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双源CT全肝低剂量灌注成像对肝硬化门静脉高压患者经颈静脉肝内门体分流术后肝血流灌注的评估价值
Role of dual-source CT low-dose whole liver perfusion imaging in evaluating liver blood perfusion after transjugular intrahepatic portosystemic shunt in cirrhotic patients with portal hypertension
文章发布日期:2016年09月07日  来源:  作者:翟亚楠,李雷,殷 亮,等   点击次数:1185次  下载次数:239次

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【摘要】:目的利用双源CT低剂量全肝灌注扫描技术观察肝硬化门静脉高压经颈静脉肝内门体分流术(TIPS)术前、术后肝实质血流动力学改变。方法收集2014年10月-2016年5月期间于兰州大学第一医院准备接受TIPS治疗的肝硬化门静脉高压患者52例,TIPS术前2 d及术后1周接受全肝灌注CT扫描,评价图像质量并利用后处理工作站观察灌注参数变化。计量资料组间比较采用配对t检验,各参数之间相关性分析采用Pearson直线相关分析法。结果肝脏动脉灌注量(HAP)由术前(19.85±9.48) ml/(min·100 ml)升高为(29.36±13.65) ml/(min·100 ml),肝动脉灌注指数(HPI)由术前(54.32±19.60)%升高为(64.11±1119)%,差异均有统计学意义(t值分别为-6.161、-6.202,P值分别为0.003、0.029);而门静脉灌流量(PVP)由术前(19.75±10.60) ml/(min·100 ml)下降为(16.13±8.60)ml/(min·100 ml),总肝灌注量(TLP)由术前(36.14±16.61) ml/(min·100 ml)上升为(44.12±14.60) ml/(min·100 ml),但差异均无统计学意义(P值均>0.05)。全肝灌注扫描平均有效辐射剂量为16.5 mSv。PVP、TLP、HPI与造影剂注射速率显著相关(r值分别为0992、-0903、-0899,P值分别为0001、0036、0038);HAP、PVP及TLP的变化与样本量呈负相关(r值分别为-0922、-0943、-0998,P值分别为0026、0016、<0001);TLP与管电压、扫描次数呈正相关(r值分别为0896、0907,P值分别为0039、0033)。结论双源CT全肝低剂量灌注可用于观察TIPS术前、术后的血流动力学变化,为术前及疗效评估提供参考。
【Abstract】:ObjectiveTo investigate the role of dual-source CT low-dose whole liver perfusion imaging in evaluating the hemodynamic changes in liver parenchyma before and after transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients with portal hypertension. MethodsA total of 52 cirrhosis patients with portal hypertension underwent whole liver perfusion CT scan 2 days before TIPS and at 1 week after TIPS. The image quality was evaluated and a post-processing workstation was used to observe the changes in perfusion parameters. Paired t-test was applied for comparison between two groups, and pearson linear correlation was applied for correlation analysis. ResultsHepatic arterial perfusion(HAP) increased from 19.85 ml/(min·100 ml)±9.48 ml/(min·100 ml) before TIPS to 29.36 ml/(min·100 ml)±13.65 ml/(min·100 ml) after TIPS (t=-6.161, P=0.003), and the hepatic arterial perfusion index(HPI) increased from 54.32%±19.60% before TIPS to 64.11%±11.19% after TIPS (t=-6.202, P=0.029). Portal vein perfusion(PVP) was reduced from 19.75 ml/(min·100 ml)±10.60 ml/(min·100 ml) before TIPS to 16.13 ml/(min·100 ml)±8.60 ml/(min·100 ml) after TIPS, and total liver perfusion (TLP) increased from 36.14 ml/(min·100 ml)±16.61 ml/(min·100 ml) before TIPS to 4412 ml/(min·100 ml)±14.60 ml/(min·100 ml) after TIPS (both P>0.05). The mean effective radiation dose of whole liver perfusion scan was 16.5 mSv. PVP, TLP, and HPI were significantly correlated with the injection rate of contrast agent(r=0992,P=0001;r=-0903,P=0036;r=-0899,P=0038). HAP, PVP, and TLP were negatively correlated with the sample size(r=-0922,P=0026;r=-0.943,P=0.016;r=-0.998,P<0001). TLP was positively correlated with the voltage of X-ray tube and scantimes(r=0896, P=0039;r=0.907,P=0.033). ConclusionDual-source CT low-dose whole liver perfusion can be used to observe the hemodynamic changes in cirrhotic patients with portal hypertension before and after TIPS and provide a reference for preoperative evaluation and therapeutic effect evaluation.
【关键字】:肝硬化; 高血压, 门静脉; 体层摄影术, X线计算机; 门体分流术, 经颈静脉肝内
【Key words】:liver cirrhosis; hypertension, portal; tomograpy, X-ray computed; portasystemic shunt, transjugular intrahepatic
【引证本文】:翟亚楠, 李雷, 殷亮, 等. 双源CT全肝低剂量灌注成像对肝硬化门静脉高压患者经颈静脉肝内门体分流术后肝血流灌注的评估价值[J]. 临床肝胆病杂志, 2016, 32(10): 1894-1899.

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