多层螺旋CT肝脏灌注成像在慢性肝纤维化、肝硬化的应用价值

Application Value of Multi-slice Spiral CT Liver Perfusion Imaging in the Chronic Hepatic Fibrosis and Cirrhosts

目的:探讨多层螺旋CT灌注参数评价慢性肝病中肝纤维化、肝硬化的临床价值。方法:对经肝穿刺病理活检确诊的轻度肝硬化(肝纤维化分期为S1、S2期)48例,重度肝纤维化(肝纤维化分期为S3、S4期)和(或)早期肝硬化41例,具有典型临床症状和影像学表现的晚期肝硬化43例及对照组38例行64层螺旋CT肝脏灌注扫描,取得不同病变阶段肝实质的灌注参数,包括肝动脉灌注量(HAP)、门静脉灌注量(PVP)、全肝总灌注量(TLP)、肝动脉灌注指数(HPI)和达峰时间(TTP)共5个指标,与病理分期进行对照研究。结果:在对照组、S1、S2期组、S3、S4期组及肝硬化组中,各组间CTP灌注参数(HAPPVP,LTP,HPI和TTP)差异均有统计学意义(F值分别为61.92、212.52、212.60、152.45和21.93,P值均<0.01)。HAP、HPI、TTP均与肝纤维化严重程度呈显著正相关(r值分别为0.587、0.754及0.605,P均<0.01);而PVP、TLP均与肝纤维化严重程度呈显著负相关(r分别为-0.902和-0.851,P均<0.01)。结论:MSCT灌注参数可较好反映肝纤维化、肝硬化的血流动力学变化,为临床提供良好的参考依据。

Objective：To investigate the value of the MSCT liver perfusion imaging parameters in the evaluation of the chronic hepatic fibrosis and cirrhosis.Methods：Live CT perfusion （CTP） was performed in 132 participants,including 48 patients with mild hepatic fibrosis （S1,S2）,41 patients with severe hepatic fibrosis （S3,S4） and early stage of hepatic cirrhosis which conformed by liver pathologic biopsy,42 patients with hepatic cirrhosis who had typical clinical and image signs,and 38 healthy subjects as control group.The data of CTP （HAP,PVP,LTP,HPI and TTP） at different stages were obtained and control study with histopathologic stage.Results：In the subgroups of the chronic hepatic fibrosis S1,S2,S3,S4 to the hepatic cirrhosis,the difference of HAP,PVP,LTP,HPI and TTP among each subgroup was si gnificant（F=61.92,212.52,212.60,152.45,21.93,respectively,P〈0.01）.HAP,HPI and TTP was significant positive correlation with the degree of the hepatic fibrosis（r=0.587,0.754,0.605,respectively,P〈0.01）,and PVP,TLP was significant negative correlation with the degree of the hepatic fibrosis （r=-0.902,-0.851,respectively,P〈0.01）.Conclusion：MSCT liver perfusion imaging parameters can reflect the hemodynamic changes of chronic hepatic fibrosis and cirrhosis.