Howard J M, Ghent C N, Carey L S, Flanagan P R, Valberg L S
Gastroenterology. 1983 Feb;84(2):209-15.
To determine whether or not hepatic computed tomography density is an alternative to liver biopsy for the diagnosis of body iron overload, hepatic computed tomography density was determined in healthy controls, patients with idiopathic hemochromatosis, and patients with liver disease. Hepatic computed tomography density was obtained from a single computed tomography slice taken through the liver on a General Electric CT/T 8800 scanner. In 69 controls, hepatic computed tomography density ranged from 11 to 36 units (mean = 30). Given an upper limit of normal of 36 computed tomography units, 4 of 6 untreated patients with idiopathic hemochromatosis had elevated hepatic computed tomography density compared with 0 of 8 patients after venesection (X2 = 7.5, p = 0.01). Hepatic computed tomography density correlated directly with serum ferritin (r = 0.72, p = 0.01). In 58 consecutive patients with clinical or biochemical evidence, or both, of liver disease who underwent liver biopsy for diagnostic purposes, 0 of 52 patients with normal hepatic iron had an elevated hepatic computed tomography density as compared with 4 of 6 patients with excess iron (X2 = 35, p less than 0.001). An elevated hepatic computed tomography density associated with an elevated serum ferritin indicates iron overload; however, a normal hepatic computed tomography density does not exclude iron overload. When computerized tomography is applied to patients with an unexplained elevation of the serum ferritin, it provides a noninvasive alternative to liver biopsy for the detection of excess hepatocellular iron.
为了确定肝脏计算机断层扫描密度是否可替代肝活检用于诊断体内铁过载，我们测定了健康对照者、特发性血色素沉着症患者和肝病患者的肝脏计算机断层扫描密度。肝脏计算机断层扫描密度是在一台通用电气CT/T 8800扫描仪上通过肝脏的单个计算机断层扫描切片获得的。在69名对照者中，肝脏计算机断层扫描密度范围为11至36单位（平均 = 30）。鉴于计算机断层扫描单位正常上限为36，6名未经治疗的特发性血色素沉着症患者中有4名肝脏计算机断层扫描密度升高，而放血治疗后的8名患者中无一例升高（X2 = 7.5，p = 0.01）。肝脏计算机断层扫描密度与血清铁蛋白直接相关（r = 0.72，p = 0.01）。在58名因诊断目的接受肝活检的有临床或生化证据或两者皆有的连续肝病患者中，52名肝铁正常的患者中无一例肝脏计算机断层扫描密度升高，而6名铁过量的患者中有4例升高（X2 = 35，p < 0.001）。肝脏计算机断层扫描密度升高且血清铁蛋白升高表明存在铁过载；然而，肝脏计算机断层扫描密度正常并不能排除铁过载。当计算机断层扫描应用于血清铁蛋白不明原因升高的患者时，它为检测肝细胞铁过量提供了一种非侵入性的替代肝活检的方法。
