Barbaro B, Manfredi R, Bombardieri G, Vecchio F M, Palazzoni G, Mancini A P, Dall'Argine S, Marano P
Department of Radiology, Università Cattolica del Sacro Cuore, Policlinico "A. Gemelli," Largo A. Gemelli 8, 00168 Rome, Italy.
J Clin Ultrasound. 2000 Nov-Dec;28(9):461-8. doi: 10.1002/1097-0096(200011/12)28:9<461::aid-jcu3>3.0.co;2-5.
The purpose of this study was to correlate portal hemodynamics on sonography and liver volume on MRI with histologic findings in asymptomatic patients with chronic hepatitis C.
Portal blood flow in the left and right portal branches in 20 healthy volunteers and in 26 patients was measured using Doppler sonography during both fasting and postprandial states. Total liver and right-and left-lobe volumes were determined using MRI. The ratio between portal blood flow and liver volume determined the "portal flow index" of the right and left lobes.
We observed a statistically significant difference (p < 0.01) between the volunteers and patients in the mean left-lobe volume (352 +/- 81 cm(3) versus 544 +/- 159 cm(3)) and in the mean left portal flow index (1.1 +/- 0.2 ml/minute/cm(3) versus 0.69 +/- 0.2 ml/minute/cm(3)) as measured before the subjects ate. After a meal, the portal blood-flow volume in the right lobe was similar in the 2 groups but in the left lobe was significantly lower in the patients (p = 0.0009). The left postprandial portal flow index was inversely correlated with the grade of liver fibrosis (r = 0.533).
The left-lobe volume (positive predictive value, 83%; negative predictive value, 72%) and left postprandial portal flow index (positive predictive value, 86%; negative predictive value, 88%) are sensitive indicators of chronic hepatitis. The left postprandial portal flow index may be a useful test for differentiating patients with minimal or no fibrosis from patients with mild to severe fibrosis.
本研究旨在将无症状慢性丙型肝炎患者的超声门静脉血流动力学和MRI肝脏体积与组织学结果进行关联。
使用多普勒超声在空腹和餐后状态下测量20名健康志愿者和26名患者的左右门静脉分支的门静脉血流。使用MRI测定全肝以及左右叶的体积。门静脉血流与肝脏体积的比值确定左右叶的“门静脉血流指数”。
我们观察到，在受试者进食前测量时，志愿者和患者的平均左叶体积（352±81 cm³对544±159 cm³）和平均左门静脉血流指数（1.1±0.2 ml/分钟/cm³对0.69±0.2 ml/分钟/cm³）存在统计学显著差异（p<0.01）。进食后，两组右叶的门静脉血流量相似，但患者左叶的门静脉血流量显著降低（p = 0.0009）。餐后左门静脉血流指数与肝纤维化分级呈负相关（r = 0.533）。
左叶体积（阳性预测值83%；阴性预测值72%）和餐后左门静脉血流指数（阳性预测值86%；阴性预测值88%）是慢性肝炎的敏感指标。餐后左门静脉血流指数可能是区分极少或无纤维化患者与轻度至重度纤维化患者的有用检测方法。
