多层螺旋CT灌注成像在评价肝硬化储备功能中的应用

The evaluation of liver reserve function by Multi-slice spiral CT perfusion image

目的探讨多层螺旋CT灌注成像(CTP)在肝硬化肝脏储备功能评价中的价值。方法行上腹部CTP增强扫描的住院患者36例,采用GE AW4.3工作站分别测量肝血流量(HBF)、血容量(HBV)、平均通过时间(MTT)、肝动脉灌注分数(HAF)、肝动脉灌注量(HAP)、门静脉灌注量(PVP)值,采用灌注参数随终末期肝病模型(MELD)将所有受检者分为A、B、C 3组,分析比较各灌注参数在3组间的变化规律及差异。结果 HBF值由(213.53±113.64)mL·min-1·100 g-1减小到(89.70±19.61)mL·min-1·100 g-1,A组与C组间差异有统计学意义(P<0.05);HBV值由(23.24±9.60)mL·100 g-1减小到(13.79±3.86)mL·100 g-1,A、B组与C组间差异有统计学意义(P<0.05);HAF值由0.20±0.11增大到0.41±0.17,A、B组与C组间差异有统计学意义(P<0.05);HAP值由(68.59±41.82)mL·min-1·100 g-1减少到(21.15±9.50)mL·min-1·100 g-1,A组与B、C组间差异均有统计学意义(P<0.05)。经相关分析,HBF、HAP与MELD分值呈负相关(r=-0.531,P<0.05;r=-0.542,P<0.05),HAF与MELD分值呈正相关(r=0.375,P<0.05)。结论 CT灌注成像可以评价肝脏储备功能,为临床评估病情及制定治疗方案提供依据。

Objective To investigate the clinical application of multi - slice spiral CT Perfusion imaging in liver reserve func- tion. Methods Thirty six cases accepted our hospitalg Multislice CT perfusion enhanced scan of cirrhosis from May 2012 to May 2013. The liver perfusion parameters were measured and calculated in GE AW4.3 work station： Hepatic blood flow （HBF）, Hepatic blood vol- ume （HBV）,Mean transit time （MTF）,Hepatic arterial fraction （HAF）,hepatic arterial perfusion （HAP） and Portal vein perfusion （PVP）. The difference of these perfusion parameters were compared between group A, B and C. Results HBF decreased from （213.53 ±113.64）mL· min^-1 · 100 g^-1 to（89.70 ± 19.61 ）mL ·min^-1 ·100 g^-1, and the difference of HBF between A and C groups was statistically significant （F=3. 62,P 〈0.05）. HBV decreased from（23.24 ±9.60）mL · min ^-1 · 100 g^-1 to（ 13.79±3.86） mL · min ^- 1· 100 g ^- 1, and HAF from 0.20 ± 0.11 ） to （ 0.41± 0.17 ; the difference of HBV, HAF between C and A, B groups were sta- tistically significant （ F = 3. 28, P 〈 0. 05 ; F = 2. 58, P 〈 0. 05 ）. HAP decreased from （68.59 ± 41.82 ） mL·min ^- 1 · 100 g^- 1 to （21.15 ± 9.50）mL · min^- 1 ·100 g^-1, and the difference of HAP between group A and B, group A and C were statistically significant （F =5.84,P 〈0.05）. HBF and HAP were positive correlation with MELD score（r = -0. 531 ,P 〈0. 05 ;r = -0. 542 ,P 〈0. 05）, HAF was negative correlation with MELD score （ r = 0. 375, P 〈 0.05 ）. Conclusion Muhislice CT liver perfusion imaging can evaluate the hepatic reserve function, and will have positive impact on clinical evaluation and treatment.