Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Eur J Radiol. 2021 May;138:109632. doi: 10.1016/j.ejrad.2021.109632. Epub 2021 Mar 6.
To quantitatively assess hypoattenuation volume ratio and hepatic parenchymal hypoattenuation on contrast enhanced computed tomography (CECT) in patients with pyrrolizidines alkaloids (PAs)-induced hepatic sinusoidal obstruction syndrome (HSOS), and evaluate the correlations of the CT-based quantitative values with clinical factors.
Thirty-five patients with PAs-induced HSOS who underwent CECT were retrospectively enrolled. The ratio of hypoattenuation volume to total liver volume, and changes in damaged area-to-normal liver density ratio (ΔDR) derived from histogram on portal venous phase were quantitatively measured. Heterogeneous hypoattenuation (CT score) scored by hypoattenuation volume ratio and ΔDR were calculated. The correlation between imaging findings and clinical factors was analyzed using Pearson correlation test.
Liver function tests were abnormal in most patients, the mean Hounsfield unit (HU) of damaged area (58.68 ± 17.3) was significantly lower (P < 0.001) than the corresponding normal liver (82.27 ± 23.97). Heterogeneous hypoattenuation were mild in 13 patients (37 %), moderate in 16 patients (46 %), and severe in 6 patients (17 %). ΔDR derived from histogram was positively correlated (weakly to moderately) with total bilirubin (r = 0.341, P = 0.045), direct bilirubin (r = 0.385, P = 0.022), and alkaline phosphatase (r = 0.491, P = 0.003), while such correlation was not observed in hypoattenuation volume ratio. The severity of heterogeneous hypoattenuation scored by hypoattenuation volume ratio and ΔDR was positively correlated (weakly) with prothrombin time (r = 0.357, P = 0.035), international normalized ratio (r = 0.363, P = 0.032), alkaline phosphatase (r = 0.359, P = 0.034), and model for end-stage liver disease (MELD) score (r = 0.347, P = 0.041).
Heterogeneous hypoattenuation scored by volume ratio and ΔDR on CECT provides a non-invasive approach in evaluating the severity of PAs-induced HSOS.
定量评估吡咯里西啶生物碱（PAs）诱导的肝窦阻塞综合征（HSOS）患者增强 CT（CECT）上的低衰减体积比和肝实质低衰减，并评估 CT 定量值与临床因素的相关性。
回顾性纳入 35 例 PAs 诱导的 HSOS 患者，对其进行 CECT 检查。定量测量门静脉期直方图上低衰减体积与总肝体积的比值（损伤面积与正常肝密度比的变化，即 ΔDR）。通过低衰减体积比和 ΔDR 计算不均匀低衰减（CT 评分）。采用 Pearson 相关检验分析影像学表现与临床因素的相关性。
大多数患者肝功能检查异常，损伤区的平均 CT 值（58.68±17.3）明显低于相应的正常肝区（82.27±23.97，P<0.001）。13 例（37%）患者存在轻度不均匀低衰减，16 例（46%）患者存在中度不均匀低衰减，6 例（17%）患者存在重度不均匀低衰减。直方图衍生的 ΔDR 与总胆红素（r=0.341，P=0.045）、直接胆红素（r=0.385，P=0.022）和碱性磷酸酶（r=0.491，P=0.003）呈正相关（弱到中度），但低衰减体积比无此相关性。低衰减体积比和 ΔDR 评分的不均匀低衰减严重程度与凝血酶原时间（r=0.357，P=0.035）、国际标准化比值（r=0.363，P=0.032）、碱性磷酸酶（r=0.359，P=0.034）和终末期肝病模型评分（r=0.347，P=0.041）呈正相关（弱）。
CECT 上的体积比和 ΔDR 评分不均一性低衰减为评估 PAs 诱导的 HSOS 严重程度提供了一种非侵入性方法。
