CT肝容积测量结合CT灌注成像评价肝功能储备的应用价值

目的:探讨螺旋CT肝容积测量结合CT灌注成像(CT perfusion imaging,CTPI)评价肝硬化肝功能储备的应用价值.方法:肝硬化组32例及正常肝脏组20例均行CT肝容积测量,肝硬化组25例及正常肝脏组20例行CTPI.比较肝硬化组与正常肝脏组之间,肝硬化组肝功能A,B,C级之间的肝容积值、血流灌注参数值及肝容积-血流灌注指数值的差异,并将肝功能分级分数与肝容积值、血流灌注参数值及肝容积-血流灌注综合指数值作相关性分析.结果:肝硬化组A,B,C级肝容积(liver volume,LV)、单位体表面积肝容积(liver volume per body surface area,LVs)呈逐级递减,各组间有统计学差异(P＜0.01).肝硬化组血流灌注参数的门静脉灌注量(hepatic portal perfusion,HPP)、肝总灌注量(total liver perfusion,TLP)、肝动脉灌注指数(hepatic arterial perfusion index,HAI)、门静脉灌注指数(portal perfusion index,PPI)均较正常肝脏组减低(P＜0.01),其中HPP呈逐级递减,各级间有统计学差异(P＜0.05或P＜0.01);PPI呈逐级递减,C级与A,B级间有统计学差异(P＜0.05或P＜0.01).肝容积-血流灌注指数的容积灌注指数(volume perfusion index,VPI)、单位体表面积容积灌注指数(volume perfusion index per body surface area,VPIs)、容积门静脉灌注指数(volume portal perfusion index,VPPI)、单位体表面积容积门静脉灌注指数(volume portal perfusion index per body suface area,VPPIs)均呈逐级递减,各级间有统计学差异(P＜0.05或P＜0.01).与其他指标相比,肝容积-血流灌注指数与肝功能分级分数具有更高的相关性,其中以VPPIs的相关性最高(r=-0.718).结论:肝容积及肝血流灌注的改变与肝硬化的临床分级相关,CT肝容积测量结合CT灌注成像能更全面地评价肝功能储备状况.

CT hepatic volume measurement combined with CT perfusionimaging in evaluating the hepatic functional reserve

Objective To investigate the application of CT hepatic volume measurement combined with CT perfusion imaging (CTPI) by Spiral CT in evaluating the hepatic functional reserve in cirrhosis. Methods CT volume measurement of livers was performed in 32 patients with cirrhosis and 20 patients with normal livers. CTPI had been taken in 25 patients with cirrhosis and 20 patients with normal livers. The hepatic volume, parameter of blood flow perfusion, and liver volume-perfusion index were observed and analyzed. Correlations between graded fractions of hepatic function and liver volume, parameter of perfusion, and liver volume-perfusion index were also analyzed. Results The values of liver volumes (LV, LVs) reduced gradually (P<0.01) among the groups of hepatic function Grade A, B, and C. The values of the hepatic portal perfusion (HPP), total liver perfusion (TLP), hepatic arterial perfusion index (HAI), and portal perfusion index (PPI) of the cirrhosis group were significantly lower than those of the normal ones (P<0.01). The values of the HPP reduced gradually among Grade A, B, and C (P<0.05 or P <0.01). The values of PPI reduced significantly between Grade C and Grade A, B (P<0.05 or P<0.01). The liver volume-perfusion indexes (VPI, VPIs, VPPI, VPPIs) reduced gradually among Grade A, B, and C (P<0.05 or P<0.01). The correlation between liver volume-perfusion indexes and graded fractions of hepatic function was higher than other indexes, among which the correlation of VPPIs was the highest. Conclusion Changes of volume and blood flow perfusion of the liver are related to the clinical grade of hepatic function. The CT volume measurement combined with CTPI will be a more comprehensive way in evaluating hepatic functional reserve.