CT平扫及增强检查肝硬化门静脉高压伴脾功能亢进的价值研究

Value of plain and enhanced CT examination in cirrhotic portal hypertension with hypersplenism

目的探讨CT平扫及增强检查在肝硬化门静脉高压伴脾功能亢进的患者的成像特点及其应用价值。方法选择2013年1月至2015年1月经腹部CT、临床检验、超声、胃镜等检查诊断有肝硬化门静脉高压伴脾功能亢进患者72例（观察组）,其中男性40例,女性32例;年龄39^69岁,平均年龄43.32岁。随机选取同期排除肝硬化、肝转移瘤及没有造成门静脉系统血流动力学改变的其他系统疾病患者100例（对照组）,其中男性58例,女性42例;年龄38^71岁,平均年龄44.01岁。对所有患者行CT平扫及增强检查,测得门静脉强化峰值时间,分别再延迟3 s、5 s、7 s、9 s接受检查。探讨门静脉系统强化峰值平均时间、门静脉主干与肝实质密度差值（P-L1值）和肝内门静脉细小分支与肝实质密度差异（P-L2值）、图像质量评分。结果观察组患者门静脉主干达到强化峰值的时间长于对照组,差异有统计学意义（P〈0.05）。对照组患者在门静脉主干达到强化峰值之后的第3秒的P-L1值、P-L2值和图像质量评分最大,高于第5秒、第7秒、第9秒时值,差异有统计学意义（P〈0.05）。观察组患者在门静脉主干达到强化峰值之后第7秒的P-L1值、P-L2值和图像质量评分最大,高于第3秒、第5秒、第9秒时值,差异有统计学意义（P〈0.05）。结论肝硬化门静脉高压伴脾功能亢进患者的门静脉主干达到强化峰值的时间长于正常人,并且在到达峰值7 s后成像最佳,图像质量评分最高。所以在对这类人进行扫描时应该延长扫描时间,以获得最佳成像。

Objective To study image characteristics and application value of plain and enhanced CT in patients of cirrhotic portal hypertension with hypersplenism. Methods From January 2013 to January 2015, a total of 72 patients of cirrhotic portal with portal（observation group） diagnosis by abdominal CT examination, clinical examination, ultrasound and endoscopy were enrolled, which included 40 males and 32 females, aged 39- 69 years old with mean age of 43.32 years old. The same period100 cases excluded cirrhosis, liver metastases and other diseases without hemodynamic changes in portal vein system were enrolled（control group）, which included 58 males and 42 females, aged 38- 71 years old with mean age of 44.01 years old. All patients underwent CT plain and enhanced MRI, and portal venous strengthening peak time and the time delayed 3-second,5-second, 7-second and 9-second were measured for examination. The portal venous system strengthening mean peak time,main portal vein and liver substantial density difference（P-L1values） and small branches of portal vein and liver substantial density difference（P-L2values） and image quality score were discussed. Results The portal venous strengthening peak time of observation group was longer than that of control group, the difference was statistically significant（P〈0.05）. In control group,the P-L1, P-L2 values and image quality score at 3-second of portal venous strengthening peak time were higher than those at 5-second, 7-second, 9-second, the difference was statistically significant（P〈0.05）. In observation group, P-L1, P-L2 values and image quality score at 7- second of portal venous strengthening peak time were higher than those at 3-second, 5-second, 9-second, the difference was statistically significant（P〈0.05）. Conclusion It is demonstrated that portal venous strengthening peak time of cirrhotic portal hypertension with hypersplenism is longer than normal, the optimal imaging time and best image quality is at 7-second after reaching peak, so it should be extended scan time to obtain the best imaging.