摘要
目的:应用螺旋CT灌注成像技术研究肝癌伴肝硬化肝脏的血流动力学改变及特点,探讨CT灌注成像技术对肝癌伴肝硬化患者手术安全性的预测价值。方法:32例肝癌伴肝硬化患者根据CT形态学分级对其肝硬化进行轻、中、重度3级划分并分组,其中轻度组17例、中度组8例、重度组7例,应用CT灌注扫描技术对肝脏血流量(blood flow,BF)、血容量(blood volume,BV)、平均通过时间(meantransittime,MTT)、肝动脉分数(hepatic arterial fraction,HAF)、对比剂到达时间(impulse residue functionto,IRFTo)、门静脉灌注量(porta lveinper fusion,PVP)和肝动脉门静脉灌注比率(HAP/PVPratio,A/V)等进行研究,分析CT灌注参数、肝硬化CT形态学分级及肝功能Child-Pugh分级三者间的相关性。20例行肝癌切除术患者应用判别函数分析CT灌注扫描预测肝癌手术治疗安全性的价值并与Child-Pugh分级进行比较。结果:CT形态学不同分级时BF、BV、IRFTo、PVP、MTT、HAF、A/V差异有统计学意义并具有相关性(P<0.05);肝功能Child-Pugh分级与CT肝硬化形态学分级呈显著正相关(r=0.891,P<0.05);20例肝癌患者术前判别函数分析,肝脏灌注参数对手术风险预测的判别符合率为95%,PVP、Child-Pugh分级判别符合率分别为90%、55%。结论:肝脏CT灌注成像不但可以反映肝癌伴肝硬化的肝脏血流灌注特点和对肝硬化程度进行定量分级诊断;而且作为影像学指标评估肝癌患者手术安全性优于Child-Pugh分级。
Objective： To assess the features of hepatic blood flow in the patients with primary liver cancer and liver cirrhosis using spiral CT, and investigate the vatue in predicting the safety of liver resection. Methods： 32 patients of primary liver cancer with cirrhosis undergoing CT scans were collected and classified into three groups by CT morphologic classification： 17 were classified as light liver cirrhosis group, 8 as moderate group, and 7 as severe group. The parameters of CT perfusion included BF, BV, MTT, HAF, IRF To, PVP and A/V were analyzed by the CT perfusion 3 software package （GE） with deconvolution method, and the correlation of CT perfusion parameters, CT mor- phologic classification and Child-Pugh＇s hepatic functional classification were appraised by spearman＇s correlation analysis, linear discriminate analysis. 20 patients with primary liver cancer underg- ing hepatectomy were researched premeditaly, and CT hepatic perfusion parameters and Child-Pugh＇s grading in predicting the risk of the operation for hepatic carcinoma were compared. Results： There were significant statistical difference and correlation in CT morphologic classifica- tion of hepatocirrhosis and BF, BV, IRF To, PVP, MTT, HAF,AN ratio （P〈0.05）, and the CT morpho- logic classification of hepatocirrhosis degree was positively correlated with Chitd-Pugh＇s classification. Based on canonical discriminant function, the classification accuractes in predicting the risk of hepatectomy reached 95.0% ,while 90.0% ,55.0% accuractes were obtained by means of PVP or hepatic Child-Pugh＇s functional classification alone. Conclusions： Hepatic perfusion with CT not only could reflect the hemodynamic alterations of liver cirrhosis, and quantitatively evaluate the liver cirrhosis degree of the patients with primary liver cancer, but also have more advantage than Child-Pugh＇s functional classification to evaluate the risk of hepatectomv.
出处
《中国现代普通外科进展》
CAS
2009年第7期565-569,共5页
Chinese Journal of Current Advances in General Surgery
基金
广西科学研究与技术开发计划项目(桂科攻0143051)
