64层螺旋CT灌注成像评价梗阻性黄疸肝血流动力学变化

Evaluation of hepatic hemodynamic changes in obstructive jaundice with 64-slice spiral CT perfusion

目的采用64层螺旋CT灌注成像研究梗阻性黄疸肝脏血流动力学的变化。方法对21例梗阻性黄疸患者和18名正常志愿者行64层螺旋CT肝脏灌注扫描,应用灌注软件获得肝脏灌注参数:肝动脉灌注量(ALP)、门脉灌注量(PVP)、肝脏灌注指数(HPI)、血流量(BF)、血容量(BV)和渗透性(P),并进行统计学分析。结果梗阻性黄疸组的ALP、HPI较对照组升高,差异有统计学意义(P<0.05),并随黄疸程度的加重呈逐渐升高的趋势;中重度黄疸组的ALP与轻度黄疸组比较差异有统计学意义;梗阻性黄疸组的BV和P较对照组降低,其中中重度黄疸组的BV值与对照组比较差异有统计学意义(P<0.05),轻度黄疸和中重度黄疸组P值与对照组比较差异有统计学意义(P<0.05);PVP与BF组间比较差异无统计学意义(P>0.05)。结论64层螺旋CT肝脏灌注成像能够反映梗阻性黄疸的肝脏血流灌注改变,对临床的早期诊断和治疗有重要价值。

Objective To investigate the value of CT perfusion imaging in study of hepatic hemodynamic changes in obstructive jaundice （OJ）. Methods Siemens 64-slice spiral CT perfusion scans of liver was performed in 21 patients with OJ （OJ group： mild stage, n=103 moderate stage, n= 11） and 18 volunteers （control group） without hepatic disorder. Arterial liver perfusion （ALP）, portal venous perfusion （PVP）, hepatic perfusion index （HPI）, blood flow （BF）, blood volume （BV） and permeability （P） were measured and statistically analyzed with Siemens BodyPerfusion software package. Results The values of ALP and HPI in OJ group were higher than those in the control group （P〈0. 05）, having trend to increase with the progress of jaundice. The difference of value of ALP between mild stage and moderate stage were statistically significant （P〈0.05） ; the value of BV and P in OJ group decreased compared with the control group （P〈0.05）, and with the different jaundice degrees, it decreased gradually. The difference of BV between moderate stage and control group, and the difference of the value of P between OJ group and control group was both statistically significant （P〈0. 05）, while the means of PVP and BF among groups were not statistically different （P〉0. 05）. Conclusion Hepatic CT perfusion imaging with 64-slice spiral CT can reflect changes of hepatic blood perfusion, and is important for early diagnosis and treatment of OJ .