Albrecht T, Blomley M J, Cosgrove D O, Taylor-Robinson S D, Jayaram V, Eckersley R, Urbank A, Butler-Barnes J, Patel N
Department of Imaging, Hammersmith Hospital, Imperial College of Science, Technology, and Medicine, London, UK.
Lancet. 1999 May 8;353(9164):1579-83. doi: 10.1016/S0140-6736(98)06373-9.
Hepatic cirrhosis is accompanied by several haemodynamic changes including arterialisation of the liver, intrahepatic shunts, pulmonary arteriovenous shunts, and a hyperdynamic circulatory state. We postulated that the hepatic first pass of a bolus of an ultrasound contrast agent injected into a peripheral vein is accelerated in patients with cirrhosis. We investigated this first pass in patients with diffuse liver disease and in normal controls to assess whether it provides useful differential diagnostic information.
We enrolled 15 patients with biopsy-proven cirrhosis, 12 patients with biopsy-proven non-cirrhotic diffuse liver disease, and 11 normal controls. We carried out continuous spectral doppler ultrasonography of a hepatic vein from 20 s before to 3 min after a peripheral intravenous bolus injection of 2.5 g Levovist. The intensity of the doppler signal was measured and used to plot time-intensity curves.
Patients with cirrhosis showed a much earlier onset of enhancement (arrival time; mean 18.3 s) and peak enhancement (mean 55.5 s) than controls (49.8 s and 97.5 s) or patients with non-cirrhotic diffuse liver disease (35.8 s and 79.7 s). All patients with cirrhosis had an arrival time of the bolus of less than 24 s, whereas the arrival time was 24 s or more in 22 of the 23 other participants. Peak enhancement was higher in patients with cirrhosis (mean 48.7 units) than in the other two groups (12.5 and 12.3 units, respectively). We found highly significant differences between the patients with cirrhosis and each of the other two groups for all variables (p<0.005), whereas we found no significant differences between non-cirrhotic patients and controls.
Our preliminary study suggests that analysis of liver transit time of a bolus of ultrasound contrast agent provides useful information about haemodynamic changes in patients with cirrhosis. Measurement of the arrival time of the bolus allows discrimination of patients with cirrhosis from controls and from patients with non-cirrhotic diffuse liver disease, and has potential as a non-invasive test for cirrhosis.
肝硬化伴有多种血流动力学改变，包括肝脏动脉化、肝内分流、肺动静脉分流以及高动力循环状态。我们推测，向外周静脉注射一剂超声造影剂后，肝硬化患者肝脏的首过效应会加速。我们对弥漫性肝病患者和正常对照者的这种首过效应进行了研究，以评估其是否能提供有用的鉴别诊断信息。
我们纳入了15例经活检证实为肝硬化的患者、12例经活检证实为非肝硬化性弥漫性肝病的患者以及11名正常对照者。在外周静脉推注2.5 g 声诺维后，从推注前20秒至推注后3分钟对肝静脉进行连续频谱多普勒超声检查。测量多普勒信号强度并用于绘制时间-强度曲线。
肝硬化患者的增强起始时间（到达时间；平均18.3秒）和峰值增强时间（平均55.5秒）比对照组（49.8秒和97.5秒）或非肝硬化性弥漫性肝病患者（35.8秒和79.7秒）早得多。所有肝硬化患者造影剂团块的到达时间均小于24秒，而其他23名参与者中有22名的到达时间为24秒或更长。肝硬化患者的峰值增强（平均48.7单位）高于其他两组（分别为12.5和12.3单位）。我们发现，肝硬化患者与其他两组在所有变量上均存在高度显著差异（p<0.005），而非肝硬化患者与对照组之间无显著差异。
我们的初步研究表明，分析超声造影剂团块的肝脏通过时间可为肝硬化患者的血流动力学变化提供有用信息。测量造影剂团块的到达时间可将肝硬化患者与对照组以及非肝硬化性弥漫性肝病患者区分开来，并且有潜力作为肝硬化的一种非侵入性检查方法。
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