320排容积CT上腹部一站式检查在肝硬化中的临床应用

发布时间：2018-06-23 05:51

本文选题：体层摄影术 + X线计算机　；参考：《重庆医科大学》2013年硕士论文

【摘要】：目的：运用320排CT一站式检查探讨肝硬化患者上腹部实质器官灌注特征、血管改变及其临床应用价值。方法：使用320排容积CT，分别对45例正常对照和45例肝硬化患者做上腹部一站式检查。①使用体部灌注软件分析，得到肝脏不同肝叶的肝动脉灌注量（HAP）、门静脉灌注量（HPP）动脉灌注分数（APF），胰腺不同部位（胰头、胰体、胰尾）及脾脏的动脉灌注量（AP），对各参数进行统计学分析。P0.05认为差异有统计学意义。②使用多平面成像(MPR)、最大密度投影(MIP)、容积再现(VR)，选择最佳时相重组增强各期图像及重组动脉血管造影（CTA）、静脉及门静脉CT静脉成像（CTV）和4D-CTA，，直接对其观察后评价血管的形态和走形。结果：⑴肝硬化组HAP、HPP、APF在各肝叶间均未表现出明显的统计学差异（P0.05），正常对照组肝左外叶HAP、APF高于肝右叶，HPP低于肝右叶、左内叶，差异均有统计学意义（P0.05）。与对照组相比，肝硬化组的HPP降低，HAP、APF增高（P0.01）。正常对照组胰头、胰体、胰尾部AP无明显统计学差异（P0.05）。肝硬化组胰体、胰尾部AP低于胰头部（P0.01）。肝硬化组胰腺各部位、脾脏的AP低于对照组（P0.01）。⑵通过CTA、CTV可清晰显示肝内各血管的解剖和变异。90例肝动脉的CTA均显示了4、5级正常肝动脉，Ⅰ型48例，Ⅱ型7例，Ⅲ型15例，Ⅴ型4例,Ⅵ型5例,Ⅸ型6例，未被列入的其他分型共5例。正常肝静脉61例，肝中静脉和肝左静脉汇合后再注入下腔静脉18例，肝中静脉和肝右静脉汇合后再注入下腔静脉5例，右下副肝静脉1例，肝静脉显影浅淡5例。正常对照组门静脉显示以4、5级分支为主，肝硬化组以3、4级为主。在肝硬化组的45例患者中，31例伴有门静脉高压侧支循环形成。食管下段及食管旁静脉曲张25例，胃短、胃后及胃左静脉静脉曲张20例，脐旁及腹壁浅静脉曲张16例，胃-肾和脾-肾分流8例，腹膜后分流5例，门静脉海绵样变6例。结论：320排容积CT一站式检查，受试者一次性注射造影剂后，经一次CT检查即可获取覆盖全上腹部器官同一时间的灌注数据，同步直观的反映正常人及肝硬化患者上腹部实质器官（肝脏、胰腺、脾脏）的血流灌注特征及血管变化，提供有价值并几乎接近生理状态的血流动力学信息，具有重要的临床意义：⑴正常人肝脏各叶的灌注情况不尽相同，胰腺各部位的灌注状态一致。肝硬化患者肝内灌注差异消失，胰腺、脾脏的灌注降低。⑵CTA、CTV能明确了解肝动脉、门静脉及肝静脉系统的正常、变异及肝硬化患者有无门脉高压以及由此导致的侧枝循环的开放情况，并能直观显示并评估静脉曲张的部位、数目、程度及与周围脏器的关系等。对肝硬化门脉高压的诊断，制定药物、外科或介入治疗计划具有重要的临床意义。
[Abstract]:Objective: To investigate the perfusion characteristics, blood vessel changes and clinical value of upper abdominal parenchymal organs in patients with cirrhosis by using 320 row CT one-stop examination.
Methods: using 320 row volume CT, 45 cases of normal control and 45 patients with cirrhosis were examined on the upper abdomen one station. (1) the volume of hepatic artery perfusion (HAP), portal perfusion (HPP) artery perfusion score (APF), the different parts of pancreas (pancreas head, pancreas body, tail of pancreas) and the splenic arteries were obtained by the analysis of body perfusion software. The amount of perfusion (AP) was statistically analyzed by.P0.05, and the difference was statistically significant. (2) using multiplanar imaging (MPR), maximum density projection (MIP), volume rendering (VR), selecting the best phase recombination enhancement phase images and recombinant arterial angiography (CTA), venous and portal vein CT venography (CTV) and 4D-CTA, directly after observation. To evaluate the shape and shape of the blood vessels.
Results: (1) there was no significant difference in HAP, HPP and APF between liver leaves in the liver cirrhosis group (P0.05). The left external lobe of the normal control group was HAP, APF was higher than the right lobe of the liver, HPP was lower than the right lobe of the liver, and the left internal lobe was statistically significant (P0.05). Compared with the control group, the HPP decreased, HAP, APF increased (P0.01). Normal control group pancreatic head, There was no significant difference between the pancreas body and the tail AP of the pancreas (P0.05). The pancreatic body in the liver cirrhosis group and the tail AP of the pancreas were lower than the head of the pancreas (P0.01). The AP of the pancreas in the liver cirrhosis group and the spleen were lower than the control group (P0.01). (2) through CTA, CTV can clearly show the anatomy and variation of the vessels in the liver, and the CTA of the.90 cases of the hepatic artery in.90 cases all showed the 4,5 normal hepatic artery, type I 48 cases, II. There were 7 cases, 15 cases of type III, 4 cases of type V, 5 cases of type VI, 6 cases of type IX, 5 cases of other types, 61 cases of normal hepatic vein, 18 cases of inferior vena cava after the confluence of the middle hepatic vein and the left vein of the liver, 5 cases of the inferior vena cava after the confluence of the middle hepatic vein and the right vein, 1 cases of the inferior right inferior hepatic vein, and the normal control group of the hepatic vein, and the normal control group. The portal vein was mainly 4,5 grade branch, and the liver cirrhosis group was mainly 3,4. Of the 45 patients with liver cirrhosis, 31 cases were accompanied by high pressure collateral circulation of the portal vein, 25 cases of lower esophagus and paroesophageal varices, 20 cases of gastric short, posterior and gastric varicose veins, 16 cases of umbilicus and abdominal wall superficial varicosity, 8 cases of stomach to kidney and splenic renal shunt. There were 5 cases of posterior diffluence and 6 cases of portal vein cavernous change.
Conclusion: 320 row volume CT one station examination, after a single injection of contrast agent, the subjects can get the perfusion data covering the whole upper abdominal organ at the same time after one time CT examination, and synchronously and intuitively reflect the blood perfusion characteristics and vascular changes of the parenchyma organs of the upper abdomen (liver, pancreas, spleen) of normal people and the patients with liver cirrhosis, and provide the price. The value and almost close to the physiological state of the hemodynamic information, which has important clinical significance: (1) the perfusion of all leaves of the normal human liver is not the same, the perfusion status of the various parts of the pancreas is the same. The hepatic perfusion difference of the patients with liver cirrhosis is disappearing, the perfusion of the pancreas and spleen is reduced. (2) CTA, CTV can clearly understand the hepatic artery, the portal vein and the hepatic vein The normal, variant and cirrhosis patients have portal hypertension and the resulting opening of the collateral circulation, and can intuitively display and evaluate the location, number, degree, and relationship with the surrounding organs. It has important clinical implications for the diagnosis of cirrhosis of the portal hypertension, the formulation of drugs, surgical or interventional therapy. Righteousness.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.5;R575.2

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