全肝容积CT灌注成像对乙型肝炎、乙型肝炎肝硬化肝储备功能评价的研究

目的 探讨全肝容积CT灌注成像(VCTP)中乙型肝炎、乙型肝炎肝硬化肝脏左叶、右叶及全肝灌注参数在评价肝脏储备功能中的价值。方法 前瞻性纳入泰安市中心医院影像科2012年11月—2014年2月间,经临床、其它检查证实为乙型肝炎的患者26例(肝炎组)、代偿期乙型肝炎肝硬化的患者24例(代偿组)、失代偿期乙型肝炎肝硬化的患者22例(失代偿组)和对照组(肝功能正常)30例。采用西门子SOMATON Definition AS+128螺旋CT行全肝容积灌注成像,对每组病例的血流量(BF)、血容量(BV)、肝动脉灌注量(ALP)、门静脉灌注量(PVP)及肝动脉灌注指数(HPI)共5个灌注指标进行分析。各组肝脏不同CT灌注参数值的比较采用单因素方差分析,以P<0.05为差异有统计学意义。结果 对照组、肝炎组、代偿组及失代偿组单因素方差分析结果显示,随着肝脏病变程度的加重,肝右叶、肝左叶及全肝灌注参数中的BF、BV、PVP值均逐渐减小,HPI却逐渐增加,4组间总体比较,差异具有统计学意义(P值均＜0.05)。肝脏右叶、左叶及全肝灌注参数对肝功能的评价是一致的,肝脏右叶、左叶灌注参数的走势无明显差异。全肝、肝右叶、肝左叶的灌注参数ALP组间比较差异无统计学意义(P值均＞0.05)。结论 全肝VCTP能反映乙型肝炎、乙型肝炎肝硬化的血流动力学变化,肝脏右叶、左叶灌注参数BF、BV、PVP都是随病变程度的加重而减小,肝脏右叶、左叶及全肝灌注参数对肝功能的评价是一致的。

Evaluation of liver reserve function using whole-liver volume computed tomography perfusion imaging in patients with hepatitis B and liver cirrhosis

Objective To investigate the value of hepatitis B, hepatitis B cirrhosis of the liver of the left lobe, right lobe and the whole liver perfusion parameters in whole liver volume CT perfusion imaging (VCTP) for evaluating liver reserve function.Methods All cases are from Taian Central Hospital from November 2012 to February 2014. The objects brought into our prospective research underwent whole liver volume CT perfusion imaging (VCTP) were composed of 26 patients with hepatitis B, 24 patients that suffered from hepatitis B cirrhosis in compensatory period and 22 patients with hepatitis B cirrhosis in decompensatory period, who were confirmed by clinical and other imaging examinations, and 30 cases in the control group. A total of five perfusion indexes that consisted of blood flow (BF), blood volume (BV), hepatic artery perfusion (ALP), portal vein perfusion (PVP) and hepatic artery perfusion index (HPI) were analyzed. The liver CT perfusion parameters in different groups were compared by one-way ANOVA analysis of variance. The Results would be statistically significant when the value of P was less than 0.05.Results The statistical analysis for parameter of perfusion of BF, BV, ALP, PVP and HPI in liver right lobe among control, hepatisis B, hepatitis B cirrhosis in compensatory period, and hepatitis B cirrhosis in decompensatory period groups was used one-way ANOVA analysis of variance.As the degree of liver pathological change was aggravated, the values of BF, BV and PVP of liver right lobe, liver left lobe and whole liver gradually decreased, but the value of HPI gradually increased, and the differences were statistically significant(all P values＜0.05). The evaluations on liver function by liver right lobe, liver left lobe and whole liver perfusion parameters were consistent, and there was no significant difference between the perfusion parameters of liver left and right lobe. The perfusion parameter of ALP had no statistical significance(all P values＞0.05).Conclusions The whole liver VCTP can reflect the hemodynamic changes of hepatitis B and hepatitis B cirrhosis. The perfusion parameters of BF, BV and PVP of liver right lobe and left lobe gradually decrease, along with the aggravation of the degree of liver pathological change. The evaluations on liver function by liver right lobe, liver left lobe and whole liver perfusion parameters are consistent.