能谱CT对胆汁淤积性肝硬化患儿肝移植术前肝脏血流动力学的评估

目的：探讨应用能谱CT对胆汁淤积性肝硬化患儿肝移植术前肝血流动力学评估的价值。方法：回顾性选取60例肝移植术前行CT检查的胆道闭锁致胆汁淤积性肝硬化患儿。肝功能Child-Pugh分级为：A级28例，B级20例，C级12例。增强CT扫描采用能谱GSI模式。选取动脉期及门脉期的碘（水）基图像，分别在肝S2、S4、S7和S8四个肝段内设立一类圆形ROI（面积约60~80 mm²），并避开大血管测量碘基值，动脉期、门脉期的ROI保持一致；分别取其平均值作为动脉期、门脉期肝实质的碘含量（I_A，I_P），并计算出肝动脉碘分数（AIF），AIF=I_A，I_P。对不同Child-Pugh分级胆汁淤积性肝硬化患者的I_A，I_P及AIF行单因素方差分析，以P<0.05为差异有统计学意义。结果：不同Child-Pugh分级的I_A，I_P及AIF分别为肝功能A级：（4.34±2.0）100μg/cm³，（12.68±2.8）100μg/cm³及0.34±0.12；肝功能B级：（5.65±2.8）100μg/cm³，（14.49±3.8）100μg/cm³及0.38±0.13；肝功能C级：（7.09±2.6）100μg/cm³，（13.89±3.5）100μg/cm³及0.51±0.14。单因素方差分析结果显示，不同Child-Pugh分级组间的I_A及AIF的总体差异均具有统计学意义（P<0.05），不同Child-Pugh组间的I_P总体差异均不具有统计学意义（P>0.05）。两两比较结果显示，A级与C级的I_A有显著性差异（P=0.004）；A级与C级、B级与C级的AIF差异具有统计学意义（P_A&C=0.001，P_B&C=0.015），其中以Child-Pugh C级组患者的AIF最大，Child-Pugh B级组次之，而Child-Pugh A级组最低。结论：能谱CT扫描获得的AIF，可以作为一个定量评价胆道闭锁致胆汁淤积性肝硬化患儿血流动力学状况的指标。

Assessing Liver Hemodynamics in Children with Cholestatic Cirrhosis before Liver Transplantation with Dual Energy Spectral CT

Objective: To evaluate the value of dual-energy spectral CT in assessing the hemodynamics in children with cholestatic cirrhosis before liver transplant. Methods: 60 children with cholestatic cirrhosis were selected retrospectively. There were 28 Child-Pugh grades A, 20 Child-Pugh grade B, and 12 Child-Pugh grade C cases based on the Child-Pugh classification criteria of liver function. Enhanced CT scan was performed using the gemstone spectral imaging (GSI) mode. The iodine concentrations for the hepatic parenchyma in the arterial phase (I_A) and portal vein phase (I_P) were measured using the iodine-based MD images with Region of interest (ROI) setting in the same location and size. The hepatic artery iodine fraction (AIF) was calculated as:AIF=iodine content (arterial phase)/iodine content (portal venous phase). The I_A, I_P and AIF of children of different Child-Pugh grades with cholestatic cirrhosis were analyzed by one-way ANOVA. Result: The I_A, I_P (100 μg/cm3) and AIF of different Child-Pugh Grades were as follows:Child-Pugh A:(4.34±2.0) 100 μg/cm3, (12.68±2.8) 100 μg/cm3 and 0.34±0.12; Child-Pugh B:(5.65±2.8) 100 μg/cm3, (14.49±3.8) 100 μg/cm3 and 0.38±0.13; Child-Pugh C:(7.09±2.6) 100 μg/cm3, (13.89±3.5) 100 μg/cm3 and 0.51±0.14. The one-way ANOVA showed that the overall difference of I_A and AIF between different Child-Pugh groups was statistically significant (P<0.05), and there was no statistically significant difference in I_P among different Child-Pugh groups (P>0.05). The multiple comparisons results indicated that I_A between grade A and grade C was significantly different. (P=0.004). AIF values were significantly different between Grade A and grade C (P=0.001), grade B and grade C (P=0.015), among which the AIF value of grade C is higher than that of grade B, and the AIF of grade A is the lowest. Conclusion: the AIF obtained by the dual energy spectral CT can be used as an indicator to evaluate the liver hemodynamics of children with cholestatic cirrhosis quantitatively.