MSCT灌注在肝纤维化早期诊断中的应用价值研究

The Value of MSCT Perfusion for the Early Diagnosis of Liver Fibrosis

目的探讨多层螺旋CT(MSCT)肝脏灌注成像在肝纤维化早期诊断中的应用价值。资料与方法28例接受MSCT肝脏灌注成像检查,其中6名为无明显肝脏疾病的自愿者(正常对照组),22例经肝脏穿刺活检证实为肝纤维化。根据Ishak评分系统及是否需要抗病毒治疗分为两组:10例为轻度肝纤维化患者,不需抗病毒药物治疗(轻度肝纤维化组),12例为显著肝纤维化患者,需行抗病毒治疗(显著肝纤维化组)。计算各组的各项灌注指标并进行组间比较。结果从正常对照组、轻度肝纤维化组到显著肝纤维化组,肝动脉分数(HAF)呈升高趋势,其平均HAF值分别为(17.09±3.43)%、(19.92±6.01)%和(21.32±7.47)%,平均通过时间(MTT)则有所降低,三组的MTT值分别为(13.49±1.02)s、(12.35±1.31)s和(12.19±3.33)s。正常对照组、轻度肝纤维化组和显著肝纤维化组的平均血流量(BF)值分别为(102.75±32.76)ml.100g-1.min-1、(114.54±25.81)ml.100g-1.min-1和(111.98±19.81)ml.100g-1.min-1;平均血容量(BV)值分别为(15.97±7.59)ml/100g、(17.07±2.94)ml/100g和(16.42±5.53)ml/100g。各组平均HAF、MTT、BF及BV值的差异无统计学意义(P>0.05)。结论MSCT肝脏灌注可用于各项肝脏血流灌注参数的定量测量,部分灌注参数值的变化对肝纤维化分期具有一定程度的参考价值,但目前尚不能有效地进行肝纤维化的早期诊断。

Objective To evaluate the usefulness of MSCT perfusion for the early diagnosis of liver fibrosis. Materials and Methods 28 subjects underwent MSCT perfusion of the liver. Among them ,6 subjects were volunteers without hepatic disease and the other 22 subjects were patients with liver fibrosis who were proved by biopsy and histology. The liver fibrosis patients were further divided into 2 groups according to the Ishak system and whether the liver fibrosis should be treated ： 10 cases were slight liver fibrosis and the other 12 cases were severe liver fibrosis. Parameters of CT perfusion were measured and compared among groups. Results The mean HAF tended to increase with the severity of liver fibrosis[ （ 17.09 ± 3.43 ） %, （ 19.92 ± 6.01 ） % and （21.32 ± 7.47 ） % for control group, slight liver fibrosis group and severe liver fibrosis group respectively ]. The mean MTT tended to decrease [ （ 13.49 ± 1.02 ） s, （ 12.35 ± 1. 31 ） s and （ 12.19 ± 3.33 ） s]. For the three groups, the mean BF were （ 102.75 ± 32.76）ml·100g^-1·min^-1, （ 114.54 ± 25.81 ）ml·100g^-1·min^-1 and（ 111.98 ＋ 19.81 ）ml·100g^-1·min^-1 ,respectively. The mean BV were （ 15.97 ±7.59） ml/100 g, （ 17.07 ±2.94） ml/100 g and （16.42 ± 5.53 ） ml/100 g, respectively. However, there was no significant differences in all the parameters between two groups （ P 〉 0. 05 ）. Conclusion Quantitative measurements for the blood perfusion of hepatic tissue could be obtained by MSCT. Some perfusion parameters could be helpful in the liver fibrosis staging to a certain extent. But its clinical effectiveness for the evaluation and diagnosis of the early liver fibrosis could not be affirmed yet by this study.