320排CT全肝脾联合灌注对肝脏早期弥漫性病变的临床应用价值

Clinical application of 320-slice CT whole liver and spleen perfusion imaging in the diagnosis of early diffuse liver lesions

目的探讨320排CT全肝脾联合灌注成像应用于肝脏早期弥漫性病变诊断的可行性及优越性。方法 23例正常肝脏志愿者(正常组)、23例肝纤维化患者(病例组)均用320排CT行全肝脾联合动态容积扫描,所获得图像利用灌注软件获取兴趣区的时间-密度曲线及灌注参数,并测量脾脏大小,然后应用合适的统计学方法对正常组及病例组各数据进行分析。结果病例组门静脉(PV)、肝脏及肝纤维化F4级脾脏的曲线峰值明显滞后,波峰宽大,且达峰后下降缓慢,形成较长时间平台期,峰值不明显。正常肝脏各肝叶肝动脉灌注量(AF)、门静脉灌注量(PF)、肝灌注指数(PI)差异均无统计学意义(P>0.05);病例组与正常组肝脏各叶PF差异有统计学意义(P<0.01),AF及PI差异无统计学意义(P>0.05);病例组与正常组的脾脏灌注参数差异有统计学意义(P<0.05);病例组中肝纤维化F2级与F3级脾脏AF及肝纤维化F2~F4级脾脏厚度的比较差异无统计学意义(P>0.05),余肝纤维化分组间的脾脏AF差异均有统计学意义(P<0.05)。结论 320排CT动态容积全肝脾灌注成像从整体上评价肝脾微循环变化,对肝脏早期弥漫性病变的灌注分析有显著优势,从而为肝脏早期弥漫性病变的诊断及分级提供了更多依据。

Objective To investigate the feasibility and advantages of the application of 320-slice CT whole liver and spleen perfusion imaging in the diagnosis of early diffuse liver lesions. Methods A total of 23 volunteers with normal liver(Normal Group) and 23 cases of liver fibrosis(Case Group) underwent whole liver and spleen dynamic volume scanning with 320-slice CT. The time-density curve and perfusion parameters of the region of interest were obtained from the images by using the perfusion software. The size of the spleen was measured. The data of the Normal Group and the Case Group were analyzed by using appropriate statistical methods. Results The curves of portal vein(PV), liver and spleen of patients with liver fibrosis of Grade F4 in the Case Group had the significantly lagged peaks, the broader crest and slow decrease after reaching the peak, forming a longer plateau period with insignificant peak value. There was no statistics difference in the AF, PF and PI among the hepatic lobes of normal liver(P>0.05). There was significant difference in PF of liver lobes between the Case Group and the Normal Group(P<0.01), but there were no significant differences in AF and PI(P>0.05). There was significant difference in spleen perfusion parameters between the Case Group and Normal Group(P<0.05). In the Case Group, there was no significant difference in the thickness of the spleen of the patients with liver fibrosis of Grade F2 and F3 and Grade F2-F4(P>0.05). There was significant difference in spleen AF among different groups of liver fibrosis grades(P>0.05). Conclusion 320-slice CT dynamic volume whole liver and spleen perfusion imaging can evaluate the microcirculation of liver and spleen on the whole. It has obvious advantages in perfusion analysis of early diffuse liver lesions, thus provides a stronger basis for the diagnosis and grading of diffuse liver lesions.