Tsushima Y, Blomley J K, Kusano S, Endo K
Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan.
Dig Dis Sci. 1999 Aug;44(8):1632-8. doi: 10.1023/a:1026679430553.
CT can measure absolute hepatic arterial and portal venous perfusion; pilot data suggests these are raised and lowered, respectively, in cirrhosis. This study examined the value of functional CT in assessing cirrhosis, using the prothrombin ratio (PTR) as a marker for hepatic parenchymal damage. Twenty subjects with viral-induced cirrhosis (11 men and 9 women; 55.41 +/- 7.86 years) and 14 controls (8 men and 6 women; 48.36 +/- 17.67 years) were studied. A single section through the liver was scanned after bolus intravenous injection of 40 ml ioversol 320 mgI/ml. Hepatic arterial and portal perfusion was measured using a previously described technique. Hepatic portal perfusion was decreased in patients (0.66 +/- 0.21 ml/min/ml) compared with controls (1.11 +/- 0.23 ml/min/ml; P < 0.0001). A strong correlation was seen between PTR and portal perfusion (r = 0.662, P = 0.0038) in cirrhotics. Hepatic arterial perfusion did not differ between patients (0.088 +/- 0.082 ml/min/ml) and controls (0.091 +/- 0.067), and did not correlate with PTR. In conclusion, portal perfusion is reduced in cirrhosis, and this reduction correlates with PTR. It could thus be used as a marker of hepatic parenchymal damage. This technique may be useful in the follow-up of chronic liver disease, potentially reducing the need for serial liver biopsy.
CT能够测量肝动脉和门静脉的绝对灌注量;初步数据表明,在肝硬化患者中,这两个指标分别升高和降低。本研究以凝血酶原比率(PTR)作为肝实质损伤的标志物,探讨功能性CT在评估肝硬化中的价值。研究对象包括20例病毒感染所致肝硬化患者(11例男性,9例女性;年龄55.41±7.86岁)和14例对照者(8例男性,6例女性;年龄48.36±17.67岁)。经静脉快速推注40 ml 320 mgI/ml的碘海醇后,对肝脏进行单层面扫描。采用先前描述的技术测量肝动脉灌注和门静脉灌注。与对照者(1.11±0.23 ml/min/ml)相比,肝硬化患者的门静脉灌注降低(0.66±0.21 ml/min/ml;P<0.0001)。肝硬化患者的PTR与门静脉灌注之间存在强相关性(r = 0.662,P = 0.0038)。肝硬化患者(0.088±0.082 ml/min/ml)与对照者(0.091±0.067)的肝动脉灌注无差异,且与PTR无相关性。总之,肝硬化患者的门静脉灌注降低,且这种降低与PTR相关。因此,门静脉灌注可作为肝实质损伤的标志物。该技术可能有助于慢性肝病的随访,有可能减少重复肝脏活检的必要性。