多层螺旋CT灌注成像联合CT门静脉造影一站式扫描技术在肝硬化中的应用  

Application of One-stop Scanning Technology Combining Multi-slice Spiral CT Perfusion Imaging and CT Portal Venography in the Diagnosis of Liver Cirrhosis

作　　者：陆丹羽 全显跃[1] 

机构地区：[1]南方医科大学珠江医院影像科,广东省广州市510280

出　　处：《中国全科医学》2015年第24期2991-2996,共6页Chinese General Practice

基　　金：广东省自然科学基金资助项目(S2013010016104)

摘　　要：目的探讨多层螺旋CT灌注成像(CTP)联合CT门静脉造影(CTPV)一站式扫描技术的可行性及其在肝硬化诊断、肝功能储备分级、了解侧支循环情况及发现其他并发症中的应用价值。方法根据自愿原则,选取南方医科大学珠江医院2014年1—10月入院且临床拟诊为肝硬化的患者83例。按照纳入与排除标准,最终共纳入74例患者为试验组,按照Child-Pugh分级标准将试验组患者进一步分为Child-Pugh A组(31例)、Child-Pugh B组(27例)和Child-Pugh C组(16例)。另同期选取临床上需要行上腹部CT增强扫描检查并且肝脏及门静脉系统正常的患者20例为对照组。对所有患者行CTP扫描,分析并比较各组患者肝动脉灌注量(HAP)、门静脉灌注量(HPP)、肝总灌注量(THP)、肝脏灌注指数(HPI)及门静脉达峰时间(TTP),分析HAP、HPP、THP及HPI与Child-Pugh分级的相关性,选择成像最佳的门静脉期数据进行CTPV重建并分析图像质量。结果 Child-Pugh A组、Child-Pugh B组、Child-Pugh C组HPP、THP低于对照组,HPI高于对照组(P<0.05);Child-Pugh C组HAP低于对照组(P<0.05);Child-Pugh B组、Child-Pugh C组HPP低于Child-Pugh A组,HPI高于Child-Pugh A组(P<0.05);Child-Pugh C组HAP、THP低于Child-Pugh A组(P<0.05);Child-Pugh C组HAP、HPP、THP低于Child-Pugh B组(P<0.05)。Child-Pugh分级与HAP无直线相关性(r=-0.143,P=0.169),与HPP、THP呈负相关(r=-0.730、-0.614,P<0.05),与HPI呈正相关(r=0.555,P<0.05)。Child-Pugh C组门静脉TTP较对照组、Child-Pugh A组、Child-Pugh B组延迟(P<0.05)。试验组与对照组CTPV图像质量比较,差异无统计学意义(u=0.526,P=0.599)。结论多层螺旋CTP联合CTPV一站式扫描技术可同时提供准确的CT灌注参数以及满意的CT血管造影图像,可为肝硬化的诊断、肝功能储备分级、了解门-体侧支循环及发现其他并发症提供更全面的影像学信息。Objective To evaluate the feasibility of the one -stop scanning technology combining multi -slice spiral CT perfusion （ CTP） imaging and CT portal venography （ CTPV） and its applicational value in the diagnosis of liver cirrhosis , the grading of liver function reserve , the monitoring of collateral circulation and the detection of other complications .Methods Based on the principle of voluntariness , 83 patients who were preliminarily diagnosed as liver cirrhosis and were admitted into Zhujiang Hospital of Southern Medical University from January to October in 2014 were selected in the study .According to the inclusion and exclusion criteria , 74 patients were enrolled as the trial group .According to the Child-Pugh grading standard , the trial group was further divided into Child -Pugh A group （ n=31 ） and Child-Pugh B group （ n=27 ） and Child -Pugh C group （ n=16 ） . Another 20 patients who were going to receive epigastrium CT enhancement scanning and were normal in liver and portal system＆amp;nbsp;were enrolled in the same period as the control group .CTP was conducted on all subjects , by which HAP, HPP, THP, HPI and TTP were analyzed and compared among all the groups .The correlations between Child -Pugh grading and HAP , HPP, THP and HPI were analyzed.The portal venous phase data with the optimal imaging was chosen to reconstruct CT portal venography and analyze the image quality.Results Child-Pugh A group, Child-Pugh B group and Child -Pugh C group were lower （ P〈0.05） in HPP and THP and higher （P〈0.05） in HPI than control group; Child-Pugh C group was lower （P〈0.05） than control group in HAP; Child-Pugh B group and Child-Pugh C group were lower （P〈0.05） in HPP and higher （P〈0.05） in HPI than Child-Pugh A group; Child-Pugh C group was lower （ P〈0.05 ） in HAP and THP than Child -Pugh A group;Child-Pugh C group was lower （P〈0.05） than Child-Pugh B group in HAP, HPP and THP.Child-Pugh grading was not correlated （r=-0.143, P=0.169） with HAP,

关 键 词：肝硬化 灌注成像 门静脉造影术 体层摄影术 X线计算机 

分 类 号：R657.31[医药卫生—外科学]