多层螺旋CT肝脏灌注成像评价慢性肝纤维化、肝硬化的价值
The value of multi-slice spiral CT liver perfusion imaging to evaluate the chronic hepatic fibrosis and cirrhosis
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.
更多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.
More- 浏览:670
- 被引:62
- 下载:584
相似文献
- 中文期刊
- 外文期刊
- 学位论文
- 会议论文