基于Couinaud分段多层螺旋CT全肝灌注成像在肝硬化血流状态评价中的应用

Whole-liver perfusion imaging by multi-slice spiral computed tomography based on Couinaud segments for evaluation of the blood flow state in patients with hepatitis B cirrhosis

目的 应用多层螺旋CT全肝灌注模式,探讨乙型肝炎肝硬化患者基于Couinaud分段的肝脏血流灌注特点,分析肝硬化患者各段灌注参数与Child-Pugh分级之间的相关性. 方法 选择乙型肝炎肝硬化组51例（Child-Pugh A级24例,B级19例,C级8例）,选择正常肝脏组20例作为对照组,应用多层螺旋CT进行全肝灌注成像检查,并分别测定Couinaud各段灌注参数值,比较肝硬化组肝脏Couinaud各段血流灌注差异,并分析不同组之间肝脏各叶的血流特点.同时比较正常组与肝硬化各组主动脉、门静脉、脾脏峰值时间及强化峰值.肝硬化Couinaud各段的灌注参数比较采用单因素方差分析;肝脏各叶不同灌注参数值在组间比较采用SNK法校正. 结果 肝硬化组主动脉、门静脉及脾脏峰值时间高于正常组,强化峰值低于正常组.肝硬化患者S3、S7段肝动脉灌注量值为（11.40±5.72）×10-2/min、（9.46±5.18）×10-2/min,S3、S7段HAP差异有统计学意义（P＜0.05）;肝脏各叶门静脉灌注、总灌注在正常组、肝硬化Child-Pugh A、B、C组间差异有统计学（P＜ 0.05）,肝动脉灌注量和灌注指数各组间差异无统计学意义（P＞0.05）,但Child-Pugh C组肝脏各叶肝动脉灌注量均高于Child-Pugh A、B组,Child-Pugh C组肝脏各叶动脉灌注指数均高于正常组、Child-Pugh A、B组.结论 肝脏Couinaud各段血流状态不尽相同,多层螺旋CT灌注成像能反映不同Chlid-Pugh分级肝硬化血流动力学改变,有助于评价肝硬化各级的血流状态及肝硬化程度.

Objective To investigate the blood flow characteristics of hepatitis B cirrhosis based on Couinaud＆#39;s hepatic segments and to analyze the correlation between perfusion parameters of liver cirrhosis in the hepatic segments and between the different Child-Pugh classifications by using the pattern of whole liver perfusion detected by multi-slice spiral computed tomography （MSCT）.Methods Whole-liver perfusion enhanced CT imaging scan was performed for 51 patients with hepatitis B cirrhosis （including 24 classified as Child-Pugh A,19 as Child-Pugh B,and 8 as Child-Pugh C） and 20 patients without any liver abnormalities （who served as the control group）.The perfusion parameters of Couinaud＆#39;s segments were measured in order to compare the blood perfusion differences among the Couinaud＆#39;s hepatic segments in liver cirrhosis.The blood flow characteristics were analyzed for each lobe and compared between groups,and the time to peak and peak of enhancement values of the aorta and portal veins and spleen were recorded and compared between groups.The F-test was used for statistical analysis.Results The liver cirrhosis group showed higher time to peak for aorta and portal veins and spleen but lower peak of enhancement values than the control group.The hepatic arterial perfusion （HAP） was significantly higher in segment 3 than in segment 7 were （11.40± 5.72 vs.9.46 ±5.18 mL/min/100 mL; P 〈 0.05）.In addition,the differences of the portal venous perfusion （PVP） and total hepatic perfusion （THP） were significant between the liver lobes in various groups （P 〈 0.05）.The HAP and hepatic perfusion index （HPI） were not significantly different between the groups,but the HAP and HPI in every lobe were higher in the Child C subgroup than in either the Child A or Child B subgroups.Conclusion The cirrhotic liver has different blood flow in the various Couinaud＆#39;s segments.Whole-liver perfusion MSCT can reflect the hemodynamic changes of liver cirrhosis and Child-Pugh classification,and as such may be helpful for distinguishing the normal liver from the cirrhotic liver.