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肝硬化伴或不伴肝细胞癌患者的肝体积测量:与 Child-Pugh、终末期肝病模型和吲哚菁绿染料试验的相关性。

Liver volumetry in cirrhotic patients with or without hepatocellular carcinoma: Its correlation with Child-Pugh, model for end-stage liver diseases and indocyanine green dye test.

机构信息

Department of Interventional Radiology, Institute of Liver and Biliary Sciences, D-1 Vasant Kunj, New Delhi, 110 070, India.

Department of Radiodiagnosis, All India Institute of Medical Sciences, Patrapada, Bhubaneswar, 751 019, India.

出版信息

Indian J Gastroenterol. 2024 Aug;43(4):760-767. doi: 10.1007/s12664-023-01490-1. Epub 2024 Feb 13.

Abstract

BACKGROUND AND OBJECTIVES

To evaluate the correlation between non-tumoral liver volume (NTLV) by computed tomography (CT) volumetry and indocyanine green retention at 15 minutes (ICG-r15%), Child-Pugh score (CTP) and model for end-stage liver diseases (MELD) score in cirrhotic patients having hepatocellular carcinoma (HCC) (group A) and in cirrhotics without HCC (group B).

METHODS

As many as 111 consecutive patients with liver cirrhosis, who underwent triple-phase CT abdomen, were retrospectively included in our study. They were classified into group A (cirrhosis with HCC, n = 69) and group B (cirrhosis only, n = 42). Segmental liver volume, tumor and NTLV were calculated using Myrian XP-Liver segmentation software. In group B, NTLV was the same as the total liver volume (TLV). The correlation of NTLV with ICG-r15%, CTP and MELD scores was analyzed using appropriate correlation tests for each group.

RESULTS

NTLV had a good and significant negative correlation with ICG-r15% (ρ =  - 512; p < 0.001) in group A, but not in group B. It also had a significant negative correlation with CTP (ρ =  - 251; p = 0.038) and MELD (ρ =  - 323; p = 0.007) scores only in group A. Furthermore, ICG-r15% had a good and significant positive correlation with CTP and MELD scores in both groups (p < 0.05).

CONCLUSION

NTLV showed a significant negative correlation with ICG-r15% in cirrhotic patients with HCC, but not in cirrhotic patients without HCC. Therefore, CT volumetry can be a valuable tool to predict the functional hepatic volume in patients of cirrhosis with HCC subjected for hepatectomy, where a facility of ICG-r15% is not available. However, further studies are needed to validate our findings in cirrhotic only patients.

摘要

背景与目的

通过计算体层摄影术(CT)容积测量非肿瘤性肝体积(NTLV),评估其与 15 分钟吲哚菁绿保留率(ICG-r15%)、Child-Pugh 评分(CTP)和终末期肝病模型(MELD)评分在患有肝细胞癌(HCC)的肝硬化患者(A 组)和无 HCC 的肝硬化患者(B 组)中的相关性。

方法

回顾性纳入 111 例接受腹部三期 CT 检查的连续肝硬化患者。他们被分为 A 组(伴 HCC 的肝硬化,n=69)和 B 组(单纯肝硬化,n=42)。使用 Myrian XP-Liver 分段软件计算肝段体积、肿瘤和 NTLV。在 B 组中,NTLV 与总肝体积(TLV)相同。使用适当的相关性检验分析 NTLV 与 ICG-r15%、CTP 和 MELD 评分的相关性。

结果

在 A 组中,NTLV 与 ICG-r15%呈良好且显著的负相关(ρ= -512;p<0.001),但在 B 组中则不然。它与 CTP(ρ= -251;p=0.038)和 MELD(ρ= -323;p=0.007)评分也有显著的负相关,仅在 A 组中。此外,ICG-r15%与两组的 CTP 和 MELD 评分均呈良好且显著的正相关(p<0.05)。

结论

在患有 HCC 的肝硬化患者中,NTLV 与 ICG-r15%呈显著负相关,但在无 HCC 的肝硬化患者中则不然。因此,CT 容积测量可能是预测 HCC 行肝切除术的肝硬化患者功能性肝体积的有价值工具,在没有 ICG-r15%的情况下可以使用。然而,需要进一步的研究来验证我们在单纯肝硬化患者中的发现。

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