脾脏大小CT测量值与慢肝纤维化、肝硬化病理学分期的相关性

目的:采用16层螺旋CT对脾脏长径、厚度、肋单元数以及脾脏容积进行测量,探讨慢肝纤维化、肝硬化脾脏大小变化规律及其与病理学分期的相关性.方法:对经肝穿病理活检确诊的肝纤维化S1期8例、S2期11例、S3期7例、S4期/早期肝硬化10例,具有典型临床症状和影像学表现的中晚期肝硬化15例以及正常组16例行16层螺旋CT脾脏容积扫描,分别测量脾脏的长径、厚度、肋单元数,采用仪器自身携带的Volume功能软件测量脾脏的容积.结果:从正常肝脏到肝硬化阶段,脾门厚度以及脾脏容积逐渐增大.重度肝纤维化S3、4期及肝硬化与其他各组之间均存在显著性差异(P<0.01),S1期与正常组以及轻度肝纤维化S1、2,S3、4期之间无显著差异.随着病变程度的加重。脾脏长径逐渐增大.典型肝硬化与其他各组比较差异均有统计学意义(P<0.01).S4期/早期肝硬化与正常组、S1、2期以及S3期与正常组、S1期之间均存在着显著性差异,而轻度肝纤维化S1、2期之间和重度肝纤维化S3、4期之间以及S1-2期与正常组之间差异均无显著意义(P>0.05).脾脏所占肋单元数随病变发展呈逐渐增大趋势.各实验组(S1期-典型肝硬化)与正常组间都存在显著性差异(P<0.01),S2、3、4、典型肝硬化各组与S1期比较差异都有显著意义。但S2期-典型肝硬化各组之间肋单元数的差异均没有统计学意义.多元线性回归分析显示,脾脏容积与肝纤维化病理学分期的回归系数最大.结论:脾脏长径、脾门厚度以及脾脏容积,尤其是脾脏容积与肝纤维化病理学分期具有显著相关性.CT测量脾脏的大小有助于肝纤维化、肝硬化的早期诊断、治疗和疗效观察.

Correlation of CT measurement of spleen size with histopathological stage of chronic hepatic fibrosis and cirrhosis

AIM:To investigate the changes in the spleen of patients with chronic hepatic fibrosis and cirrhosis by measuring the length,thickness, number of rib units and volume of the spleen with 16-slice spiral CT,and to establish the correlation between these values and his- topathological stage METHODS:Volume CT scan was performed in 67 participants,including 36 patients with he- patic fibrosis,who were divided into S1(8/36), S2(11/36),S3(7/36) and S4(10/36)groups, confirmed by liver biopsy,15 patients with liver cirrhosis with typical clinical and imaging signs, and 16 normal participants as a control group. We measured the length,thickness,number of rib units and volume of the spleen. RESULTS:Compared with normal subjects,the hilar thickness and volume of the spleen were enlarged gradually in patients with liver cir- rhosis.The differences between typical cirrhosis and other groups were significant,as were the differences between S3,S4 and the others,but no significant difference between S1 and control group,S3 and S4,S1 and S2 was observed.The length of the spleen increased gradually with the development of hepatic fibrosis.The difference between typical cirrhosis and the other groups was significant,as were the differences between S4 and S0-2,S1-3 and S1,control group,but no significant differences between S1 and S2,S3 and S4,or S1-2 and control group were observed.The number of rib units tended to increase with the development of fibrosis.Significant differences were seen between the S1 cirrhosis and control groups,and the S1 and S2 cirrhosis groups,but no significant differences were observed among the S2-cirrhosis groups.Multiple linear regression analysis showed that the regression coefficient for the spleen volume was at a maximum. CONCLUSION:The length,hilar thickness and especially the volume of the spleen correlate closely with the histopathological stage of he- patic fibrosis and cirrhosis.The measurement of spleen size with CT should be helpful for the early diagnosis,treatment and follow-up of he- patic fibrosis and cirrhosis.