ratios of liver/ spleen may be helpful for the diagnosis of early cirrhosis,but its clinical application value was limited,it＇s impossible to diagnose hepatic fibrosis or early cirrhosis by measuring the density of liver only.