五期增强CT扫描评估正常肝实质及肝硬化患者肝脏灌注特性的可行性研究  

Feasibility of five-phase-contrast-enhanced CT scanning in the evaluation of normal hepatic and cirrhotic perfusion charactistics

作　　者：李清[1] 谢双双[2] 侯文静 石祥[2] 程悦[2] 沈文[2] 

机构地区：[1]天津医科大学一中心临床学院,天津300192 [2]天津市第一中心医院放射科,天津300192

出　　处：《放射学实践》2018年第1期40-45,共6页Radiologic Practice

基　　金：国家自然科学基金(81671657);天津市卫生计生委科技基金(15KG133)

摘　　要：目的:探究五期增强CT扫描灌注参数评估正常肝实质及肝硬化者肝脏灌注特性的可行性及准确性。方法:正常或肝单发血管瘤(直径<2cm)者16例及肝硬化患者10例纳入本研究,均行腹部CT平扫及五期增强检查,包括动脉早期、动脉期、门脉期流入期、门脉期及延迟期。另外回顾性收集12例正常或肝单发血管瘤(直径<2cm)者的肝脏灌注数据纳入本研究。经后处理获取肝脏灌注参数,包括肝动脉灌注量(HAP)、门静脉灌注量(PVP)、肝动脉灌注指数(HPI)、血流量(BF)和血容量(BV)。由2位观察者分别测量五期增强CT及常规CT灌注后处理获取的各肝脏灌注参数。记录以上各扫描方式的容积CT剂量指数(CTDIvol)值。采用组内相关系数(ICC)评估2位观察者测量结果的一致性,比较正常肝实质五期增强CT与常规CT灌注、正常肝实质与肝硬化患者五期增强CT所得各灌注参数的差异,并比较五期增强CT扫描与常规CT灌注扫描的CTDIvol值差异。结果:2位观察者测量各灌注参数结果的一致性均良好(ICC值为0.818~0.996)。正常肝实质五期增强CT与常规CT灌注得到的HPI、HAP、PVP、BF值差异均无统计学意义(P值分别为0.475、0.219、0.073、0.108),而两者BV差异有统计学意义(P<0.001)。五期增强CT扫描得到的参数中,肝硬化组HPI、HAP较正常肝实质组升高,PVP较正常肝实质组减低,且差异均有统计学意义(P值分别为<0.001、0.042、0.002);而两组间BV、BF值差异均无统计学意义(P值分别为0.488、0.093)。平扫加五期增强CT扫描的CTDIvol为(53.78±13.67)mGy,常规CT灌注扫描的CTDIvol为45.45mGy,两者差异有统计学意义(P=0.005);单期增强CT扫描的CTDIvol为(8.96±2.28)mGy,为常规CT灌注扫描的19.7%。结论:五期增强CT对正常肝实质灌注评估结果与常规灌注CT具有较好的一致性,有望应用于肝硬化患者肝脏灌注改变的评估。Objective： To investigate the feasibility and the accuracy of five-phase-contrast-enhanced CT scanning in the evaluation of perfusion characteristics in normal hepatic and cirrhotic parenchyma. Methods： 16 subjects with normal liver or with solitary hepatic hemangioma （d〈2cm） and 10 patients with hepatic cirrhosis were recruited in this study. All of them undertook abdominal unenhanced and five-phase-contrast enhanced CT scanning,including early arterial, arterial, early portal venous,portal venous and delayed phases. The hepatic perfusion CT data of another 12 subjects with normal liver or solitary hepatic hemangioma （d〈2cm） were recruited retrospectively for analysis. All of these hepatic perfusion parameters in 5 phase-contrast-enhanced CT were measured by 2 observers independently. The perfusion parameters,including hepatic arterial perfusion （HAP）, portal vein perfusion （PVP）,hepatic perfusion index （HPI）,blood flow （BF） and blood volume （B were also recorded）. The intraclass correlation coefficient （ICC） was used to assess interobserver agreement for hepatic perfusion parameters measurement. Student t-test was used to compare these hepatic perfusion parameters of normal hepatic parenchyma from above two methods and those of normal hepatic paren- chyma and cirrhosis from five-phase-contrast-enhanced CT,as well as to compare CTDI of five-phase-contrast-enhanced CT and routine perfusion CT scan. Results：The consensus of interohserver measurement of these perfusion parameters was in good agreement （ICC：0. 818~0. 996）. No significant difference was existed in HPI, HAP,PVP and BF of normal hepatic parenchyma obtained from five-phase- contrast-enhanced CT and cinventional perfusion CT （P=0. 475,0. 219,0. 073,0. 108 respectively）, but BV obtained from the two methods was significantly different （P〈0. 001）. In five-phase-contrast- enhanced CT scan, HPI, HAP obtained from cirrhosis were higher than those obtained from normal hepatic parenchyma,but PVP was lowe

关 键 词：体层摄影术 X线计算机 灌注成像 五期增强CT 肝疾病 肝硬化 

分 类 号：R575.2[医药卫生—消化系统] R814.42[医药卫生—内科学]