双能量CT评估不同Child-Pugh分级肝硬化肝脾血流动力学的初步研究

A preliminary study of dual-energy CT in evaluation for hepatic and splenic hemodynamic parameters in cirrhosis with different Child-Pugh classification

目的:应用双能量CT碘图定量研究肝硬化肝脾血流动力学参数变化与对应Child-Pugh分级的相关性。方法:选取48例肝硬化患者(肝硬化组)与23例健康志愿者(对照组)的动脉期及门静脉期碘图,测算肝脏动脉期碘浓度(I_(a))与门静脉期碘浓度(I_(p))、门静脉碘浓度(PVIC)、肝动脉碘分数(AIF)、脾脏动脉期碘浓度(SI_(a))与门静脉期碘浓度(SI_(p))。肝硬化组48例中,Child-Pugh分级A级27例,B级14例,C级7例。多组比较采用单因素方差分析,两变量相关性采用Spearman相关分析。结果:肝硬化A、B、C级与对照组4组间6个参数差异均有统计学意义(均P<0.001),肝硬化组I_(a)、AIF、SI_(a)均高于对照组(均P<0.05),I_(p)、PVIC均低于对照组(均P<0.05)。肝硬化组I_(a)、AIF、SI_(a)、SI_(p)均与Child-Pugh分级呈正相关(均P<0.05),I_(p)、PVIC均与Child-Pugh分级呈负相关(均P<0.05)。结论:肝硬化患者与健康人肝脾血流动力学参数存在差异;且肝硬化患者的肝脾血流动力学参数与Child-Pugh分级具有相关性。双能量CT可作为评估肝硬化肝脾血流动力学变化的无创定量工具。

Objective:To investigate the changes of hepatic and splenic hemodynamic parameters and their correlation with the Child-Pugh classification using dual-energy CT iodine image.Methods:Arterial and portal venous phase iodine maps of 48 cirrhotic patients(the cirrhotic group)and 23 control individuals(the control group)were retrieved to measure six parameters:iodine concentration in arterial phase(I_(a)),iodine concentration in portal venous phase(I_(p)),portal venous iodine concentration(PVIC),arterial iodine fraction(AIF),splenic iodine concentration in arterial phase(SI_(a))and splenic iodine concentration in portal venous phase(SI_(p)).48 patients were divided into three subgroups,Child-Pugh A subgroup(27 cases),Child-Pugh B subgroup(14 cases),and Child-Pugh C subgroup(7 cases).One-way ANOVA was used for multiple groups comparisons,and Spearman correlation was used for two-variable correlations.Results:There were significant differences in all six parameters among the four groups(all P<0.001),I_(a),AIF and SI_(a)in Child-Pugh A,B,C subgroups were higher than those in the control group(all P<0.05)and I_(p)and PVIC were lower(all P<0.05).I_(a),AIF,SI_(a)and SI_(p)in the cirrhosis group were positively correlated with the Child-Pugh classification(all P<0.05),while I_(p)and PVIC were negatively correlated(both P<0.05).Conclusions:The hepatic and splenic hemodynamic parameters in cirrhosis patients have differences with those in healthy people.The hepatic and splenic hemodynamic parameters in cirrhosis patients are correlated with the Child-Pugh classification.Dual-energy CT can be used to explore the hemodynamic changes in cirrhosis.