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

发布时间：2017-12-27 14:34

本文关键词：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　出处：《临床肝胆病杂志》2016年10期 　论文类型：期刊论文

【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16.5m Sv。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]:Objective To observe the hemodynamic changes of hepatic parenchyma after portal vein hypertension through transjugular intrahepatic portosystemic shunt (TIPS) by dual source CT whole liver perfusion scan. 52 patients with liver cirrhosis and portal hypertension were collected from October 2014 May in First Hospital Affiliated to Lanzhou University during -2016 years to accept TIPS treatment of TIPS cases, 2 D before and after the operation 1 weeks underwent whole liver perfusion CT scan and postprocessing workstation using the observation of perfusion parameters change image quality evaluation. The paired t test was used among the data groups, and the correlation analysis between the parameters was analyzed by Pearson linear correlation analysis. Results hepatic artery perfusion (HAP) by preoperative (19.85 + 9.48) ml/ (min 100 ml) increased to (29.36 + 13.65) ml/ (min 100 ml), hepatic artery perfusion index (HPI) by preoperative (54.32 + 19.60)% was increased (64.11 + 11.19)%, the difference there was statistically significant (t = -6.161, -6.202, P = 0.003, 0.029); and portal vein perfusion (PVP) by preoperative (19.75 + 10.60) ml/ (min 100 ml) decreased (16.13 + 8.60) ml/ (min 100 ml), total liver perfusion (TLP) from preoperative (36.14 + 16.61) ml/ (min 100 ml) up to (44.12 + 14.60) ml/ (min 100 ml), but the differences were not statistically significant (P 0.05). The average effective radiation dose of all liver perfusion scan was 16.5m Sv. PVP, TLP and HPI were significantly correlated with the injection rate of contrast medium (r = 0.992, -0.903, -0.899, P values were 0.001, 0.036, 0.038); negative correlation with the change of sample HAP, PVP and TLP (r = -0.922, -0.943, -0.998, P = 0.026 0.016, 0.001); TLP was positively correlated with tube voltage, number of scans (r = 0.896, 0.907, P = 0.039, 0.033). Conclusion the low dose perfusion of the whole liver of CT can be used to observe the hemodynamic changes before and after the operation of TIPS, so as to provide reference for the preoperative and therapeutic evaluation.
【作者单位】：兰州大学第一医院放射科;兰州大学第一医院介入科;甘肃省卫生职业学院医学影像教研室;甘肃省人民医院核医学科;甘肃省妇幼保健院辅助生殖医学中心;
【基金】：兰州大学第一医院2015年度院内青年基金(ldyyyn2015-13)
【分类号】：R575.2;R816.5
【正文快照】： 上消化道出血是肝硬化门静脉高压患者死亡的主要原因,而经颈静脉肝内门体分流术(TIPS)可以有效预防上消化道出血,降低门静脉压力和保证肝脏有效灌注是决定TIPS成败的关键。目前临床上主要依赖数字减影血管造影进行门静脉测压和超声多普勒检查来评价门静脉压力和流速,虽然实现

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