规范化CT门静脉成像在肝纤维化及肝硬化中应用的实验研究

发布时间：2018-12-15 03:40

【摘要】：目的：以数字减影血管造影（DSA）金标准为基础，规范多层螺旋CT门静脉造影(MSCTP)的成像方法。方法：采用健康中国贵州成年小型猪16只为研究对象,以门静脉最佳显示层面为中心，在全麻下采用同层动态扫描方式行16层螺旋CT动态扫描,成像速度1帧/s,循环45次。运用灌注软件包分析，生成时间-密度曲线，获得门静脉强化峰值所对应的最佳显影时间点（TTP）。待动物体内造影剂代谢完全后，利用TTP，行MSCT门静脉血管造影（MSCTP），并使用最大密度投影（MIP）及多平面容积重建（MPVR），可以清晰显示门脉主干及属支，并测量门静脉主干及属支直径。采用DSA行间接门静脉造影电影采集，测量门静脉最佳显影时间及门脉主干、属支管径。对比分析MSCTP及DSA两种技术下测量门静脉系统最佳显影时间及管径。结果：（1）MSCTP与DSA门静脉TTP分别为39.73±8.27s与14.40±0.75s，MSCTP测得的TTP明显长于DSA（p 0.05），但二者具有良好的相关性（r=0.749，p 0.05）。（2）MSCTP测得的门静脉主干管径（PVD）、肠系膜静脉管径（SMVD）及脾静脉管径（SPVD）分别为8.50±0.801mm、7.13±0.71mm、5.54±0.89mm，DSA测得的相应管径分别为7.65±1.17mm、5.74±1.05mm、5.03±0.98mm，MSCTP测定的相应管径值均高于DSA（p 0.05）；但两种技术下测得的对应管径值具有良好相关性（r=0.700，0.624and0.958，respectively，all p 0.05）。结论：多层螺旋CT动态扫描可优化门静脉CT成像技术，MSCTP将有助于门静脉系统的形态学分析，为肝硬化门脉高压相关研究提供规范化MSCTP技术。目的：(1)探讨以CT动态增强扫描中门静脉强化达峰时间（TTP）为基础的在肝纤维化及肝硬化的规范门静脉成像扫描时间窗。(2)应用规范化门静脉成像，探讨门静脉系统管径对实验性肝纤维化及肝硬化的诊断价值。(3)分析肝纤维化及肝硬化过程中门静脉系统管径与肝储备功能的相关性。材料与方法：使用健康中国小型猪16只，采用四氯化碳(CC14)制造肝纤维化及肝硬化模型。实验动物正常（第0周）至自建模开始后第5周、第9周、第16周及第21周接受CT动态增强扫描，获得门静脉强化程度达到峰值时间，以此确定门静脉最佳成像时间，并以此为门静脉成像延迟时间行门静脉成像扫描，并测量门静脉主干管径（PVD）、肠系膜上静脉管径（SMVD）、脾静脉管径（SVD），同时统计分析上述参数在疾病发展过程中的变化规律及诊断价值。造模开始后第0、5、9、16、21周同时进行肝穿刺活检及肝储备功能生化指标检测。结果：（1）TTP在从肝脏正常进展到肝纤维化再到肝硬化病程中的变化规律：在实验动物肝纤维化与肝硬化发展过程中，门静脉达峰时间（TTP）随疾病进展逐渐延长(r=0.234; p0.05)，并在肝正常，肝纤维化及肝硬化中存在明显差异(p＜0.05)。（2）肝纤维化与肝硬化的规范化门静脉成像时间临界点：CT规范化门静脉成像时间，肝纤维化期扫描延迟时间窗为约为40.5-47秒；肝硬化时延迟时间最短约为47秒。（3）规范化CT门静脉成像时间窗在肝纤维化及肝硬化中的应用：在实验动物肝纤维化与肝硬化发展过程中，PVD（r=0.613）、SMVD（r=0.424）、SVD（r=0.272）逐渐增粗，其中SVD增大最为明显（p＜0.05）。（4）规范化门静脉成像门静脉系统管径与肝储备功能的相关性：SVD与肝储备功能各项指标均相关（r=-0.419、0.359、0.35，，respectively; all p0.05）；PVD、SMVD与肝功能各项指标不相关或不完全相关。(5)在诊断肝纤维化ROC曲线中，仅SVD有诊断意义，其曲线下面积为0.883；PVD和SVD均对诊断肝硬化有意义，其ROC曲线下面积依次0.744和0.752，其中SVD曲线下面积较大(p 0.05)。结论：CT动态增强扫描获得的TTP有助于规范CT门静脉成像扫描时间窗，规范化门静脉成像SVD对诊断肝纤维化及肝硬化具有重要价值。
[Abstract]:Objective: To study the imaging method of multi-slice spiral CT portography (MSCTP) based on the digital subtraction angiography (DSA) gold standard. Methods: 16 adult small-scale pigs in Guizhou were used as the research object. The optimal display level of portal vein was the center. The dynamic scanning of 16-layer spiral CT was performed by the same layer dynamic scanning mode under general anesthesia. The imaging speed was 1 frame/ s, and the circulation was 45. times. The time-density curve is generated by using the perfusion software package to obtain the optimal developing time point (TTP) corresponding to the peak value of the portal vein.) After the metabolism of the contrast agent in the body of the animal is complete, using the TTP, the MSCT portal vein angiography (MSCTP) and the maximum density projection (MIP) and the multi-plane volume reconstruction (MPVR), the main stem and the branch of the portal vein can be clearly displayed, and the portal trunk and the branch of the portal vein are measured. Path: The optimal development time of the portal vein and the trunk of the main stem of the portal vein were measured by means of DSA line indirect portal venography. Method for measuring the optimal developing time and tube of portal vein system under two kinds of techniques: MSCTP and DSA Results: (1) The portal TTP of MSCTP and DSA was 39.73, 8.27s and 14.40-0.75s, and the TTP measured by MSCTP was significantly longer than that of DSA (p-0.05), but both had good correlation (r = 0.749, p-0). (2) The diameter of the portal vein (PVD), the diameter of the mesenteric vein (SMVD) and the diameter of the splenic vein (SPVD) measured by the MSCTP were 8.50, 0.801mm, 7.13, 0.71mm, 5.54 and 0.89mm, respectively. The corresponding pipe diameters measured by the DSA were 7.65, 1.17mm, 5.74, 1.05mm, 5.03 and 0.9. The value of the corresponding pipe diameter measured by MSCTP was higher than that of DSA (p-0.05); however, the corresponding pipe-diameter values measured under the two techniques had a good correlation (r = 0.700, 0.6424 and 0.958, respectively, all p 0. Conclusion: The multi-slice spiral CT dynamic scan can optimize the portal CT imaging technique, and the MSCTP will be helpful to the morphological analysis of the portal vein system and to provide the standardized MS for the high-pressure related research of the portal vein of the liver cirrhosis. Objective: (1) To explore the standard portal vein for hepatic fibrosis and liver cirrhosis, which is based on the portal vein enhanced peak time (TTP) in the CT dynamic enhanced scan. imaging scanning time window. (2) The portal vein imaging was applied to investigate the effect of the diameter of the portal vein on the experimental liver fibrosis and the liver. Diagnostic value of sclerotherapy. (3) Analysis of hepatic fibrosis and portal system diameter and liver storage in the course of liver cirrhosis Correlation of preparation function. Materials and methods: using 16 healthy Chinese small pigs, and using carbon tetrachloride (CC14) to make liver Model of fibrosis and cirrhosis. The experimental animals were normal (Week 0) to Week 5, Week 9, Week 16, and Week 21 after the start of the modeling, and the CT dynamic enhanced scan was performed at Week 9, Week 16, and Week 21 to obtain a peak time for portal enhancement to determine The optimal imaging time of the portal vein was performed, and the portal vein image was scanned by the portal vein imaging delay time, and the main diameter of the portal vein (PVD), the superior mesenteric vein diameter (SMVD) and the splenic vein diameter (SVD) were measured, and the above parameters were statistically analyzed in the course of the disease development. The changes and diagnostic value of liver biopsy and liver storage were performed at 0, 5, 9, 16 and 21 weeks after the start of the model. The results were as follows: (1) The change of TTP in the course of liver fibrosis and the course of liver cirrhosis: in the course of the development of experimental animal's liver fibrosis and liver cirrhosis, the time of portal hypertension (TTP) was gradually prolonged with the disease progression (r = 0.234; p 0.05), and is present in normal liver, liver fibrosis and liver cirrhosis Significant difference (p <0.05). (2) The standard portal imaging time critical point of liver fibrosis and liver cirrhosis: CT normalized portal vein imaging time, liver fibrosis stage scanning delay time window of about 40. 5-47 seconds; liver cirrhosis The shortest delay time is about 47 seconds. (3) The application of the standardized CT portal imaging time window in the development of liver fibrosis and liver cirrhosis: In the course of experimental animal liver fibrosis and the development of liver cirrhosis, PVD (r = 0.613), SMVD (r = 0.424), and SVD (r = 0.272) gradually increase, in which the maximum value of SVD is the most (4) The correlation between the diameter of the portal vein system and the function of the liver reserve was observed (p <0.05). (4) The correlation between the diameter of the portal vein system and the function of the liver reserve was normalized (r =-0.419, 0.359, 0.35, spectively; all p0.05); PVD, SMVD and liver function (5) In the ROC curve of the diagnosis of hepatic fibrosis, only SVD had the diagnostic significance, the area under the curve was 0.883, the PVD and SVD were significant to the diagnosis of liver cirrhosis, the area under the ROC curve was 0.744 and 0.752, where the SVD curve Conclusion: The TTP of CT dynamic enhanced scan can be used to regulate the scanning time window of the portal vein of the CT, and to normalize the SVD of the portal vein to the diagnosis of the liver.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.5;R575.2

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