超声造影评价肝硬化的可行性研究

Evaluation of hepatic perfusion of cirrhosis by contrast-enhanced ultrasonography

目的探讨超声造影反映肝硬化进程中肝血流灌注的变化规律。方法对40例肝硬化患者（病例组）和25例健康人（对照组）进行超声造影检查，应用QLAB分析软件，将肝实质作为感兴趣区绘制时间-强度曲线，测量肝动脉灌注时间（Tap）及肝动脉灌注强度（Iap），肝实质灌注达峰时间（Tpeak）及肝实质灌注峰值强度（Ipeak），门静脉灌注达峰时间（Tpp,Tpp=Tpeak—Taf）及门静脉灌注强度（Ipp,Ipp=Ipeak-Iaf），计算Ipp／Ipeak值。比较两组间Ipp、Ipeak、Ipp及Ipp／Ipeak的差异，并应用受试者操作特性（ROC）曲线进行分析。结果病例组与对照组比较，Iap增大（P〈0．001），Ipp、Ipp／Ipeak均缩小（P〈0．001）。而Ipeak在两组间差异无统计学意义。Ipp、Ipp、Ipp／Ipeak诊断肝硬化的灵敏度分别为67．3％、92．7％、96．4％，特异度分别为80．0％、96．0％、92．3％。结论超声造影参数可以反映肝硬化肝血流灌注的变化，尤其Ipp／Ipeak在肝硬化和正常肝之间存在显著差异。

Objective To evaluate hepatic perfusion assessed by contrast-enhanced ultrasonography （CEUS） for predicting cirrhosis accurately and non-invasively. Methods Forty patients with cirrhosis and twenty-five healthy controls were given CEUS examination, and time-intensity curves were drawn as the regions of interest located in liver parenchyma by using QLAB analyzing soft. The parameters of the two groups as follows; intensity of arterial perfusion （Ipp）, intensity of total perfusion of liver parenchyma （Ipeak） ,intensity of portal venous perfusion （Ipp）, the ratio of portal venous perfusion and total perfusion （Ipp/Ipeak） were compared by independent-samples t test, and the diagnostic value of parameters were analyzed by receiver operating characteristic （ROC） curve. Results Iap was bigger,while Ipp,Ipp/Ipeak were smaller in patients than that in controls（ P 〈0. 001）. But there was no significant difference on Ipeak between the two groups. When Ipp ,Ipp ,Ipp/Ipeak were used for the diagnosis of cirrhosis, the sensitivity were 67.3%, 92.7%,96.4% and the specificity were 80.0%, 96.0%, 92.3%, respectively. Conclusions CEUS can reflect the changes of the blood perfusion of cirrhotic liver. CEUS parameters Ipp, Ipp, Ipp/ Ipeak are significant different between the two groups and can be the non-invasive diagosis parameters of cirrhosis.