用磁共振成像和多普勒超声测量的肝血流参数：与肝硬化程度和门静脉高压的相关性。

Hepatic flow parameters measured with MR imaging and Doppler US: correlations with degree of cirrhosis and portal hypertension.

作者信息

Annet Laurence, Materne Roland, Danse Etienne, Jamart Jacques, Horsmans Yves, Van Beers Bernard E

机构信息

Department of Radiology, Université Catholique de Louvain, St-Luc University Hospital, Avenue Hippocrate 10, B-1200 Brussels, Belgium.

出版信息

Radiology. 2003 Nov;229(2):409-14. doi: 10.1148/radiol.2292021128. Epub 2003 Sep 11.

DOI:10.1148/radiol.2292021128

PMID:12970464

Abstract

PURPOSE

To determine the correlations between hemodynamic parameters of hepatic flow measured with magnetic resonance (MR) imaging and Doppler ultrasonography (US) and the severity of cirrhosis and portal hypertension.

MATERIALS AND METHODS

Forty-six patients referred for measurements of portal venous pressure (three with normal liver, 12 with chronic hepatitis, and 31 with cirrhosis [10 with Child-Pugh class A cirrhosis; 13 with class B cirrhosis; and eight with class C cirrhosis]) were included in the study. Apparent liver perfusion, apparent arterial and portal perfusion, portal fraction, distribution volume, and mean transit time were measured with dynamic contrast material-enhanced MR imaging. Portal velocity, portal flow, congestion index, right hepatic artery resistance index, and modified hepatic index were measured with Doppler US. Results in patients with cirrhosis and those without cirrhosis were compared with the Wilcoxon rank sum test. Correlations were assessed with Spearman rank correlation coefficients.

RESULTS

With MR imaging, all flow parameters except distribution volume were significantly different between patients with and those without cirrhosis (P <.05). There was a significant correlation between all flow parameters measured with MR imaging and portal pressure (P <.02). Apparent arterial (P =.024) and portal (P <.001) perfusion, portal fraction (P <.001), and mean transit time (P =.004) were correlated with Child-Pugh class. Flow parameters measured with Doppler US did not differ significantly between patients with and those without cirrhosis. Only right hepatic arterial resistance (P <.007) and portal flow (P <.043) were weakly (r < 0.7) correlated with portal pressure. No Doppler US parameter was correlated with Child-Pugh class.

CONCLUSION

Hepatic flow parameters measured with MR imaging correlate with the severity of cirrhosis and portal hypertension. Doppler US parameters are only weakly correlated with portal pressure.

摘要

目的

确定通过磁共振（MR）成像和多普勒超声（US）测量的肝血流动力学参数与肝硬化和门静脉高压严重程度之间的相关性。

材料与方法

本研究纳入了46例因测量门静脉压力而转诊的患者（3例肝脏正常，12例慢性肝炎，31例肝硬化[10例Child-Pugh A级肝硬化；13例B级肝硬化；8例C级肝硬化]）。通过动态对比剂增强MR成像测量肝脏表观灌注、表观动脉灌注和门静脉灌注、门静脉分数、分布容积和平均通过时间。通过多普勒US测量门静脉速度、门静脉血流、充血指数、肝右动脉阻力指数和改良肝指数。使用Wilcoxon秩和检验比较肝硬化患者和非肝硬化患者的结果。使用Spearman秩相关系数评估相关性。

结果

通过MR成像，除分布容积外，所有血流参数在肝硬化患者和非肝硬化患者之间均有显著差异（P<.05）。通过MR成像测量的所有血流参数与门静脉压力之间存在显著相关性（P<.02）。表观动脉灌注（P=.024）和门静脉灌注（P<.001）、门静脉分数（P<.001）和平均通过时间（P=.004）与Child-Pugh分级相关。通过多普勒US测量的血流参数在肝硬化患者和非肝硬化患者之间无显著差异。仅肝右动脉阻力（P<.007）和门静脉血流（P<.043）与门静脉压力呈弱相关性（r<0.7）。没有多普勒US参数与Child-Pugh分级相关。