多层螺旋CT全肝灌注成像对不同程度脾功能亢进患者肝脾血流状态的评估

目的应用多层螺旋CT全肝灌注模式,探讨不同程度脾功能亢进患者脾脏体积、肝总动脉、脾动静脉、门静脉内径差异及肝脏血流状态变化情况。方法收集慢性乙型肝炎肝硬化脾功能亢进患者42例,无肝脾疾病患者15例作为对照,所有患者均行多层螺旋CT全肝灌注成像:(1)测量比较不同程度脾功能亢进组与对照组脾脏体积、肝总动脉、脾动静脉、门静脉内径之间的差异;(2)分析比较脾脏体积与各相关血管内径之间的相关性;(3)测量比较基于Couinaud分段肝脏五叶相关灌注参数值:肝动脉灌注量(HAP)、门静脉灌注量(PVP)、总肝灌注量(TLP)和肝动脉灌注指数(HPI)。计量资料采用单因素方差分析,采用Pearson相关分析对脾脏体积与各血管内径进行相关性分析。结果(1)肝硬化脾功能亢进组脾脏体积及脾动脉、脾静脉、门静脉内径均大于对照组,差异有统计学意义(F值分别为37.108、17.484、23.124、13.636,P值均<0.05)。(2)中、重度脾功能亢进组脾脏体积及脾动脉、脾静脉、门静脉内径明显大于轻度脾功能亢进组,差异有统计学意义(F值分别为25.418、13.293、15.136、7.093,P值均<0.05),但中、重度脾功能亢进组间差异无统计学意义(P>0.05)。(3)脾静脉、门静脉、脾动脉内径与脾脏体积呈正相关(r值分别为0.680、0.548、0.726)。(4)脾功能亢进组全肝叶PVP、TLP均低于对照组,差异有统计学意义(P<0.05);不同程度脾功能亢进组HPI均高于对照组,中、重度脾功能亢进组肝右后叶HPI高于轻度脾功能亢进组,差异有统计学意义(F值为3.555、4.570,P值均<0.05);各组间全肝叶HAP差异无统计学意义(P>0.05),但重度脾功能亢进组全肝叶HAP均低于对照组、轻及中度脾功能亢进组。结论不同程度脾功能亢进患者脾动静脉内径均有不同程度的增宽,与脾脏体积增大一致,且中、重度为著;不同程度脾功能亢进患者门静脉灌注量及总肝灌注量均减少,肝动脉灌注量以重度脾功能亢进患者减少显著。

Quantitative assessment of hepatic and splenic blood flow status in patients with hypersplenism of different degrees based on multi-slice spiral CT whole-liver perfusion imaging

Objective To investigate the differences and changes of blood flow status of splenic volume,common hepatic artery,splenic arteriovenous,inner diameter of portal vein and hepatic in patients with hypersplenism of different degrees using multi-slice spiral CT whole-liver perfusion model.Methods 42 cases with hypersplenism of chronic hepatitis B with cirrhosis and 15 cases without hepatosplenic disease were collected as controls.All patients underwent multi-slice spiral CT whole-liver perfusion imaging.(1)The differences of spleen volume,common hepatic artery,splenic arteriovenous,and portal vein diameter between different degrees of hypersplenism and the control group were measured and compared.(2)The correlation between spleen volume and the inner diameter of each related vessels were analyzed and compared.(3)The values of perfusion parameters related to the five lobes of the liver in Couinaud segments based on hepatic artery perfusion(HAP),portal venous perfusion(PVP),total hepatic perfusion(TLP)and hepatic artery perfusion index(HPI)were measured and compared.One-way ANOVA was used to analyze the measurement data.The correlation between the spleen volume and the inner diameter of each blood vessel was analyzed by Pearson’s correlation analysis.Results(1)spleen volume and the inner diameter of splenic artery,splenic vein and portal vein in the cirrhotic hypersplenism group were significantly larger than control group,and the difference was statistically significant(F=37.108,17.484,23.124,13.636,P<0.05).(2)spleen volume and the inner diameter of splenic artery,vein and portal vein in the moderate and severe hypersplenism groups were significantly larger than the mild hypersplenism group,and the difference was statistically significant(F=25.418,13.293,15.136,7.093,P<0.05),but there was no statistically significant difference between the moderate and severe hypersplenism groups(P>0.05).(3)The inner diameter of splenic vein,portal vein,and splenic artery was positively correlated with spleen volume(r=0.680,0.548,and 0.726).(4)PVP and TLP of the whole liver in hypersplenism group were lower than control group(P<0.05),and the differences were statistically significant(P<0.05).HPI in the right posterior lobe of the liver in the moderate and severe hypersplenism group was higher than mild hypersplenism group(F=3.555,4.570,P<0.05),and there was no significant difference in the HAP in the whole liver among the groups(P>0.05),but the HAP in the whole liver in the severe hypersplenism group was lower than control,mild and moderate hypersplenism group.Conclusion The inner diameter of the splenic arteriovenous in patients with hypersplenism of different degrees has widened to varying degrees,and is consistent with the increase in spleen volume,particularly in moderate and severe cases.Portal venous perfusion and total liver perfusion in patients with hypersplenism of different degrees have declined and the hepatic arterial perfusion in patients with severe hypersplenism is significantly reduced.