肝硬化患者64层螺旋CT全肝灌注成像研究

Whole-liver Perfusion Scans with 64-slice Spiral CT in Patients with Liver Cirrhosis

目的探讨全肝灌注成像一站式检查方法评估肝硬化严重程度的可行性和显示肝血管及侧枝循环开放的价值。方法前瞻性纳入经临床、其它影像检查证实为肝硬化的住院患者40例和正常检查者20例行全肝灌注扫描。利用CT肝脏灌注软件得到腹主动脉和门静脉时间-密度曲线(TDC)、肝脏感兴趣区(ROI)灌注参数值:肝动脉灌注量(HAP)、门静脉灌注量(HPP)、总肝灌注量(TLP)和肝动脉灌注指数(HPI),同时得到各灌注参数对应的伪彩图。测量正常组与肝硬化肝功能Child-Pugh分级各组腹主动脉和门静脉达峰时间、峰值及灌注参数;观察肝硬化门体侧枝循环开放情况。结果肝硬化组较正常组腹主动脉及门静脉达峰时间延迟(P<0.05),峰值减低(P<0.05)。HAP,肝硬化Child A级较正常组和Child B、C级升高(P<0.05)。HPP和TLP肝硬化组Child A～C级较正常组逐渐减低(P<0.05)。HPI,Child C级较其余3组升高(P<0.05)。肝硬化组中侧枝循环开放较多组HPP和TLP值较无或少侧支循环形放组升高(P<0.05)。结论全肝灌注扫描可有效评估肝硬化肝功能损害的程度,重建得到的肝血管图像可显示肝血管全貌及门体侧枝循环开放情况。

Objective To test the value of whole-liver perfusion in demonstrating liver angiography and assessing the degree of liver cirrhosis.Methods Forty patients with confirmed liver cirrhosis（patient group） and twenty patients without any liver abnormalities（control group） were prospectively enrolled in this study.All patients underwent whole-liver perfusion CT scans.The time density curve（TDC）,hepatic arterial perfusion（HAP）,hepatic portal perfusion（HPP） and total liver perfusion（TLP） were measured using a special software for the whole-liver perfusion.The CTA imaging of hepatic vessels was obtained by reconstructing the single scanning images.The peak values and time to reach peak values of abdominal aorta and portal veins and the hepatic perfusion parameters were measured.The collateral vessels were observed.Results Delay in the time to reach peak values and reduced peak values of the abdominal aorta and portal veins in patients with live cirrhosis were observed compared to the controls（P〈0.05）.The HAP value in Child A was higher than those in Child B,C and the controls（P〈0.05）.The HPP and TLP values decreased gradually in Child A,B and C,all with significance compared to the controls（P〈0.05）.The HPI values in Child C was higher than those in other groups（P〈0.05）.Reconstructed CTA images showed that different collateral vessels were developed at the end-stage of chronic liver cirrhosis due to severe portal hypertension.The parameters of HPP and TLP in the group with more collateral vessels development were greater than those in other groups（P〈0.05）.Conclusion The whole-liver perfusion is valuable in evaluation the severity of liver cirrhosis.The CT angiography can precisely illustrate the hepatic vascular anatomy of liver and the collateral vessels.