CT灌注成像诊断奥沙利铂肝窦损伤的效能分析  

Efficacy analysis of CT perfusion imaging in the diagnosis of oxaliplatin induced hepatic sinusoidal injury

作　　者：付雪林 邓军[1] 黄国中 周建忠 黄小宁[1] FU Xuelin;DENG Jun;HUANG Guozhong;ZHOU Jianzhong;HUANG Xiaoning(Medical Imaging Center,the Second Affiliated Hospital of Nanchang University,Nanchang 330006)

机构地区：[1]南昌大学第二附属医院医学影像中心,江西南昌330006

出　　处：《实用放射学杂志》2022年第4期573-576,共4页Journal of Practical Radiology

基　　金：江西省教育厅科学技术研究项目(14069);江西省卫生健康委员会科技计划项目(202130388);江西省应用研究培育计划(20212BAG70035).

摘　　要：目的探讨CT灌注成像诊断奥沙利铂肝窦损伤的效能.方法收集128例接受奥沙利铂化疗方案的胃癌、结直肠癌患者的影像资料.由2位放射科医师分别对患者CT门静脉期肝脏实质不均匀强化程度进行4分法评分.评分≥2分作为诊断肝窦阻塞综合征(HSOS)标准,将患者分为HSOS组和无HSOS组.应用后处理软件测量患者门静脉灌注(PVP)、动脉增强分数(AEF)并计算门静脉灌注指数(PVPI),进行统计学分析.结果2位医师对肝脏实质不均匀强化程度评分具有较好的一致性(Kappa=0.828,P<0.05).其中,无HSOS组有58例(45.3%)患者,HSOS组有70例(54.7%)患者.HSOS组患者PVP明显低于无HSOS组[(0.254±0.072)mL·min^(-1)·100mL^(-1)vs(0.315±0.057)mL·min^(-1)·100mL^(-1),P<0.05],而2组患者间AEF无明显差异性[(0.434±0.057)%vs(0.449±0.052)%,P>0.05],并且HSOS组PVPI明显高于无HSOS组(0.320±0.138vs 0.144±0.129,P<0.05).PVPI诊断HSOS的受试者工作特征(ROC)曲线的曲线下面积(AUC)为0.828[95%置信区间(CI)0.754,0.902],临界值为0.212,敏感性为71.9%,特异性为76.8%.结论CT灌注成像参数PVP可以定量肝窦门静脉血流灌注,PVPI可以反映化疗后肝窦门静脉血流降低率,PVP和PVPI对诊断奥沙利铂肝窦损伤具有一定的临床价值.Objective To investigate the efficacy of CT perfusion imaging in the diagnosis of hepatic sinusoidal injury induced by oxaliplatin.Methods The imaging data of 128 patients with gastric and colorectal cancer who received oxaliplatin chemotherapy were collected.Two radiologists independently scored the degree of heterogeneous enhancement of liver parenchyma in portal venous phase with 4-point method.The score 22 was used as the diagnostic standard for hepatic sinusoidal obstruction syndrome(HSOS),and all patients were divided into HSOS group and non-HSOS group.The portal venous perfusion(PVP)and arterial enhancement fraction(AEF)were measured by post-processing software,the portal venous perfusion index(PVPI)was then calculated.And the statistical analysis were performed on all the data mentioned above.Results The scores of the degree of heterogeneous enhancement of liver parenchyma were well consistent between the two radiologists(Kappa=0.828,P<0.05).There were 58 non-HSOS patients(45.3%)and 70 HSOS patients(54.7%)in this study.The PVP of the HSOS group was significantly lower than that of the non-HSOS group[(0.254±0.072)mL·min^(-1)·100 mL^(-1) vs(0.±0.057)mL·min^(-1)·100 mL^(-1),P<0.05],while there was no significant difference in AEF between the two groups[(0.434±0.057)%vs(0.449±0.052)%,P>0.05].And PVPI in HSOS group was significantly higher than that in non-HSOS group(0.320±0.138 vs 0.144+0.129,P<C0.05).The area under the curve(AUC)for the diagnosis of HSOS with PVPI was 0.828[95%confidence interval(CI)0.754,0.902],the cut-off value was 0.212,the sensitivity and specificity was 71.9%and 76.8%,respectively.Conclusion Hepatic sinusoidal portal vein perfusion can be quantitatively measured by CT perfusion-like imaging parameters such as PVP.And the reduction rate of hepatic sinusoidal portal vein blood flow after chemotherapy can be reflected by PVPI.The parameters of PVP and PVPI have certain clinical value in the diagnosis of hepatic sinusoidal injury induced by oxaliplatin.

关 键 词：奥沙利铂 肝窦阻塞综合征 计算机体层成像 

分 类 号：R979.1[医药卫生—药品] R575[医药卫生—药学] R814.42