64层螺旋CT静脉成像在肝硬化门脉高压症早期诊断中的价值

目的 探讨64层螺旋CT在肝硬化门脉高压的早期诊断.方法 研究经病理和/或临床诊断的42例肝硬化早期、中晚期病人64层螺旋CT门静脉及肝静脉血管成像表现,测量42例患者及15例健康者门静脉和肝右静脉管径并分析64层螺旋CT门脉血管成像法在肝硬化门脉高压症的早期诊断价值.结果 所有病人的观察血管在显示较佳的基础上,测得门静脉宽度(PV)在正常对照组(＜12 mm)与其他2组比较有显著性差异,肝硬化代偿组与失代偿组之间差异无明显统计学意义;肝右静脉宽度(RHV)在代偿期内径明显增宽,＞10 mm,而失代偿期肝静脉明显变窄,血管强化密度减低;PV/RHV比值在失代偿期约1.77±0.06,正常对照组及肝硬化代偿组PV/RHV均＜1.5.利用后处理软件最大密度投影(MIP)观察门静脉及肝右静脉血管,代偿组可显示3级以上的门静脉及肝右静脉,失代偿组肝右静脉显示欠佳,最多显示1级,门静脉属支走行扭曲且最多显示3级.结论 64层螺旋CT肝、门静脉血管成像对临床肝硬化门脉高压的早期诊断有重要临床意义.     

肝脏及其相关脏器在肝炎后肝硬化中的时间-密度曲线研究

目的 探讨从正常肝脏到肝炎后肝硬化的演变过程中,相关脏器的时间-密度曲线(TDC)变化规律.资料与方法 3组共120例(正常对照组34例,肝炎肝纤维化组48例,肝炎后肝硬化组38例)经CT同层动态增强扫描得到腹主动脉、门静脉、肝实质、脾脏实质等4个感兴趣区(ROI)TDC,分析3组ROI达峰时间(TTP)和峰值高度(PV).结果 3组主动脉的TTP无差异性,PV有统计学差异;3组门静脉、肝脏、脾的,TTP及PV均有统计学意义,均为TTP渐延长,PV渐下降.结论 门静脉、肝脏、脾等相关脏器的TDC表现反映了肝炎后肝硬化的血流动力学变化.     

慢性重型肝炎患者血清游离IGF-1检测及意义

目的分析血清游离IGF1水平变化与慢性重型肝炎患者的病情发展和预后的关系。方法应用ELISA方法检测44例慢性重型肝炎、46例肝硬化和43例慢性肝炎患者血清游离IGF1水平。并与肝功能各项指标、凝血酶原活动度和胆碱酯酶进行对照。结果慢性重型肝炎、肝硬化和慢性肝炎患者血清游离IGF1水平分别为0.24±0.15、0.33±0.17和1.06±0.70ng/ml,慢性重型肝炎与肝硬化和慢性肝炎有显著性差异(P<0.01);慢性重型肝炎早、中期IGF1水平比较,差异无显著性(P>0.05);早期与晚期比较,差异有显著性(P<0.0);中期与晚期比较,差异亦有显著性(P<0.05)。死亡组32例患者的血清游离IGF1平均低于0.2ng/ml,而存活组12例患者平均高于0.35ng/ml。结论在慢性重型肝炎患者血清游离IGF1显著下降,并与重型肝炎严重程度有关,因此可作为判断慢性重型肝炎预后的一个重要指标。     

16层螺旋CT评价肝硬化患者血流灌注参数变化

目的:探讨MSCT灌注成像技术在评估肝硬化血流动力学变化中的应用价值。材料和方法:对68例患者行肝灌注扫描,其中对照组29例,代偿期肝硬化22例,失代偿期肝硬化17例。通过扫描软件得出肝血流量(BF)、血容量(BV)、对比剂平均通过时间(MTT)、渗透表面积乘积(PS)、肝动脉灌注指数(HAF)。分析这些参数在肝硬化患者中的变化规律及临床意义。结果:对照组、代偿期肝硬化组和失代偿期肝硬化组的PS、HAF的均值是逐渐增加的。对照组、代偿期肝硬化组和失代偿期肝硬化组的BV、MTT均值是逐渐减小的。对照组、代偿期肝硬化组和失代偿期肝硬化组间的BF均值有显著性差异。结论:MSCT灌注成像技术可用来评价肝硬化血流动力学变化及其程度。     

磁共振电影相位对比定量肝硬化门静脉血流与肝功能分级的关系

目的 采用电影相位对比磁共振成像(Cine PC MRI)评价肝硬化门静脉高压患者门静脉血流动力学与Child-Pugh肝功能分级的关系. 资料与方法 49例肝硬化门静脉高压患者,男26例,女23例,平均年龄47.8岁;19名正常对照者,男10名,女9名,平均年龄43.5岁.按Child-Pugh肝功能分级,A级10例,B级31例,C级8例.采用Cine PC MRI对门静脉血流进行定量测量. 结果 肝硬化组按照Child A、B、C顺序,门静脉血流速度逐渐降低,组内差异具有显著性统计学意义(P<0.05);Child C级的门静脉流速与A、B级及正常组相比,流速明显减低,差异具有显著性统计学意义(P<0.01).肝硬化Child B、C级患者较正常组门静脉直径增宽、截面积明显增大(P<0.05).Child C级较B级门静脉血流量明显减少(P<0.05). 结论 Cine PC MRI监测门静脉血流动力学有助于评价肝硬化患者的肝功能、门静脉高压严重程度.     

肝病患者蝰蛇毒磷脂时间测定的临床意义

中国蝰蛇毒试剂系广州蛇毒研究所从广东产圆斑蝰蛇毒提取。它具有直接激活凝血因子Ⅹ的作用。测定蝰蛇毒磷脂时间(RVVCT),同时测定凝血酶原时间(PT)可鉴别Ⅹ因子和Ⅶ因子的缺乏。 实验以50名健康人作对照。急性肝炎31例,慢性活动性肝炎23例,失代偿性肝硬化伴腹水者31例,重型肝炎6例(其中急性重型2例,慢性重型4例),肝癌5例(均合并肝硬化)。 结果表明:急性肝炎组RVVCT和PT与对照组比较均无差异(P>0.05)。慢性活动性肝炎、肝硬化、重型肝炎和肝癌组的RVVCT和PT与对照组比较差异非常显著(P<0.01)。RVVCT和PT延长的     

电影相位对比MRI肝硬化上消化道出血门静脉血流动力学研究

目的:采用电影相位对比MRI定量肝硬化门静脉血流,评价其与消化道出血的关系.方法:对49例门静脉高压症患者行电影相位对比MRI门静脉血流定量测量,依照病史分为出血组31例,无出血组18例;另选对照组19例.结果:门静脉高压出血组及未出血组门静脉主干截面积与正常组比较均显示明显增大(P＜0.05),肝硬化出血组门静脉流速较未出血组流速增高,但较正常对照组减低,该差异无统计学意义(P＞0.05),肝硬化出血组门静脉血流量明显增高,与正常组及肝硬化未出血组比较,差别具有统计学意义(P＜0.05).结论:电影相位对比MRI能客观反映门静脉血流动力学改变.     

3.0 T磁共振相位对比法定量肝硬化门静脉血流动力学与肝功能状况的相关性研究

目的 运用磁共振相位对比法(PC-MRI)对门静脉系统血流参数进行测量,探讨PC-MRI在乙肝肝硬化肝功能状况评价中的应用价值及意义.方法 40例乙肝肝硬化患者,男32例,女8例,年龄29～70岁,平均52.3岁,其中Child-PughA级15例,B级13例,C级12例;10例对照组患者,男6例,女4例,年龄40 ～ 60岁,平均42岁.通过PC-MRI测量门静脉、肠系膜上静脉及脾静脉的截面积(S,mm2)、平均血流量(Q,ml/s)和平均流速(V,cm/s).结果 对照组门静脉截面积(SPV)明显小于肝硬化各组(P＜0.05);随着肝硬化程度的加重,门静脉平均血流量(QPV)和平均流速(VPV)逐渐减小(P＜0.05),Child-Pugh C级的VPV明显低于Child-Pugh A、B级(P＜0.05);肝硬化各组肠系膜上静脉截面积(SSMV)明显高于正常组(P＜0.05),Child-Pugh B级低于Child-Pugh A、C级(P＜0.05);Child-Pugh B、C级SSV较正常组明显增大,且差异具有统计学意义(P＜0.05).QPV、VPV、脾静脉平均血流量(QSV)和脾静脉平均流速(VSV)与MELD评分呈负相关(P＜0.05),相关系数分别为-0.396、-0.464、-0.453、-0.549.结论 PC-MRI可有效评价乙肝肝硬化不同肝储备功能状态的门静脉系统血流状态,是评价肝硬化严重程度及肝脏储备功能的重要影像学手段.     

肝硬化患者肺微循环多层螺旋CT灌注研究

目的:采用MSCT灌注成像技术研究肝硬化患者肺部微循环灌注参数的变化。材料和方法:对20例正常对照组、24例代偿期肝硬化组和19例失代偿期肝硬化组行16层螺旋CT肺部同层动态增强扫描后,在工作站上使用perfusion3软件包对扫描数据进行处理,得出感兴趣区的时间-密度曲线(time-density curve,TDC)和各灌注参数值,包括血流量(blood flow,BF)、血容量(blood volume,BV)、对比剂平均通过时间(mean transit time,MTT)和表面渗透积乘积(permeability surface area product,PS)。采用SPSS11.5软件包对上述数据进行统计学分析。结果:BF、BV值在各组的总体均数差别有统计学意义(P<0.01)。失代偿期肝硬化组的BF、BV值较正常对照组和代偿期肝硬化组都明显增加,组间差别有统计学意义(P<0.01)。代偿期肝硬化组的BF、BV值与正常对照组比较,组间差别无统计学意义(P>0.05)。MTT值各组的总体均数间差别有统计学意义(0.05>P>0.01)。失代偿期肝硬化组的MTT值较正常对照组和代偿期肝硬化组减少,组间差别有统计学意义(0.05>P>0.01)。PS值各组间差别无统计学意义(P>0.05)。结论:MSCT肺部微循环灌注成像技术可反映肝硬化患者病情程度。     

多层螺旋CT肝脏灌注测量在肝硬化中的初步应用

目的探讨多层螺旋CT肝脏灌注测量在肝硬化中的应用价值。资料与方法37例接受多层螺旋CT肝脏灌注测量。20例无明显肝脏疾患的志愿者(正常组),17例肝硬化患者(肝硬化组),再按其肝硬化程度分为两组:9例为轻中度肝硬化(轻中度肝硬化组),8例为重度失代偿肝硬化(重度失代偿组)。计算各例的各项灌流指标并进行组间比较。结果(1)肝硬化组与正常组相比,门静脉灌流量(HPP)、门静脉灌流指数(PPI)明显减低[HPP:(0.49±0.19)ml·min-1·ml-1与(0.60±0.16)ml·min-1·ml-1,P=0.045;PPI:0.58±0.14与0.67±0.06,P=0.015],门静脉与肝动脉灌流比率(HPP/HAP)亦明显减低(1.63±0.87与2.12±0.65,P=0.04),肝动脉灌注指数(HPI)升高(0.42±0.14与0.33±0.06,P=0.015),提示肝硬化时HPP减少,门静脉血流在肝脏血供中的比例减少,而动脉的灌流比重增加;(2)重度失代偿组肝硬化HAP较轻中度组明显升高[分别为(0.48±0.16)ml·min-1·ml-1与(0.25±0.07)ml·min-1·ml-1,P=0.002],HPI亦明显升高(分别为0.54±0.10与0.32±0.07,P=0.0001),PPI则明显降低(分别为0.46±0.10与0.68±0.07,P=0.0001),提示不同程度肝硬化其灌注指标存在差异,灌注改变与肝硬化程度有关。结论肝脏CT灌注测量可以反映肝硬化的血流灌注改变,灌注值的变化也能够提示肝硬化的程度。     

Portal venous hemodynamics in chronic liver disease: effects of posture change and exercise

Changes of portal hemodynamics with the progression of chronic liver disease and changes caused by body posture and physical exercise were investigated using an ultrasonic pulsed Doppler flowmeter in healthy adults and in patients with chronic persistent hepatitis, chronic active hepatitis, and cirrhosis. Portal venous velocity was significantly reduced in patients with chronic active hepatitis, cirrhosis without a large splenorenal shunt, and cirrhosis with a large splenorenal shunt, compared with normal subjects and patients with chronic persistent hepatitis. Portal venous flow, by contrast, was significantly reduced only in patients with cirrhosis and a large splenorenal shunt compared with normal subjects and with the other three groups; there was no significant difference in portal venous flow among the latter four groups. Both portal venous velocity and flow showed a tendency toward further reduction in patients with cirrhosis who had hepatofugal flow of part of the superior mesenteric venous blood into the splenic vein and a large splenorenal shunt. Both exercise and posture change from supine to sitting significantly reduced portal venous velocity and portal venous flow in normal subjects, as well as in the patients with chronic liver disease.     

Blood flow dynamics of the portal venous system in liver cirrhosis using pulse Doppler method

Blood flow dynamics of the portal venous system including portal vein, splenic and superior mesenteric arteries, in thirty seven cases with liver cirrhosis and 32 controls were studied by means of the pulse doppler method. Maximum blood flow velocity of the main portal vein in liver cirrhosis was 0.21 m/sec in mean, significantly lower than in controls. Blood flow volume of the portal vein in liver cirrhosis was 18.9 ml/min.kg, which was a significant increase compared with that of controls. The cases of liver cirrhosis showed an increased blood flow volume of the splenic and superior mesenteric arteries, showing an increased pre-load to the spleen. In 5 cases, liver volume measured by computed tomography was not changed despite of an increase of the main portal venous flow volume. Three of these 5 cases were of more advanced liver cirrhosis with over 40 percent of ICG value. They bend to have higher portal venous velocity than the other cases with less advanced liver cirrhosis. No correlation of the splenic arterial flow volume and the spleen volume was thought to indicate after-load to the spleen as a factor of splenic enlargement.     

Assessment of portosystemic shunting from superior mesenteric vein by duodenal administration of iodoamphetamine I123

Portosystemic shunting (PSS) from the superior mesenteric vein (SMV) was evaluated with the duodenal administration of iodoamphetamine 1123 (IMP) in patients with chronic hepatitis and liver cirrhosis. After duodenal intubation, IMP was administered through a tube, and then scintigraphy including the pulmonary and hepatic regions was performed. In all patients, images of the liver and/or lungs were observed within 10 min and became clear with time, due to a good absorption of IMP from the intestine. On the other hand, IMP appears not to be absorbed from the stomach. The portosystemic shunt index was calculated by dividing counts of lungs by counts of liver and lungs. The shunt index (mean±SE) was 1.5%±0.8%, 12.6%±3.7% and 28.3%±4.5% in chronic hepatitis, compensated cirrhosis and decompensated cirrhosis, respectively. This index was significantly higher in cirrhosis, especially in decompensated cirrhosis. Therefore, transintestinal portal scintigraphy with IMP could be a useful method for the non-invasive and quantitative evaluation of PSS from the SMV in portal hypertension. Offprint requests to: T. Kashiwagi     

Assessment of portosystemic shunting from superior mesenteric vein by duodenal administration of iodoamphetamine I123.

Portosystemic shunting (PSS) from the superior mesenteric vein (SMV) was evaluated with the duodenal administration of iodoamphetamine I123 (IMP) in patients with chronic hepatitis and liver cirrhosis. After duodenal intubation, IMP was administered through a tube, and then scintigraphy including the pulmonary and hepatic regions was performed. In all patients, images of the liver and/or lungs were observed within 10 min and became clear with time, due to a good absorption of IMP from the intestine. On the other hand, IMP appears not to be absorbed from the stomach. The portosystemic shunt index was calculated by dividing counts of lungs by counts of liver and lungs. The shunt index (mean +/- SE) was 1.5% +/- 0.8%, 12.6% +/- 3.7% and 28.3% +/- 4.5% in chronic hepatitis, compensated cirrhosis and decompensated cirrhosis, respectively. This index was significantly higher in cirrhosis, especially in decompensated cirrhosis. Therefore, transintestinal portal scintigraphy with IMP could be a useful method for the non-invasive and quantitative evaluation of PSS from the SMV in portal hypertension.     

"Congestion index" of the portal vein

The "congestion index" is used to mean the ratio between the cross-sectional area (cm2) and the blood flow velocity (cm/sec) of the portal vein, as determined by a duplex Doppler system. The indices as determined in normal subjects and patients with liver disease were as follows: normal subjects (n = 85), 0.070 +/- 0.029 cm X sec; acute hepatitis (n = 11), 0.071 +/- 0.014 cm X sec; chronic active hepatitis (n = 42) 0.119 +/- 0.084 cm X sec; cirrhosis (n = 72), 0.171 +/- 0.075 cm X sec; and idiopathic portal hypertension (n = 11), 0.180 +/- 0.107 cm X sec. There was a statistically significant difference between the congestion indices from the normal subject group and indices obtained from patients with chronic hepatitis, cirrhosis, and idiopathic portal hypertension. A weak positive correlation was obtained between the congestion index and the portal venous pressure, measured simultaneously through a percutaneously placed catheter (n = 64, r = 0.45, p less than 0.01). It is suggested that the congestion index reflects the pathophysiological hemodynamics of the portal venous system in portal hypertension.     

门脉循环γ照相,B超和肝功能测定对肝硬化诊断的对比研究

本文应用门脉循环γ照相测定门脉分流指数，评估其在肝硬化诊断中的作用，并与Ｂ超和５组肝功能测定进行对比。研究表明，核素门脉分流指数随着慢性肝病的肝纤维化进程不断升高，正常人＜慢性肝炎＜代偿期肝硬化＜失代偿期肝硬化。本法敏感性为９２．３％，Ｂ超为７７．４％，肝功能总体为７０．９％；本法特异性为１００％，准确率９５．１％，阳性预测值１００％，阴性预测值８８．４％。说明门脉循环γ照相是安全、简便，早期诊断肝硬化的可靠方法。     

CT signs of hepatofugal portal venous flow in patients with cirrhosis

OBJECTIVE: We investigated whether CT signs can be used to predict hepatofugal flow in the main portal vein in patients with cirrhosis. MATERIALS AND METHODS: We retrospectively identified 36 patients with cirrhosis, 18 with hepatopetal and 18 with hepatofugal flow in the main portal vein, who underwent contemporaneous abdominal sonography and CT. Two independent observers evaluated the following features on the randomized CT studies: diameter of the portal, splenic, and superior mesenteric veins; spleen size; and the presence of ascites, varices, or arterial phase portal venous enhancement. These data were correlated with the flow direction seen on sonography. RESULTS: A small main portal vein was the only sign significantly (p 相似文献   

Clinical significance of the measurement of hepatic blood flow using xenon 133 and balloon catheter in patients undergoing treatment for hepatocellular carcinoma.

Total hepatic blood flow and portal blood flow were measured separately using a modified xenon 133 clearance method during angiography in 71 patients with chronic liver diseases, including 40 with proven hepatocellular carcinoma, and in 12 patients without detectable chronic liver injury who served as controls. Total hepatic and portal blood flow rates in controls were 805 +/- 149 ml/min and 667 +/- 206 ml/min, respectively. Total hepatic blood flow was significantly decreased in patients with compensated and decompensated liver cirrhosis (519 +/- 156 ml/min and 317 +/- 153 ml/min, respectively; P less than 0.01), as was portal blood flow (399 +/- 134 ml/min and 271 +/- 134 ml/min, respectively; P less than 0.01). Following transcatheter arterial embolization or hepatic resection (in 35 and 13 patients, respectively), hepatic failure occurred in 3 cases each. Embolization appeared contraindicated when hepatic portal blood flow was under 125 ml/min, and safe hepatic resection required an anticipated residual hepatic portal blood flow of at least 250 ml/min.     

Measurement of hepatic blood flow by use of per-rectal portal scintigraphy with 133Xe.

A relatively noninvasive method is needed to evaluate the hepatic blood flow of patients with liver disease. We used per-rectal portal scintigraphy with 133Xe, and analysed the time-activity curves of the liver and portal vein. To do this, wash-out curves of the liver were plotted, and the hepatic blood flow and the ratio of the blood flow to the right lobe of the liver to that to the left lobe (R/L ratio) were calculated. The mean hepatic blood flow was 137 +/- 23 ml/100 g/min for four patients with fatty liver, 139 +/- 16 ml/100 g/min for seven patients with chronic persistent hepatitis, 120 +/- 15 ml/100 g/min for ten patients with chronic aggressive hepatitis, and 75 +/- 21 ml/100 g/min for 14 patients with cirrhosis. All seven patients with hepatic blood flow that was less than 100 ml/100 g/min and an R/L ratio less than 1.0 had cirrhosis. Only two of the 22 patients with hepatic blood flow that was greater than 100 ml/100 g/min and an R/L ratio greater than 1.0 had cirrhosis. Per-rectal portal scintigraphy can be used to measure the hepatic blood flow, but it was not useful for the diagnosis of fatty liver.     

64层螺旋CT门静脉三维重组对门静脉高压侧支循环的研究及临床应用

目的：评价64层螺旋CT门静脉三维重组对门静脉高压侧支循环的诊断价值及临床应用。方法：正常者20例,肝硬化患者39例,行64层螺旋CT门静脉造影,容积数据采用最大密度投影（MIP）、容积再现法（VR）、表面遮盖法（SSD）、多平面重组（MPR）三维重组,观察门静脉高压肝内门静脉、属支及侧支循环的影像学特征。结果：64层螺旋CT门静脉三维重组能准确显示侧支循环分布范围、初步评估病变程度,门静脉高压症组门静脉属支管径显著大于正常组（P=0.000）,64层螺旋CT诊断食管胃底静脉曲张与胃镜诊断有高度一致性。结论：64层螺旋CT门静脉三维重组能够多角度、立体观察侧支循环情况,对预测其并发症、手术方案的制定具有重要的指导意义。