运用CT动态灌注成像技术测定肝脏血流量的临床研究

目的 探讨CT灌注成像的测定方法和技术原理，以及肝硬化程度与肝脏血流量动态变化关系。资料与方法 肝硬化患者27例，其中Child A级12例，Child B级10例，CMld C级5例。对照组为无肝脏疾病者18例。选取同时含有肝脏、脾、主动脉和门静脉的层面进行CT动态增强扫描，绘制感兴趣区时间-密度曲线(TDC)，计算肝脏血流量各参数。结果 (1)肝硬化患者的肝动脉灌注量(HAP)、门静脉灌注量(PVP)和总肝血流量(THBF)均较正常组降低，平均通过时间(MTT)较正常组延长。(2)肝硬化程度不同时，部分肝血流灌注参数存在显著性差异。(3)脾灌注量和门静脉灌注量呈正相关。结论 (1)肝脏CT灌注成像可定量测定肝血流量参数。(2)肝硬化时肝脏血流灌注的变化与疾病的严重程度相关。

Hepatic Blood Flow in Liver: Clinical Application of CT Dynamic Perfusion

Objective To evaluate the principle and the technique of CT perfusion and the changes of hepatic blood flow in patients with liver cirrhosis. Materials and Methods Dynamic single-section CT of liver was performed in 45 participants, including 27 patients with liver cirrhosis and 18 patients without liver disease (control subjects). In accordance with the Child-Pugh classification, 12 patients were classified as Child A, l0 with Child B, and 5 with Child C. CT scans sections were obtained at a single-level including the liver, spleen, aorta, and portal vein, the attenuation of these organs was measured to draw time density curves to calculate the liver CT perfusion parameters.Results (1)Hepatic artery perfusion, portal venous perfusion, total hepatic perfusion, hepatic perfusion index and mean transit time were decreased significantly compared with control group. (2)There were significant difference in partial liver perfusion paramrters according to the severity of liver cirrhosis. (3)Positive correlation was observed between splenic perfusion and portal venous perfusion. Conclusion (1)Dynamic single-section CT perfusion could quantify hepatic blood flow. (2)Hepatic perfusion parameters measured with CT were significantly altered in cirrhosis and correlated with the severity of liver cirrhosis.