64层螺旋CT灌注成像对肝硬化定量评估的临床研究

目的应用64层螺旋CT灌注技术测量肝硬化患者的血流灌注,研究64层螺旋CT对肝硬化病变程度的定量、无创评估。方法对42例不同肝功能分级(Child-Pugh)的肝硬化患者进行64层螺旋CT灌注扫描,测得其肝脏、脾脏以及主动脉的时间密度曲线(TDC),获得肝动脉灌注量(HAP)、门静脉灌注量(HPP)和肝动脉灌注指数(HPI)=HAP/(HAP+HPP)。研究灌注参数与Child-Pugh分级之间的关系。结果与健康对照组比较,肝硬化组的动脉期、门静脉期以及肝脏实质期的TDC曲线均较健康组上升缓慢、峰值延迟、峰值下降以及下降也缓慢。Child-Pugh A以及B级肝硬化的HAP同对照组比较降低有统计学意义(P=0.01,0.02),Child-Pugh C级与对照组的HAP比较无统计学意义(P=0.63)。对于HPP,肝硬化Child-Pugh A级组与健康组比较下降有统计学意义(P=0.01),Child-Pugh B级组与健康组比较降低也有统计学意义(P=0.00)。Child-Pugh C级与A级组HPP下降有统计学意义(P=0.01)。结论肝脏的CT灌注可以反映肝硬化的血流变化,为肝硬化的病变程度进行定量评估提供参考。

Quantitative evaluation of liver cirrhosis by 64-slice spiral CT perfusion imaging

Objective To measure hepatic blood flow of cirrhotic patients using 64-slice spiral CT scan, and to explore the quantitative and non-invasive evaluation for detecting liver cirrhosis severity. Methods Forty-two cirrhotic patients in various Child-Pugh stages underwent 64-slice spiral CT perfusion scan, with time density curve （TDC） of liver, spleen and aortas tested, and hepatic arterial perfusion （HAP）, hepatic portal perfusion （HPP） and hep- atic perfusion index HPI[HPI=HAP/（CHAP＋HPP）] were obtained. Relationship between perfusion indexes and Child- Pugh staging was explored. Results Comparing with control group, TDC curve in arterial phase, portal venous phase and hepatic parenchymal phase of cirrhosis group elevated and descended slowly, with a delayed peak value. Statistical significance of HAP was found when Child-Pugh stage A and stage B cirrhotic patients comparing with control group （P=0.01, P=0.02）, and no statistical significance of HAP was found between patients in Child-Pugh stage C and control group （P=0.63）. As to HPP, significant differences of decrease between Child-Pugh A group and control group, Child-Pugh B group and control group, Child-Pugh stage C group and Child-Pugh A were all observed （P=0.01, P=0.00 and P=0.01, respectively）. Conclusion Hepatic CT perfusion scan may reflect change of blood flow in those with liver cirrhosis, supplying a reference for quantitative evaluation of liver cirrhosis severity.