CT评价门静脉右支前间隙改变及与肝纤维化和肝硬化病理学分期的关系  

Change of Space Anterior to the Right Portal Vein in Liver Fibrosis and Cirrhosis:CT Analysis

作　　者：胡菊林[1] 戴小平[1] 周建波[2] 李金明[1] 梁青[1] 肖影群[1] 邓秋华[1] 田克凰[1] 

机构地区：[1]江西省南昌市第九医院放射科,江西南昌330002 [2]湖南省益阳市中心医院放射科,湖南益阳413000

出　　处：《中国医学影像学杂志》2014年第9期674-677,共4页Chinese Journal of Medical Imaging

基　　金：江西省南昌市指导性科技计划项目[洪科发计字(2011)158号第31项]

摘　　要：目的探讨肝门区门静脉右支前间隙改变与肝纤维化、肝硬化病理学分期的相关性。资料与方法对经病理穿刺活检证实的肝纤维化S1期（17例）、S2期（13例）、S3期（15例）、S4期（21例）和中晚期肝硬化（22例）患者及20例对照组患者行CT平扫和增强扫描,在CT增强图像上测量各组门静脉右支前间隙宽度,将所测结果与病理学分期进行相关性分析。建立ROC曲线用于门静脉右支前间隙改变判断S≥4即早期肝硬化的评价。结果门静脉右支前间隙从S3期开始至肝硬化期逐渐增宽,其中S4期门静脉右支前间隙增宽与对照组、S1~S3期组比较差异有统计学意义（P〈0.05或P〈0.01）,肝硬化期组与其他各组比较差异均有统计学意义（P〈0.01）。Spearman等级分析显示门静脉右支前间隙变化与肝纤维化、肝硬化病理分期呈正相关（r=0.704,P〈0.01）。ROC曲线显示CT测量门静脉右支前间隙判断S≥4的曲线下面积为0.897,最佳诊断宽度为≥10 mm,灵敏度和特异度分别为88.1%和71.4%。结论门静脉右支前间隙改变与肝纤维化、肝硬化病理学分期具有良好的相关性,通过CT测量门静脉右支前间隙改变有助于肝纤维化、肝硬化程度的判断,尤其是对早期肝硬化的诊断。Purpose To explore the relationship between the change of space anterior to right portal vein and the pathological staging in liver fibrosis/cirrhosis. Materials and Methods Plain and contrast enhanced CT scan were performed in patients with biopsy proven liver fibrosis/cirrhosis including S in 17 patients, S2 in 13 patients, S in 15 patients, S in 21 patients and cirrhosis in 22 patients. Twenty subjects were included as control group. The width of anterior space of right portal vein was measured on contrast enhanced CT and correlated with fibrosis staging. The receiver operating characteristic curve was created for cirrhosis diagnosis. Results The width of anterior space of right portal vein enlarged in patients with S3 fibrosis to cirrhosis （P〈0.05 or P〈0.01）. It was significantly bigger in group S4 compared to other groups （P〈0.01）. Spearman rank correlation analysis showed significant positive correlation between the width of anterior space and liver fibrosis staging （r=0.704, P〈0.01）. ROC curve analysis showed the area under curve （AUC） of 0.897 with the optimum width of ≥10 mm. Conclusion The change in the space anterior to the right portal vein is positively correlated with live fibrosis staging. CT measurement helps early diagnose and assess the severity of liver fibrosis and cirrhosis.

关 键 词：体层摄影术 螺旋计算机 肝硬化 门静脉 病理学 外科 

分 类 号：R575.2[医药卫生—消化系统] R445.3[医药卫生—内科学]