能谱CT成像定量评估Budd-Chiari综合征患者TIPS术治疗前后肝功能状态临床价值研究  

Quantitative evaluation of hepatic function by EDCT in patients with Budd-Chiari syndrome before and after TIPS

作　　者：巴正武 栗海龙[3] 杨慧 Ba Zhengwu;Li Hailong;Yang Hui(Department of Radiology,Fifth Provincial People's Hospital,Xining 810000,Qinghai Province,China)

机构地区：[1]青海省第五人民医院CT室,西宁市810000 [2]青海省第五人民医院肿瘤科,西宁市810000 [3]青海大学附属医院CT室

出　　处：《实用肝脏病杂志》2019年第5期680-683,共4页Journal of Practical Hepatology

基　　金：西宁市卫生人才发展计划项目(编号：278997)

摘　　要：目的探讨应用能谱CT成像定量评估Budd-Chiari综合征(BCS)患者在经颈静脉肝内门体静脉分流术(TIPS)治疗前后肝功能状态的临床价值。方法2012年5月~2018年4月我院收治的BCS患者58例,其中Child-Pugh A级、B级和C级分别为21例、18例和19例。病理学类型为下腔静脉阻塞型15例,肝静脉阻塞型17例和混合型26例。所有患者均接受TIPS治疗,手术前后行能谱CT扫描,采用Couinaud肝脏分段,在I^VIII段及相同层面的腹主动脉勾画感兴趣区(ROI),计算肝脏各段标准化碘基值。结果治疗前,Child A级患者I^VIII段标准化碘基值分别为(0.32±0.21)、(0.33±0.12)、(0.31±0.07)、(0.31±0.02)、(0.31±0.02)、(0.31±0.03)、(0.31±0.09)和(0.31±0.11),均显著高于Child B级患者【分别为(0.28±0.14)、(0.28±0.13)、(0.28±0.08)、(0.27±0.09)、(0.22±0.09)、(0.25±0.10)、(0.27±0.13)和(0.28±0.10),P<0.05】或Child C级患者【分别为(0.21±0.10)、(0.20±0.09)、(0.19±0.07)、(0.19±0.11)、(0.19±0.12)、(0.19±0.10)、(0.20±0.11)和(0.19±0.10),P<0.05】;治疗后,随着肝功能的恢复,不同分级的BCS患者不同肝段标准化碘基值也有所升高,并且Child A级患者碘基值升高更明显。结论应用能谱CT成像定量评估Budd-Chiari综合征患者肝功能状态有重要的临床价值,可以通过标准化碘基值间接反映肝脏的血供状况,对BCS患者治疗疗效进行定量评估,为临床后续治疗提供更多有用的信息。Objective The aim of this study was to explore the clinical value of quantitative assessment of liver functions by energy dispersive CT imaging in patients with Budd-Chiari syndrome before and after treatment.Methods Fifty-eight patients with BCS were enrolled to our hospital between May 2012 and April 2018,and they were classified into Child class A(n=21),class B(n=18)and class C(n=19).All the patients underwent transjugular intrahepatic portosystemic shunt(TIPS)and before and after the treatment,the energy spectrum CT scanning was performed.After CT scanning,the image was transmitted to the post-processing workstation.Regions of interest(ROI)was plotted in Couinaud segment I-VIII.The normalized iodine concentration at each segment of the liver before and after the treatment were calculated.Results Before TIPS,the normalized iodine concentration at segment I to VIII in patients with Child class A were(0.32±0.21),(0.33±0.12),(0.31±0.07),(0.31±0.02),(0.31±0.02),(0.31±0.03),(0.31±0.09)and(0.31±0.11),all significantly greater than【(0.28±0.14),(0.28±0.13),(0.28±0.08),(0.27±0.09),(0.22±0.09),(0.25±0.10),(0.27±0.13)and(0.28±0.10),respectively,P<0.05】in patients with Child class B or【(0.21±0.10),(0.20±0.09),(0.19±0.07),(0.19±0.11),(0.19±0.12),(0.19±0.10),(0.20±0.11)and(0.19±0.10),respectively,P<0.05】in patients with Child class C;after the TIPS procedure,the normalized iodine concentration at each segment in patients with different liver function classification elevated obviously as the liver functions improved,and the normalized iodine concentration in patients with Child class A elevated greatly.Conclusion The application of energy-spectrum CT imaging has important value in quantitatively evaluating the liver functions in patients with Budd-Chiari syndrome before and after treatment.It might indirectly reflect the blood supply of liver according to the normalized iodine concentration,by which the clinicians might therefore quantitatively evaluate the curative efficacy of any treatment i

关 键 词：BUDD-CHIARI综合征 经颈静脉肝内门体静脉分流术 能谱CT 标准化碘基值 疗效评估 

分 类 号：R57[医药卫生—消化系统]