慢性丙型肝炎病毒感染中的肝纤维化：用灌注 CT 区分最小纤维化和中间纤维化。

Liver fibrosis in chronic hepatitis C virus infection: differentiating minimal from intermediate fibrosis with perfusion CT.

机构信息

Unit for Training and Research in Medicine, Université Paris 7 Denis Diderot, Paris, France.

出版信息

Radiology. 2010 Jul;256(1):135-42. doi: 10.1148/radiol.10091295.

DOI:10.1148/radiol.10091295

PMID:20574090

Abstract

PURPOSE

To prospectively assess the utility of perfusion computed tomography (CT) for differentiating minimal from intermediate fibrosis in treatment-naïve patients with chronic hepatitis C virus (HCV) infection.

MATERIALS AND METHODS

This study was approved by the Institutional Review Board, and informed consent was obtained. Fifty-two patients with treatment-naïve HCV infection underwent perfusion CT and percutaneous liver biopsy on the same day. Portal vein, arterial, and total liver perfusion; mean transit time; and distribution volumes for the right and left liver lobes were measured. Liver samples were scored for fibrosis, and fibrosis area was determined. Differences in quantitative perfusion parameters between patients with minimal fibrosis (score of F1) and those with intermediate fibrosis (score of F2 or F3) were tested.

RESULTS

In patients with intermediate fibrosis (F2 and F3) compared with those with minimal fibrosis (F1), the portal venous perfusion (87 mL min(-1) 100 mL(-1) +/- 27 [standard deviation] vs 138 mL min(-1) 100 mL(-1) +/- 112, P = .042) and total liver perfusion (107 mL min(-1) 100 mL(-1) +/- 31 vs 169 mL min(-1) 100 mL(-1) +/- 137, P = .02) were significantly decreased, and the mean transit time was significantly increased (16 seconds +/- 4 vs 13 seconds +/- 5, P = .025). At multivariate analysis, only the mean transit time was an independent factor (odds ratio, 1.18; 95% confidence interval: 1.02, 1.37; P = .030). Receiver operating characteristic curve analysis showed that a mean transit time threshold of 13.4 seconds allowed discrimination between minimal and intermediate fibrosis with a sensitivity of 71% and a specificity of 65%.

CONCLUSION

The results of this study show that perfusion changes occur early during fibrosis in chronic HCV infection and can be detected with perfusion CT. Perfusion CT may help to discriminate minimal from intermediate fibrosis. Mean transit time appears to be the most promising perfusion parameter for differentiating between fibrosis stages, although the large amount of overlap in the measured parameters limits the clinical utility of this test at present.

摘要

目的

前瞻性评估灌注 CT 在诊断慢性丙型肝炎病毒（HCV）感染初治患者的轻微与中重度纤维化中的作用。

材料与方法

本研究经机构审查委员会批准，并获得了患者的知情同意。52 例初治 HCV 感染患者在同一天接受了灌注 CT 和经皮肝活检。测量门静脉、肝动脉和全肝灌注、平均通过时间（MTT）、左右肝叶分布容积。肝组织标本进行纤维化评分，并确定纤维化面积。检测纤维化轻微（F1 评分）和中重度（F2 或 F3 评分）患者之间定量灌注参数的差异。

结果

与纤维化轻微（F1）患者相比，中重度纤维化（F2 和 F3）患者的门静脉灌注（87 mL min(-1) 100 mL(-1) +/- 27 [标准差] vs 138 mL min(-1) 100 mL(-1) +/- 112，P =.042）和全肝灌注（107 mL min(-1) 100 mL(-1) +/- 31 vs 169 mL min(-1) 100 mL(-1) +/- 137，P =.02）显著降低，MTT 显著增加（16 秒 +/- 4 vs 13 秒 +/- 5，P =.025）。多因素分析显示，只有 MTT 是独立的影响因素（比值比，1.18；95%置信区间：1.02，1.37；P =.030）。ROC 曲线分析显示，MTT 阈值为 13.4 秒时，可诊断轻微与中重度纤维化，其敏感度为 71%，特异度为 65%。