Gauthier Thomas P, Wasan Harpreet S, Muhammad Aun, Owen David R, Leen Edward L S
Imperial College London, London, England; Philips Healthcare, Bothell, Washington, USA.
J Ultrasound Med. 2011 Mar;30(3):379-85. doi: 10.7863/jum.2011.30.3.379.
This study assessed the potential of quantitative analysis of contrast bolus kinetics to reflect global liver blood flow.
A dynamic contrast-enhanced ultrasound flow phantom was developed. A peristaltic pump established constant volume flow ranging between 16.5 and 49.5 mL/min (2-mm tube) and 85.5 and 256.5 mL/min (5-mm tube). After bolus injection of 2 doses of a contrast agent, a region of interest was drawn over the cross section of the tube used for a particular acquisition; the rise time, peak intensity, and wash-in slope were derived from time-intensity curves. Twenty healthy volunteers and 25 patients with biopsy-proven colorectal liver metastases were scanned with dynamic contrast-enhanced ultrasound. The rise time, peak intensity, and wash-in slope were derived from hepatic artery and portal vein time-intensity curves. Hepatic artery/portal vein ratios of the parameters were also calculated.
In the in vitro experiment, the rise time decreased while the peak intensity and wash-in slope increased with increasing volume flow for both tube diameters and contrast bolus volumes. In the clinical study, the rise time was lowered in the hepatic artery but elevated in the portal vein, and the peak intensity and wash-in slope were elevated in the hepatic artery but lowered in the portal vein in patients with colorectal liver metastases compared with healthy volunteers, although not in a statistically significant manner. This finding was consistent with an increase in hepatic artery blood flow, a decrease in portal vein blood flow, or both in patients with colorectal liver metastases compared with healthy volunteers. Only the 3 hepatic artery/portal vein ratios of the parameters achieved statistical significance in differentiating healthy volunteers from patients with colorectal liver metastases (P < .05).
Surrogate measurements of liver blood flow may be derived from quantitative analysis of dynamic contrast-enhanced ultrasound studies. They may have potential for quick and easy assessment of altered hepatic hemodynamics.
本研究评估了对比剂团注动力学定量分析反映全肝血流的潜力。
研制了一种动态对比增强超声血流模型。蠕动泵建立了16.5至49.5 mL/分钟（2毫米管径）和85.5至256.5 mL/分钟（5毫米管径）的恒定体积流量。在团注2剂对比剂后，在用于特定采集的管的横截面上绘制感兴趣区域；上升时间、峰值强度和流入斜率由时间-强度曲线得出。对20名健康志愿者和25名经活检证实为结直肠癌肝转移的患者进行了动态对比增强超声扫描。上升时间、峰值强度和流入斜率由肝动脉和门静脉时间-强度曲线得出。还计算了这些参数的肝动脉/门静脉比值。
在体外实验中，对于两种管径和对比剂团注体积，随着体积流量增加，上升时间缩短，而峰值强度和流入斜率增加。在临床研究中，与健康志愿者相比，结直肠癌肝转移患者肝动脉上升时间降低，门静脉上升时间升高，肝动脉峰值强度和流入斜率升高，门静脉峰值强度和流入斜率降低，尽管差异无统计学意义。这一发现与结直肠癌肝转移患者与健康志愿者相比肝动脉血流增加、门静脉血流减少或两者兼而有之相符。只有这3个参数的肝动脉/门静脉比值在区分健康志愿者和结直肠癌肝转移患者方面具有统计学意义（P < .05）。
肝血流的替代测量可从动态对比增强超声研究的定量分析中得出。它们可能具有快速、简便评估肝脏血流动力学改变的潜力。
