16层CT灌注成像评价肝功能的临床价值

Clinical value of hepatic functional reserve:an evaluation on 16-slice spiral CT perfusion imaging combined with CT hepatic volume measurement

目的探讨16层螺旋CT肝脏各叶容积测量变化结合CT灌注成像(CTPI)评价肝硬化肝功能储备的临床价值。方法肝硬化组40例(Child分级为ChildA级者12例,ChildB级者15例,ChildC级者13例)及正常肝脏组13例均行CT肝各叶容积测量,所有病例均行CTPI。比较不同肝功能分级肝硬化组与正常肝脏组之间以及组内各叶肝容积值、容积百分比、血流灌注参数值及肝容积-血流灌注指数值的差异,并将肝功能分级分数与肝各叶容积值、血流灌注参数值及肝容积百分比血流灌注综合指数值作相关性分析。结果肝硬化组A、B、C级肝各叶容积(LV)中,早期左外叶增大最为明显(P<0.01),尾状叶早期增大不明显,晚期明显增大(P<0.01);肝硬化组血流灌注参数肝动脉灌注量(HAP)、门静脉灌注量(HPP)、肝总灌注量(TLP)、肝动脉灌注指数(HAI)、门静脉灌注指数(PPI)中,早期(ChildA级)HAP、HPP、TLP明显减低,并伴随着肝硬化分级升高持续减低;HAI晚期明显增高(P<0.05)。单位体表面积肝容积动脉灌注指数(VAPIs),单位体表面积肝容积灌注指数(VPIs)、单位体表面积容积门静脉灌注指数(VPPIs)随着肝功能由ChildA、B、C级逐级减低,组间比较差异具有统计学意义(P<0.05)。单位体表面积肝动脉灌注指数(VAPIs)呈递减趋势,B级后变为显著。以上指标均有很好的相关性。结论容积变化肝左叶、尾状叶体积百分比的改变、肝血流灌注中HPP、TLP、HAI,容积-灌注综合指标VAPIs、VIPs、VPIs的改变评价肝硬化不同分级较为客观,且与临床分级密切相关,两者结合能更全面客观的评价肝功能储备状况。

Objective To investigate the clinical value of hepatic functional reserve in cirrhosis by 16-slice spiral CT hepatic volume measurement in each lobe combined with CT peffusion imaging （CTPI）. Methods CT hepatic volume measurements were performed in 13 normal subjects and 40 patients with cirrhosis （12 in Child A, 15 in Child B and 13 in Child C stage）. CTH were performed in all patients. Data of hepatic volume ,percentage of volume, parame- ters of blood flow perfusion ,and liver volume-perfusion index were compared and analyzed between cirrhosis group and normal controls. Correlations between graded fractions of hepatic function and liver volume in each lobe ,parameters of perfusion,and liver volume-perfusion index were also analyzed. Results Among the groups of cirrhosis Grade A, B, and C, for the values of liver volumes （LV）, left external lobe significantly enlarged in prophase （P〈0.01）and caudate lobe did not enlarged significantly in prophase but became bigger obviously in advanced stage （P〈O.01）. Among the val- ues of hepatic arterial perfusion （HAP）, hepatic portal perfusion （HPP）, total liver perfusion （TLP） of the cirrhosis,hepat- ic arterial perfusion index （HAI） and portal perfusion index （PPI）, HAP, HPP and TLP evidently decreased in early Child A and with the rise of the classification of cirrhosis, and HAl evidently increased in advanced stage （P〈O.05）. A- mong the volume hepatic arterial perfusion index per body surface area （VAPIs）, volume perfusion index per body sur- face area （VHs） and volume portal perfusion index per body surface area（VPPIs） dropped with the hepatic function from Child A to B to C（P〈0.05）. VAPIs had a descending trend which was significant after Child B. All these data had good correlation. Conclusion Changes of volume in the left external lobe and the caudate lobe, blood flow perfusion of the liver in HPP, TLP and HAI,and volume-perfusion index in VPPIs and VPIs were found to he reasonable to evaluate the different Child-Pugh grading of cirrhosis. In addition, it is closely related to the clinical grading. The CT volume measurement combined with CTPI can be a more comprehensive method in evaluating hepatic functional reserve.