超声造影评价肝纤维化血流灌注特征的初步研究

目的:探讨超声造影评价肝纤维化血流灌注特征的临床应用价值。方法:肝纤维化组15例,均经超声引导下肝组织活检病理证实,选取健康志愿者15例为正常对照组。所有研究对象经肘静脉团注对比剂SonoVue 2.4ml,行实时灰阶超声造影检查,记录对比剂肝动脉到达时间(hepatic artery arrival time,HAAT)、门静脉到达时间(portal vein arrival time,PVAT)、肝静脉到达时间(hepatic vein arrival time,HVAT)及相应血管灌注强度参数(peak intensity,PI),同时计算肝动-静脉渡越时间(hepatic artery to hepatic vein transit time,HA-HVTT)、门静脉-肝静脉渡越时间(portal vein to hepatic vein transittime,PV-HVTT)及门静脉-肝动脉间隔时间(PVAT-HAAT,VVT),分析2组间上述各参数差异有无统计学意义。结果:肝纤维化组PVAT较正常对照组缩短,差异有统计学意义(P<0.05),肝纤维化组HVAT、HA-HVTT、PV-HVTT及VVT较正常对照组缩短,差异均有统计学意义(P<0.01);2组HAAT、HA-PI、PV-PI及HV-PI差异均无统计学意义。结论:超声造影定量参数PVAT、HVAT及PV-HVTT可反映肝纤维化微循环及血流动力学改变,有望成为无创评价肝纤维化的定量指标。

The pilot study of assessing blood perfusion assessment by contrast-enhanced ultrasound in liver fibrosis patients

Objective： to study the clinical application value of contrast-enhanced ultrasound（CEUS）in assessing blood perfusion characteristics of liver fibrosis. Methods： 15 cases of liver fibrosis proven by biopsy were enrolled in this study while 15 healthy volunteers served as control group. After intravenous bolus injection of SonoVue 2.4 ml, real-time gray scale CEUS was per- formed to observe hepatic artery arrival time（HAAT）, portal vein arrival time（PVAT）,hepatic vein arrival time（ HVAT）and the peak intensity（PI）. In addition,hepatic artery to hepatic vein transit time（HA-HVTT） ,portal vein hepatic vein transit time （PV-HVTT） and portal vein hepatic artery interval time（PVAT-HAAT, VVT）were calculated. Statistical difference was ana- lysed between two groups. Results： compared with control group, PVAT shortened significantly（ P〈0.05）, and HVAT, HA- HVTT,PV-HVTT,VVT shortened significantly（P〈0.01 ）in liver fibrosis group. There were no statistical significance in HAAT,HA-PI, PV PI and HV-PI difference between two groups. Conclusions： The perfusion parameters, such as PVAT, HVAT and PV-HVTT may reflect the change of microcirculation and blood flow dynamics in patient with liver fibrosis, and they are expected to be quantitative index for non-invasive diagnosis of liver fibrosis in future.