多层螺旋计算机X线体层扫描肝脏灌注成像的临床应用初步研究

目的 探讨多层螺旋CT肝脏灌注成像技术在肝脏疾病诊断中的应用价值。方法 48例接受多层螺旋CT肝脏灌注成像检查,其中20例为无明显肝脏疾病的志愿者,17例肝硬化患者,11例肝癌患者。计算各组受检者的各项灌注指标并进行比较。结果 (1)肝硬化组与正常组相比,门静脉灌流量(HPP,ml·min~(-1)·ml~(-1))与门静脉灌流指数(PPI)明显减低(HPP:0.49±0.19与0.60±0.16,P=0.038;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),肝动脉灌流指数升高(0.42±0.14与0.33±0.06,P=0.015),提示肝硬化时门静脉的灌流量减少,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)肝癌组的肝动脉灌流量明显高于正常组与肝硬化组(F=11.71,P<0.0001),而HPP明显下降(F=22.84,P<0.0001),HPP/HAP也明显减小(F=20.67,P<0.0001),说明肝癌主要由动脉供血,动脉、门静脉两部分对其供血的比例与正常肝和肝硬化相反。结论 多层螺旋CT肝脏灌注可分别评价肝脏动脉、门静脉的灌注情况,以灌注特点及测得的灌注指标反映肝脏病变的血流动力学改变,且此方法具有无创性和可重复性,在肝脏疾病的诊断、鉴别诊断等方面具有重要的临床实用价值。

Pilot study on clinical application of hepatic perfusion with multi-slice spiral CT

OBJECTIVE: To research the value of hepatic perfusion with multi-slice spiral CT in the diagnosis of liver diseases. METHODS: Among the 48 patients undergone dynamic CT of the liver, 20 were volunteers without hepatic disorder, 17 with cirrhosis, 11 suffered from hepatic cancer. The perfusion indexes were calculated and compared. RESULTS: (1) Compared with the control group, HPP (ml/min/ml), PPI and HPP/HAP of patients with cirrhosis were significant lower (HPP: 0.49+/-0.19 vs 0.60+/-0.16, P=0.038; PPI: 0.58+/-0.14 vs 0.67+/-0.06, P=0.015; HPP/HAP: 1.63+/-0.87 vs 2.12+/-0.65, P=0.04), whereas HPI was higher (0.42+/-0.14 vs 0.33+/-0.06, P= 0.015), which indicated the decrease of portal inflow and the increase of arterial inflow in cirrhosis patients. (2) Patients with hepatic cancer got a significant higher average HAP than that in volunteers and cirrhosis patients (F=11.71, P<0.001), while their HPP and HPP/HAP showed significant declining (F=22.84, P=0.0001; F=20.67, P<0.0001, respectively), which implied that hepatic cancer was mainly supplied by artery. CONCLUSIONS: Hepatic perfusion with multi-slice spiral CT is an non-invasive technique to evaluate the arterial and portal inflow separately, which can inflect the hemodynamic change of the lesion by the perfusion indexes, and identify the condition of the tissue round the lesion prior to morphologic change. This method shows important value of diagnosis and differential diagnosis in hepatic diseases.