CT灌注、MR灌注及MR扩散加权成像在肝硬化中的应用价值比较  

Comparison of Diagnostic Value of CT Perfusion,MR Perfusion and DWI in Liver Cirrhosis

作　　者：史丽静[1] 陈炜[2] 田建明[2] 郭勇[1] 林伟[1] 郑奎宏[1] 钱明珠[1] 

机构地区：[1]海军总医院影像中心磁共振室,北京100037 [2]第二军医大学附属长海医院放射科

出　　处：《实用放射学杂志》2008年第3期323-326,共4页Journal of Practical Radiology

摘　　要：目的比较CT灌注、MR灌注及MR扩散加权成像(Diffusion weighted imaging,DWI)对不同程度肝硬化的鉴别能力。方法共36例行磁共振扩散加权成像、CT和MR灌注成像。正常对照组11例,肝硬化组25例,属肝功能Child-Pugh分级A级的13例,定为肝硬化1组,肝功能Child-Pugh分级为B级的8例,C级的4例,一并归入肝硬化2组。DWI扫描,计算各例肝脏的ADC值并进行组间比较。CT、MR灌注成像,以脾脏的峰值时间为界,分别计算脾脏峰值前后肝脏的曲线最大斜率(steepest slope,SS),以脾峰值前后2个斜率的比值作为评估指标进行组间对比。记为[SSr(ct)=SS前/SS后]和[SSr(mr)=SS前/SS后]。结果肝硬化1组的肝脏平均ADC值(1.35±0.12)×10-3mm2/s,肝硬化2组为(1.32±0.16)×10-3mm2/s,2组间比较P>0.05;正常对照组平均ADC值为(1.52±0.31)×10-3mm2/s,与2组肝硬化的组间比较均无统计学差异(P>0.05)。CT灌注结果:3组的SSr(ct)分别为0.95±0.28,2.01±0.66,0.72±0.26。MR灌注结果:肝硬化1组的SSr(mr)为1.17±0.49,肝硬化2组为2.31±0.76,正常对照组为0.66±0.24。肝硬化患者动门脉灌注比例较正常组加大,但肝硬化1组与正常组尚无明显统计学差异,而肝硬化2组与正常组间差异具有统计学意义(P<0.05),且和肝硬化1组相比,肝硬化2组动门脉灌流已经出现比例倒置,2组间差异明显(P<0.05)。结论CT、MR灌注成像能够反映肝硬化的血流灌注的情况,也能反映和肝硬化的程度有相关性,较之DWI成像和ADC值对肝硬化的评价,CT和MR灌注成像更有优势。Objective To compare the diagnostic value of CT perfusion, MR perfusion and DWI in liver cirrhosis. Methods 36 cases underwent CT, MR perfusion and DWI including 11 volunteers and 25 cirrhosis. According to the degree of their liver function, 13 patients of cirrhosis belong to group of cirrhosis 1 （ Child - Pugh A ） , 12 patients of cirrhosis belong to group of cirrhosis 2 （ 8 cases were Child - Pugh B, the other 4 were Child - Pugh C）. The ADC values of each case were calculated and the results were compared between the 3 groups. When CT and MR perfusion were finished,the perfusion curves of hepatic parenchyma were separated into two parts according to the TTP of spleen, the steepest slope （ SS ） of each part was calculated, named [ SSr（ ct ） = SSpre/SSpost] to CT perfusion and [ SSr（mr） = SSpre /SSpost ] to MR perfusion. Then SSr（ct） and SSr（mr） were compared between the 3 groups. Results The ADC value of the 3 group（ cirrhosis 1, cirrhosis 2 and normal liver） were（1.35 ±0.12） × 10^-3mm^2/s, （1.32 ±0.16） × 10^-3mm^2/s and （1.52 ±0.31） × 10^-3mm^2/s, respectively The SSr （ ct ） of the 3 groups was （ 0.95 ±0.28 ） , （ 2.01 ±0.66 ） and （0.72±0.26）,respectively. While theSSr（mr） was （1.17 ± 0.49） , （2.31 ± 0.76） and （0.66 ± 0.24） , respectively. The ADC values of cirrhosis 2 groups were lower than normal group, but the difference was not of significant （ P 〉 0.05 ） , also the results between cirrhosis 1 and cirrhosis 2 （ P 〉 0.05 ） were the same. As to the results of SSr（ct） and SSr（mr） , results of cirrhosis 2 were significantly higher than that in cirrhosis 1 group and normal group （ P 〈0.05 ） , but the result between cirrhosis 1 and normal liver was not of significant（ P 〉 0.05 ）. Conclusion CT and MR perfusion has more advantage than DWI to evaluate cirrhosis, perfusion evaluation can reflect the blood flow of cirrhosis, and the results： SSr（ ct） and SSr（ mr） also can reflect the se

关 键 词：肝脏 磁共振成像 体层摄影术 X线计算机 灌注 扩散加权成像 肝硬化 

分 类 号：R575.2[医药卫生—消化系统] R445.2[医药卫生—内科学]