超声造影指导肝纤维化分级的初步研究

目的探讨超声造影在肝纤维化分级中的意义。方法12只实验兔,通过腹腔注射四氯化碳（0.10ml/kg）制作动物模型,经肝穿刺活检病理证实肝纤维化模型建立成功,并予以F0～F4分级。应用脂质-氟烷气体超声造影剂进行肝超声造影,并用自身前后对照的方法,在肝纤维化模型建立前后测量造影剂通过时间及超声造影剂灰阶时间-强度曲线。结果肝静脉显影时间及肝动静脉渡越时间随肝纤维化程度增加而递减（F4期肝动静脉渡越时间平均为5.16s,与F0～F3期比较,差异有统计学意义,P〈0.01）,时间-强度曲线提示随肝纤维化程度加重,造影早期门静脉-肝实质灰阶强度差逐渐增大。结论超声造影肝静脉内造影剂出现时间、肝动静脉渡越时间及造影早期门静脉-肝实质灰阶强度差可视为无创诊断肝纤维化的指标。

Primary research on diagnosis of liver fibrosis stage by perfusion dynamics of ultrasound contrast agent

Objective To discuss the indicative significance of ultrasound contrast agent on liver fibrosis stage according to the perfusion dynamics of a self-made contrast agent. Methods Experimental models of hepatic fibrosis involving five stages from F0 to F4 were created by intraperitoneally injecting CCl4 (0.10 ml/kg).Liver fibrosis was validated by pathological examination of liver biopsy.Intrahepatic perfusion characteristics of the lipid-coated contrast agent were analyzed through intrahepatic circulatory time and time-acoustic intensity curve.Results Hepatic vein arrival time and hepatic artery to vein transmit time of the contrast agent decreased with the development of liver fibrosis (the mean of hepatic artery to vein transmit time on F4 stage was 5.16 seconds,showing significant difference compared with those in other stages,P<0.01).The difference of peak signal intensity between portal vein and parenchyma became larger with the progression of fibrosis stage as the time-intensity curve showed.Conclusions Hepatic vein arrival time,hepatic artery to vein transmit time and the difference peak signal intensity bwtween portal vein and parenchyma were considered to be the noninvasive diagnostic parameters to differentiate the degree of hepatic fibrosis.