CT灌注成像对肝硬化血流动力学分析及肝硬化程度评估的相关性研究

Study on analyzing hepatic blood flow and evaluating degree of liver fibrosis in patients with liver cirrhosis by using CT perfusion

目的探讨CT动态灌注成像对肝硬化血流量动态变化分析及对肝硬化程度分级的价值。方法肝硬化患者21例采用Child-Pugh分级法进行肝硬化程度分级;对照组为无肝脏疾病者20例,选取同时含有肝脏、脾、主动脉和门静脉的层面进行CT动态增强扫描,计算肝脏血流量。结果对照组肝动脉灌注量(HAP)为(10.67±2.13)ml/(min.ml),门静脉灌注量(PVP)为(76.15±7.89)ml/(min.ml),总肝血流量(TLP)为(85.89±8.66)ml/(min.ml),肝动脉灌注指数(HPI)为(14.32±3.01)%。肝硬化时HAP为(15.89±6.23)ml/(min.ml),PVP为(52.16±16.76)ml/(min.ml),TLP为(68.03±10.16)ml/(min.ml),HPI为(26.19±12.96)%。肝硬化患者的HAP和HPI均较正常组升高,PVP、TLP较正常组降低。两组间比较均有统计学意义,肝硬化时肝血容量(TBV)、平均通过时间(MTT)较正常组升高,但无统计学意义(P>0.05);肝硬化时HPI与肝纤维化程度显著相关。结论 CT灌注参数与肝纤维化程度密切相关,CT灌注成像可以定量地反映肝脏的血流动力学改变并对肝纤维化程度进行评估。

Objective To analyze hepatic blood flow and investigate of correlation between hepatic perfusion parameters by CT perfusion and the severity of liver fibrosis in patients with liver cirrhosis.Methods CT perfusion of liver was performed in 41 cases,including 21 patients with liver cirrhosis accordance with the Child-Pugh classification and 20 patients without liver disease（control group）.CT scanning sections were obtained at a single-level including the liver,spleen,aorta,and portal vein,the attenuation of these organs was measured to draw time density curves to calculate the liver CT perfusion parameters.Results In control group,hepatic arterial perfusion（HAP）,portal venous perfusion（PVP）,total liver perfusion（TLP） was respectively（10.67±2.13）ml/（min·ml）,（76.15±7.89）ml/（min·ml）,（85.89±8.66）ml/（min·ml）.And hepatic perfusion index（HPI） was（14.32±3.01）%.HAP,PVP and TLP in patients with liver cirrhosis was respectively（15.89±6.23）ml/（min·ml）,（52.16±16.76）ml/（min·ml）,（68.03±10.16）ml/（min·ml）.And HPI was（26.19±12.96）%.PVP and TLP were decreased in patients with liver cirrhosis（P〈0.05）,but HAP and HPI were increased（P〈0.05）.And TBV and MTT were increased,but there were no significant differences in TBV and MTT between each groups（P〉0.05）.HPI was closely related to the degree of fibrosis.Conclusion The parameters of CT perfusion significantly correlated with the severity of liver fibrosis and cirrhosis.Quantitative measurement of hepatic blood flow by CT perfusion is useful for evaluation of the severity of fibrotic change.