CT灌注成像结合CT肝体积测量评价肝硬化肝脏储备功能的应用  

Application of CT perfusion imaging combined with liver volume measurement in evaluating the liver reserve function in cirrhosis

作　　者：贾晶[1] 陈勇[2] 冀鑫[1] 马彩花 张莉萍[2] 刘珊[2] 马小斌[2] 高知玲[2] 郭玉林[2] 

机构地区：[1]宁夏医科大学,宁夏银川750004 [2]宁夏医科大学总医院放射科

出　　处：《实用放射学杂志》2014年第3期445-449,466,共6页Journal of Practical Radiology

基　　金：网家自然科学基金地区科学基金项目（61061005）.

摘　　要：目的 探讨肝硬化各级肝脏血流状态和体积变化规律。方法 肝硬化患者37例，依据肝功能分级标准将肝硬化患者分3组，其中Child-Pugh A级15例，Child-Pugh B级14例，Child-Pugh C级8例，对照组12例，测量所有受检者肝右叶、左内叶、左外叶的肝血流量（hepatic blood flow,HBF）、血容量（hepatic blood volume,HBV）平均通过时间（mean transit time,MTT）、肝动脉灌注分数（hepatic arterial fraction,HAF）、肝动脉灌注量（hepatic arterial perfusion,HAP）、门静脉灌注量（portal vein perfusion,PVP）值及各叶体积，分析比较肝功能不同级别各叶灌注参数及体积变化的规律，并将体积变化与各叶灌注参数进行相关性分析。结果 肝硬化组中左内叶及肝右叶体积呈逐渐递减趋势（P〈0.05），肝右叶体积在Child-Pugh A级时较正常组增大；左外叶体积呈逐渐增大（P〉0.05）。随着肝硬化程度的加重，各叶BF、BV、HAP、PVP呈逐渐递减，MTT及HAF呈逐渐递增。肝硬化组肝右叶体积改变与BF值（r=0.353,P=0.032）及PVP值（r=0.446,P=0.001）呈正相关；左内叶体积与BV值（r=0.337,P=0.018）及HAP值 （r=0.432,P=0.002）呈正相关。结论 肝硬化各肝叶体积大小及血流灌注参数的变化与疾病的严重程度有关。肝右叶体积变化BF值及PVP值呈正相关；左内叶体积变化与BV值及HAP值呈正相关。Objective To investigate the changes of liver volume and perfusion parameters in liver cirrhosis with CT. Methods 37 patients with cirrhosis were divided into three groups including Child-Pugh A in 15, B in 14 and C in 8. 12 subjects with normal liver were regarded as a control group. CT perfusion imaging （CTPI） and CT volume measurement of livers were performed, and the right liver lobe, left medial lobe and left lateral lobe were measured respectively. The differences of hepatic bolld flow（HBF）, hepatic blood volume（HBV） , mean transit time（MTT） , hepatic arterial fraction（HAF） , hepatic arterial perfusion（ HAP）, portal vein perfu- sion（PVP） and liver volume between different groups and their correlation were compared and analyzed. Results In cirrhosis group, the volumes of right liver lobe and left medial lobe were gradually decreased, the volume of right liver lobe in patients with Child- Pugh A was more bigger than that of normal liver, and the volume of left lateral lobe was increased with the severity of the disease. With the gradual severity of cirrhosis, values of BF, BV, HAP and PVP in each liver lobe were decreased, and however the MTT and HAF were opposite. In cirrhosis group, there were positive correlations between right liver lobe volume and BF （r=0.353, P= 0. 032） or PVP（r=0. 446, P=0. 001）, and between left medial lobe volume and BV （r=0. 337, P=0. 018） or HAP （r=0. 432, P=0. 002）. Conclusion Liver lobe volume and perfusion parameter are associated with the severity of the cirrhosis, and there are positive correlations between right liver lobe volume and BF or PVP, and between left medial lobe volume and BV or HAP.

关 键 词：计算机体层成像 灌注成像 体积测量 肝硬化 

分 类 号：R814.42[医药卫生—影像医学与核医学] R575.2[医药卫生—放射医学]