中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2012年
4期
317-321
,共5页
龙莉玲%黄仲奎%丁可%廖锦元%江建宁
龍莉玲%黃仲奎%丁可%廖錦元%江建寧
룡리령%황중규%정가%료금원%강건저
肝硬化%体层摄影术,X线计算机%对比研究
肝硬化%體層攝影術,X線計算機%對比研究
간경화%체층섭영술,X선계산궤%대비연구
Hepatic cirrhosis%Tomography,X-ray computed%Comparative study
目的 探讨MSCT灌注参数评价慢性肝纤维化、肝硬化的价值.方法 对经肝穿刺病理活检确诊的轻度肝纤维化(肝纤维化分期为S1、S2期)31例,重度肝纤维化(肝纤维化分期为S3、S4期)和(或)早期肝硬化34例,具有典型临床症状和影像表现的晚期肝硬化42例以及对照组30例行16层螺旋CT肝脏灌注扫描,取得不同病变阶段肝实质的灌注参数,包括肝动脉灌注量(HAP)、门静脉灌注量(PVP)、全肝总灌注量(TLP)、肝动脉灌注指数(HPI)及达峰时间(TTP)5个指标,并与病理分期作对照研究.各组肝脏不同CT灌注参数值的比较采用方差分析；各灌注参数值与肝纤维化严重程度的相关性采用秩相关分析；采用多因素分析(Logistic回归)探讨肝脏灌注参数值中对肝纤维化病理分期影响最大的指标.结果 对照组、S1、S2期组、S3、S4期组及肝硬化组的HAP值分别为(28.9±8.6)、(24.6±2.4)、(29.2±2.3)和(38.9±7.0)ml·100 ml-1·min-1,表现为先下降后增高,各组间差异有统计学意义(F =40.26,P＜0.01)；上述各组PVP分别为(111.3±18.1)、(92.9±5.3)、(73.0±9.0)和(54.1 ±13.8)ml·100 ml-1·min-1,TLP分别为(140.2 ±25.9)、(117.1±4.5)、(102.3±8.7)和(93.0±ll.8)ml.100 ml-1·min-1,差异均有统计学意义(F值分别为136.79、67.40,P值均＜0.01)；各组的HPI分别为(20.4±2.6)％、(21.0±2.1)％、(28.5±3.1)％和(42.6±1 1.1)％,TTP分别为(123.7±22.2)、(137.1 ±27.1)、(145.0±28.6)和(166.5 ±25.1)s,差异亦均有统计学意义(F值分别为93.05、17.37,P值均＜0.01).PVP、TLP与肝纤维化严重程度呈显著负相关,r值分别为-0.920和-0.846,P值均＜0.01；HAP、HPI、TTP则与肝纤维化程度呈正相关关系,r值分别为0.611、0.882和0.545,P值均＜0.01.在肝脏CT灌注扫描的参数值中,PVP的标准化回归系数最大(-8.798).ROC曲线判断得到的最佳临界点PVP =84.76 ml· 100 ml-1· min1作为重度肝纤维化S3、S4期和(或)早期肝硬化的诊断阈值,其敏感度和特异度分别为0.890、0.950,准确度达0.931.结论MSCT灌注参数能反映肝纤维化、肝硬化的血流动力学改变；CT灌注成像有助于鉴别重度肝纤维化和(或)早期肝硬化及晚期肝硬化.
目的 探討MSCT灌註參數評價慢性肝纖維化、肝硬化的價值.方法 對經肝穿刺病理活檢確診的輕度肝纖維化(肝纖維化分期為S1、S2期)31例,重度肝纖維化(肝纖維化分期為S3、S4期)和(或)早期肝硬化34例,具有典型臨床癥狀和影像錶現的晚期肝硬化42例以及對照組30例行16層螺鏇CT肝髒灌註掃描,取得不同病變階段肝實質的灌註參數,包括肝動脈灌註量(HAP)、門靜脈灌註量(PVP)、全肝總灌註量(TLP)、肝動脈灌註指數(HPI)及達峰時間(TTP)5箇指標,併與病理分期作對照研究.各組肝髒不同CT灌註參數值的比較採用方差分析；各灌註參數值與肝纖維化嚴重程度的相關性採用秩相關分析；採用多因素分析(Logistic迴歸)探討肝髒灌註參數值中對肝纖維化病理分期影響最大的指標.結果 對照組、S1、S2期組、S3、S4期組及肝硬化組的HAP值分彆為(28.9±8.6)、(24.6±2.4)、(29.2±2.3)和(38.9±7.0)ml·100 ml-1·min-1,錶現為先下降後增高,各組間差異有統計學意義(F =40.26,P＜0.01)；上述各組PVP分彆為(111.3±18.1)、(92.9±5.3)、(73.0±9.0)和(54.1 ±13.8)ml·100 ml-1·min-1,TLP分彆為(140.2 ±25.9)、(117.1±4.5)、(102.3±8.7)和(93.0±ll.8)ml.100 ml-1·min-1,差異均有統計學意義(F值分彆為136.79、67.40,P值均＜0.01)；各組的HPI分彆為(20.4±2.6)％、(21.0±2.1)％、(28.5±3.1)％和(42.6±1 1.1)％,TTP分彆為(123.7±22.2)、(137.1 ±27.1)、(145.0±28.6)和(166.5 ±25.1)s,差異亦均有統計學意義(F值分彆為93.05、17.37,P值均＜0.01).PVP、TLP與肝纖維化嚴重程度呈顯著負相關,r值分彆為-0.920和-0.846,P值均＜0.01；HAP、HPI、TTP則與肝纖維化程度呈正相關關繫,r值分彆為0.611、0.882和0.545,P值均＜0.01.在肝髒CT灌註掃描的參數值中,PVP的標準化迴歸繫數最大(-8.798).ROC麯線判斷得到的最佳臨界點PVP =84.76 ml· 100 ml-1· min1作為重度肝纖維化S3、S4期和(或)早期肝硬化的診斷閾值,其敏感度和特異度分彆為0.890、0.950,準確度達0.931.結論MSCT灌註參數能反映肝纖維化、肝硬化的血流動力學改變；CT灌註成像有助于鑒彆重度肝纖維化和(或)早期肝硬化及晚期肝硬化.
목적 탐토MSCT관주삼수평개만성간섬유화、간경화적개치.방법 대경간천자병리활검학진적경도간섬유화(간섬유화분기위S1、S2기)31례,중도간섬유화(간섬유화분기위S3、S4기)화(혹)조기간경화34례,구유전형림상증상화영상표현적만기간경화42례이급대조조30례행16층라선CT간장관주소묘,취득불동병변계단간실질적관주삼수,포괄간동맥관주량(HAP)、문정맥관주량(PVP)、전간총관주량(TLP)、간동맥관주지수(HPI)급체봉시간(TTP)5개지표,병여병리분기작대조연구.각조간장불동CT관주삼수치적비교채용방차분석；각관주삼수치여간섬유화엄중정도적상관성채용질상관분석；채용다인소분석(Logistic회귀)탐토간장관주삼수치중대간섬유화병리분기영향최대적지표.결과 대조조、S1、S2기조、S3、S4기조급간경화조적HAP치분별위(28.9±8.6)、(24.6±2.4)、(29.2±2.3)화(38.9±7.0)ml·100 ml-1·min-1,표현위선하강후증고,각조간차이유통계학의의(F =40.26,P＜0.01)；상술각조PVP분별위(111.3±18.1)、(92.9±5.3)、(73.0±9.0)화(54.1 ±13.8)ml·100 ml-1·min-1,TLP분별위(140.2 ±25.9)、(117.1±4.5)、(102.3±8.7)화(93.0±ll.8)ml.100 ml-1·min-1,차이균유통계학의의(F치분별위136.79、67.40,P치균＜0.01)；각조적HPI분별위(20.4±2.6)％、(21.0±2.1)％、(28.5±3.1)％화(42.6±1 1.1)％,TTP분별위(123.7±22.2)、(137.1 ±27.1)、(145.0±28.6)화(166.5 ±25.1)s,차이역균유통계학의의(F치분별위93.05、17.37,P치균＜0.01).PVP、TLP여간섬유화엄중정도정현저부상관,r치분별위-0.920화-0.846,P치균＜0.01；HAP、HPI、TTP칙여간섬유화정도정정상관관계,r치분별위0.611、0.882화0.545,P치균＜0.01.재간장CT관주소묘적삼수치중,PVP적표준화회귀계수최대(-8.798).ROC곡선판단득도적최가림계점PVP =84.76 ml· 100 ml-1· min1작위중도간섬유화S3、S4기화(혹)조기간경화적진단역치,기민감도화특이도분별위0.890、0.950,준학도체0.931.결론MSCT관주삼수능반영간섬유화、간경화적혈류동역학개변；CT관주성상유조우감별중도간섬유화화(혹)조기간경화급만기간경화.
Objective To investigate the value of the MSCT liver perfusion imaging parameters in the evaluation of the chronic hepatic fibrosis and cirrhosis. Methods Liver CT perfusion ( CTP ) was performed in 107 participants,including 31 patients with mild hepatic fibrosis( S1,S2),34 patients with severe hepatic fibrosis ( S3,S4 ) and early stage of hepatic cirrhosis which conformed by liver pathologic biopsy,42 patients with hepatic cirrhosis who had typical clinical and image signs,and 30 healthy subjects as control group.The data of CTP ( HAP,PVP,LTP,HPI and TTP) at different stages were obtained with Body perfect CT-syngo CT2007A and control study with histopathologic stage.Compared the study index by the one-way ANOVA analysis. Used Spearman rank correlation to analysis the relationship between liver perfusion imaging parameters and the degrees of the chronic hepatic fibrosis. Used Logistic regression to analysis the maximum.regression coefficient among the liver perfusion imaging paraneters,which affected the histopathologic stage mostly.Results In the subgroups of the chronic hepatic fibrosis S1,S2,S3,S4 to the hepatic cirrhosis,HAP values was (28.9 ±8.6),(24.6 ±2.4),(29.2 ±2.3) and (38.9 ± 7.0) ml · 100 ml -1 · min-1,respectively.HAP decreased firstly,then increased.Statistic analysis showed the difference of HAP between later-stage cirrhosis and other groups( F =40.26,P ＜ 0.01 ).PVP values of above subgroups was (111.3 ± 18.1),(92.9 ±5.3),(73.0 ±9.0) and (54.1 ± 13.8) ml · 100 ml-1 ·min -1,respectively.TLP values of above subgroups was ( 140.2 ± 25.9 ),( 117.1 ± 4.5 ),( 102.3 ± 8.7 )and (93.0 ± 11.8) ml · 100 ml-1.min-1,respectively.The difference of PVP,TL.P among each subgroup was significant ( F =136.79,67.40,respectively,P ＜ 0.01 ).HPI values of above subgroups was (20.4 ± 2.6)％,(21.0 ±2.1)％,(28.5 ±3.1)％ and (42.6± 11.1)％,respectively.TTP values of above subgroups was (123.7±22.2),(137.1 ±27.1),(145.0 ±28.6) and (166.5 ±25.1)s,respectively.The difference of HPI,TTP among each subgroup was significant( F =93.05,17.37,respectively; P ＜0.01 ).PVP,TLP was significant negative correlation with the degree of the hepatic fibrosis( r =-0.920,-0.846,respectively; P ＜0.01 ).HAP,HPI and TTP was significant positive correlation with the degree of the hepatic fibrosis( r =0.611,0.882 and 0.545,respectively; P ＜ 0.01 ).Logistic regression analysis showed the regression coefficient of PVP( - 8.798) was maximum.With an area under the receiver operating characteristic curve of PVP =84.76 ml · 100 ml- 1 · min- 1 as a diagnose critical point.The sensitivity was 0.890,the specificity was 0.950,and the accuracy was 0.931 in the prediction of the chronic hepatic fibrosis.Conclusions MSCT liver perfusion imaging parameters can reflect the hemodynamic changes of chronic hepatic fibrosis and cirrhosis.CTP may be helpful for differentiation the severe hepatic fibrosis and early stage of hepatic cirrhosis and later-stage cirrhosis.
