256层CT全肝灌注评估肝硬化段性功能储备  

Evaluation of the Hepatic Segmental Function Reserve of Cirrhosis by Whole-liver Perfusion with 256-slice CT

作　　者：吴国华[1] 殷允娟[1] 侯海燕[1] 常军[1] 姜建威[1] 

机构地区：[1]南通大学第三附属医院放射科

出　　处：《中国医学计算机成像杂志》2015年第3期246-250,共5页Chinese Computed Medical Imaging

基　　金：无锡市医院管理中心医学技术重大项目No.YGZF1108~~

摘　　要：目的：以临床Ch ild-pug h分级为标准,应用256层CT全肝灌注扫描对肝硬化患者行段性功能储备评估。方法：20例无明显肝脏疾患的患者及23例肝硬化患者均行全肝灌注检查,得到肝脏灌注图像,分别测量肝脏各段灌注参数：肝动脉灌注量（HAP）、门静脉灌注量（HPP）、肝总灌注量（TLP）、肝动脉灌注指数（HAPI）以及门静脉灌注指数（HPPI）。对正常组及肝硬化组行肝段性灌注测量,对肝脏各段血流灌注参数行统计学分析。结果：正常肝脏各段间HAP、HPP、TLP、HAPI、HPPI均无统计学差异,HAP：HPP=1/3~1/4;Ch ild-pug h A级H A P、T LP存在段间差异（P〈0.05）,H A P：H PP=1/2~1/3;Ch ild-pug h B级H A P存在段间差异（P〈0.05）,HAP：HPP=1/2~1/3;Child-pugh C级各灌注参数均存在段间差异（P〈0.05）,HAP：HPP=2/1~2/3。正常组与肝硬化各组间比较：除Ⅱ、Ⅲ段HAP组间无统计学差异外,Ⅰ-Ⅷ段各灌注参数均存在部分组间差异（P〈0.05）,Ⅰ-Ⅷ段HPP肝硬化各组与正常组均有统计学差异,随着肝功能受损程度的加重,肝脏各段HAP、HAPI值呈上升趋势,HPP、TLP、HPPI值呈下降趋势,肝动脉与门静脉系统血供比例逐渐增大。结论：256层CT全肝灌注模式可用于直观定量反映肝硬化肝脏各段血流灌注特征,对肝脏储备功能分段评估具有一定临床应用价值。Purpose： To explore the liver function reserve of cirrhosis segmentally by the whole liver perfusion scanning mode using 256-slice CT. Methods： Whole-liver MSCT perfusion were performed in 20 patients with normal hepatic function and 23 patients with cirrhosis, the hepatic arterial perfusion （HAP）, hepatic portal perfusion （HPP）, total liver perfusion （TLP）, hepatic arterial perfusion index （HAPI） and hepatic portal perfusion index （HPPI） of the whole hepatic segments were calculated. The perfusion parameters between the cirrhosis group and the normal group were analyzed by statistical software. Re- suits： There was no significant difference on HAPs, HPPs, TLPs, HAPIs, HPPIs among eight segments of the normal liver. The ratio of HAP to HPP was approximately 1/3-1/4. There were significant differences on HAPs and TLPs among partial liver segments in Child A, and the ratio of HAP to HPP was 1/2-1/3; There was significant difference on HAPs among partial liver segments in Child B, and the ratio of HAP to HPP were 1/2-1/3; There was significant difference on HAPs, HPPs, TLP, HAPI and HPPI among partial liver segments in Child C, and the ratio of HAP to HPP was about 2/1-2/3. Between normal group and cirrhosis group, there were no significant differences on HAP in II. HI segment. There were differences on all perfusion parameters in I-vm of each segment. When the liver function damage became more serious, the values of HAPs and HAPIs for each segment had an increase trend, while that of HPPs, TLPs, and HPPIs decreased, and the ratio of hepatic artery and portal venous system also had an increase trend. Conclusinn：The whole liver perfusion parameters could directly and quantitatively reflect the cirrhotic liver perfusion characteristics segmentally, and liver perfusion imaing is valuable for the evaluation of segmental liver function reserve before partial precise hepatectomy or transplantation.

关 键 词：肝段 全肝灌注成像 肝硬化 

分 类 号：R575.2[医药卫生—消化系统] R816.5[医药卫生—内科学]