Clinical Study Of 64-slice Spiral CT Perfusion Imaging For Hepatic Fibrosis

ObjectiveThe purpose of this study is to dynamically observe the changes of perfusion parameters by scanning patients of hepatic fibrosis at different pathologic stage with 64-slice spiral CT,and analyze its hemodynamic changes and pathological foundation compared with normal control group and the corresponding pathologic changes.At the same time,the correlation analysis between perfusion parameters and serum index was made.This study aimed to investigate the law of CT hepatic perfusion parameters changes and the value of CT perfusion imaging in diagnosis of hepatic fibrosis in patients,and the prospect of its clinical application is discussed.Materials and Methods1.68 patients(all cases were chronic hepatitis B),with an average age of 42 years old(ranging from 19 to 65 years old,male 48,female 20)were included in our research. The final diagnosis of all cases was confirmed by puncture biopsy and met the programme of prevention and cure for viral hepatitis,four hepatic fibrosis groups were formed accordingly,group1:stage S1,16 cases;group2:stage S2,17cases;group3: stage S3,17 cases and group 4:stage S4,18 cases.20 volunteers without hepatic disorder(confirmed by clinical history,physical examination and laboratory,Ultrasound examination that there is no liver,kidney,spleen disease)were chosen as normal control group and all cases with an average age of 45.4 years old(ranging from 22 to 63 years old,male 15,female 5).2.64-slice spiral CT perfusion scan was performed in eighty-eight patients.First, after plain CT scanning of the whole liver,multi-slice through the hepatic hilar lever at the center was repeatedly scanned for 55s after 5 seconds of intravenous bolus injection of 50 ml nonionic contrast medium(400 mgI/ml)at a rate of 5 ml/sec.Second,liver perfusion parameters such as Arterial liver perfusion(ALP),Portal venous perfusion (PVP),Hepatic perfusion index(HPI),Blood flow(BF),Blood volume(BV)and Permeability(P)were calculated respectively.According to the perfusion parameters, the state of liver blood flow in different periods of hepatic fibrosis was evaluated. Statistical analysis was performed by SPSS 11.5 statistical software.P＜0.05 was considered statistically significant.3.Serum index of liver fibrosis included Hyaluronic Acid(HA),Laminin(LN), procollagen typeⅢpropetide(pⅢp)and typeⅣcollagen(ⅣC).Their correlation with the CT hepatic perfusion parameters in different stages of liver fibrosis was analyzed.Results1.CT perfusion parameters change in hepatic fibrosis group.Compared with the control group,the values of ALP and HPI in hepatic fibrosis group increased markedly, but the values of PVP,BF and BV decreased.Apart from ALP and P,the difference of the values between two groups was statistically significant.2.CT perfusion parameters change in different hepatic fibrosis groups.With the different fibrosis degrees,the difference of HPI,PVP,BF and BV among the groups was statistically significant,but ALP and P didn't have change.The values of PVP,BF and BV in hepatic fibrosis groups were lower than those of the control group,and with the progress of hepatic fibrosis,they trended to decrease.The difference of PVP,BF and BV between stage S3,S4 and control group,stage S1 was statistically significant,and the difference of the values between stage S2 and control group was also significant. However,the values of HPI increased compared to the control group(P＜0.05),and with the different fibrosis degrees,it increased gradually.The difference of HPI between stage S3,S4 and control group,stage S1 was significant(P＜0.05).Although the difference of ALP among the different hepatic fibrosis groups was not statistically significant,the increasing can still be seen.The values of P between each groups showed no significant difference(P＞0.05).3.The correlation of CT hepatic perfusion parameters with Serum index of liver fibrosis.PVP,BF and BV were inverse correlation with LN,IVC and HA,while HPI was direct correlation with LN,IVC and HA. Conclusion1.Hepatic perfusion imaging with 64-slice spiral CT can reflect hemodynamic change in certain hepatic fibrosis stage,and CT perfusion parameters in hepatic fibrosis, such as Arterial liver perfusion(ALP),Portal venous perfusion(PVP),Hepatic perfusion index(HPI),Blood flow(BF),Blood volume(BV)and Permeability(P) could be quantified.2.Hepatic perfusion parameters measured with 64-slice spiral CT were significantly altered in hepatic fibrosis and correlated with the severity of liver fibrosis.With the progress of hepatic fibrosis,the values of PVP,BF and BV trended to decrease,however, HPI increased gradually with the different fibrosis degrees.3.CT perfusion imaging is a non-invasive method evaluating the state of hepatic blood perfusion of the tissues and organs in living organisms,which can reflect the hemodynamic changes of tissues and organs in the good Anatomy background,and it could provide reliable evidence for the early detection of hepatic fibrosis in different pathologic stage,follow-up patients and assessing the effect of anti-fibrosis,which is important in clinical practice.4.There is a certain correlation of CT hepatic perfusion parameters with Serum index of liver fibrosis.Perfusion parameters can reflect the deposition of collogen and the changes of microcirculation in liver,and both can be combined together to evaluate the blood perfusion state of hepatic fibrosis stage.