多层螺旋CT全肝灌注成像对脾功能亢进患者血流状态的定量评价

Quantitative evaluation of blood flow state in patients with hypersplenism based on multi-slice spiral CT whole liver perfusion imaging

目的探讨不同严重程度脾功能亢进患者的血流状态以及肝脾血管内径的变化情况。方法选取2018年6月至2022年9月期间入院诊治肝硬化伴脾功能亢进患者36例,另选择同期健康体检者40例作为对照组,比较脾功能亢进患者与健康对照组临床资料、肝脾影像学特征以及肝脏灌注参数。结果脾功能亢进组ALT、AST和GGT水平分别为87.6(34.3,378.7)U/L、75.6(39.3,361.2)U/L和65.7(31.3,83.6)U/L,高于健康对照组的16.2(12.6,25.1)U/L、18.0(12.0,24.8)U/L和16.3(11.6,24.0)U/L(P<0.05)。脾功能亢进患者脾动脉直径、脾静脉直径、门静脉直径和脾脏体积分别为(7.2±1.3)mm、(13.5±2.5)mm、(16.9±2.4)mm和(1842±859.4)cm^(3),大于健康对照组的(5.6±0.8)mm、(10.0±1.6)mm、(14.3±1.8)mm和(398.5±149.8)cm^(3)(P<0.05)。中度脾功能亢进组脾动脉直径、脾静脉直径、门静脉直径和脾脏体积分别为(8.0±1.2)mm、(14.9±1.4)mm、(17.8±2.0)mm和(2361.8±894.0)cm^(3),重度脾功能亢进组脾动脉直径、脾静脉直径、门静脉直径和脾脏体积分别为(7.0±0.8)mm、(14.1±2.5)mm、(17.9±2.2)mm和(1994.4±783.7)cm^(3),均显著大于轻度脾功能亢进组的(6.4±1.0)mm、(11.9±1.9)mm、(15.9±1.8)mm和(1253.4±582.6)cm^(3)(P<0.05)。脾功能亢进组患者尾状叶、左外叶、左内叶、右前叶和右后叶的PVP和TLP灌注参数分别为(46.3±15.5)mL/min和(54.9±21.0)mL/min、(40.7±14.5)mL/min和(49.6±15.1)mL/min、(37.6±13.9)mL/min和(49.7±13.2)mL/min、(41.8±13.6)mL/min和(47.5±15.3)mL/min、(44.7±14.5)mL/min和(56.3±10.0)mL/min,低于健康对照组的(80.4±52.7)mL/min和(91.6±56.8)mL/min、(87.8±39.4)mL/min和(98.6±51.3)mL/min、(78.0±46.5)mL/min和(87.7±48.4)mL/min、(79.2±51.1)mL/min和(87.0±42.1)mL/min、(73.1±39.3)mL/min和(85.0±37.1)mL/min(P<0.05)。HPI灌注参数分别为(18.5±12.7)%、(20.6±12.0)%、(23.6±14.8)%、(13.8±11.5)%和(20.6±7.5)%,高于健康对照组的(12.4±6.8)%、(14.2±8.2)%、(11.7±9.0)%、(12.2±9.6)%和(12.9±7.4)%。结论脾功能亢进患者脾血管均出现扩张,且中重度患者扩张程度更显著,脾功能亢进患者肝脏血液灌注减少。

Objective To investigate the variations in blood flow status and changes in the internal diameter of hepatic and splenic vessels in patients with different degrees of hypersplenism.Methods A total of 36 patients diagnosed with liver cirrhosis and hypersplenism were enrolled between June 2018 and September 2022.Additionally,40 healthy individuals who underwent examinations at our hospital during the same period were selected as the control group.Clinical data,imaging features of the liver and spleen,as well as liver perfusion parameters were compared between patients with hypersplenism and the healthy control group.Results The comparative analysis of clinical data revealed that patients diagnosed with hypersplenism exhibited significantly elevated levels of ALT,AST and GGT,with values of 87.6(34.3,378.7)U/L,75.6(39.3,361.2)U/L and 65.7(31.3,83.6)U/L,respectively.These levels were notably higher compared to the healthy control group,which had values of 16.2(12.6,25.1)U/L,18.0(12.0,24.8)U/L and 16.3(11.6,24.0)U/L(P<0.05).Upon evaluation of imaging parameters,,it was discovered that the diameter of the splenic artery,splenic vein,portal vein,and spleen volume in patients with hypersplenism were significantly elevated compared to those of the healthy control group.Specifically,they measured approximately(7.2±1.3)mm,(13.5±2.5)mm,(16.9±2.4)mm and(1842±859.4)cm^(3),respectively,while the healthy control group were(5.6±0.8)mm,(10.0±1.6)mm,(14.3±1.8)mm and(398.5±149.8)cm^(3)(P<0.05).Additionally,the measurements of splenic artery,splenic vein,portal vein and spleen in the group with moderate hypersplenism were(8.0±1.2)mm,(14.9±1.4)mm,(17.8±2.0)mm and(2361.8±894.0)cm^(3),respectively.In contrast,the severe hypersplenism group displayed measurements of(7.0±0.8)mm,(14.1±2.5)mm,(17.9±2.2)mm and(1994.4±783.7)cm^(3),which were significantly higher than those observed in the mild hypersplenism group[(6.4±1.0)mm,(11.9±1.9)mm,(15.9±1.8)mm and(1253.4±582.6)cm^(3)(P<0.05)].In terms of liver perfusion parameters,the PVP and TLP parameters for the caudate lobe,left lateral lobe,left medial lobe,right anterior lobe and right posterior lobe in hypersplenism group were(46.3±15.5)ml/min and(54.9±21.0)ml/min,(40.7±14.5)ml/min and(49.6±15.1)ml/min,(37.6±13.9)ml/min and(49.7±13.2)ml/min,(41.8±13.6)ml/min and(47.5±15.3)ml/min,(44.7±14.5)ml/min and(56.3±10.0)ml/min.These values were significantly lower when compared to the healthy control group[(80.4±52.7)ml/min and(91.6±56.8)ml/min,(87.8±39.4)ml/min and(98.6±51.3)ml/min,(78.0±46.5)ml/min and(87.7±48.4)ml/min,(79.2±51.1)ml/min and(87.0±42.1)ml/min,(73.1±39.3)ml/min and(85.0±37.1)ml/min(P<0.05)].The HPI parameters in the hypersplenism group were(18.5±12.7)%,(20.6±12.0)%,(23.6±14.8)%,(13.8±11.5)%and(20.6±7.5)%,which were significantly higher than those in the healthy control group[(12.4±6.8)%,(14.2±8.2)%,(11.7±9.0)%,(12.2±9.6)%and(12.9±7.4)%].Conclusion Patients with hypersplenism exhibited dilated splenic,with more pronounced dilation observed in those with moderate and severe hypersplenism.Additionally,hepatic blood perfusion was reduced in patients with hypersplenism.