Clinical Study Of 256 Slice CT Perfusion Imaging Before And After TIPS

Objectives:To evaluate the value of TIPS by analyzing the hepatic perfusion changes during the normal liver,cirrhosis before and after transjugular intrahepatic portosystermic stent shunt.Materials and Methods:256-slice CT perfusion scan of the whole liver and image post-processing were obtained in 93 individuals who included 25 control subjects,48 patients with liver cirrhosis,and 20 patients before and after transjugular intrahepatic portosystermic stent shunt. At the bottom level of the porta hepatis (TIPS stent lower),the TDCs of regions of interest (ROIs) were drawn in the aorta,the portal vein,the liver and spleen.The time-density curves,time to peak (TTP) and peak value (PV) of all ROIs were recorded.The other level selected can display the left lateral lobe and left inernal lobe of liver, the right anterior lobe and right posterior lobe of liver. Four lobe of the liver perfusion parameters including the hepatic arterial perfusion(HAP), hepatic portal perfusion(PVP), total liver perfusion(TLP), hepaticarterial perfusion index(HPI) were calculated. Each lobe of the liver was measured 3 times. Averages of the hepatic perfusion parameters of four lobe were the whole liver perfusion parameters. Then, the TDC shape, TTP, PV and hepatic perfusion parameters in the control subjects and the cirrhosis group, before and after TIPS were compared.Results:1. Compared with the control subjects, the TDC changes of cirrhosis group of all ROIs:a,TDC of abdominal aorta was same as control subjects showed a sudden jump and drop.But the TTP in advance and PV decreased were satistically significant, b,The portal TDC of baseline segment extended, ascending and descending segment were more moderate than control subjects, amplitude widened. TTP delayed and PV decreased were satistically significant. c,Increased rate of liver TDC was slower than the control subjects. TTP delayed and PV decreased significantly were satistically significant. d,TDC of spleen was different from control subjects.It has 3 types. TTP delayed and PV decreased were satistically significant.2.Compared with the before TIPS group, the TDC changes of the after TIPS group of all ROIs:a,TDC of abdominal aorta was same as the before TIPS group showed a sudden jump and drop. PV decreased was satistically significant.b,The portal TDC of baseline segment was shortening. Ascending segment was steeper than the before TIPS group. TTP earlier and PV increased were satistically significant. c,Increased rate of liver TDC was faster than the beforeTIPS group. TTP in advance was satistically significant. d,TDC of spleen has changed.It only showed ascending segment fast and descending segment slow different from the before TIPS group. TTP in advance was satistically significant.3. Compared with the control subjects, hepatic perfusion parameters changes of cirrhosis group:HAP rise was no satistically significant.;HPI rise, PVPand TLP decreased were satistically significant.4. Compared with the before TIPS group,hepatic perfusion parameters changes of the after TIPS group:HAP and HPI increased were satistically significant. PVP and TLP dropped were no satistically significant.Conclusion:The 256-slice CT hepatic perfusion imaging can accurately reflect hemodynamic changes of the normal liver,cirrhosis before and after transjugular intrahepatic portosystermic stent shunt.Hepatic perfusion parameters changes:after cirrhosis,HAP unchanged, PVP and TLP decreased; after TIPS,HAP increased, PVP and TLP unchanged. TDC changes:after cirrhosis, the liver, spleen and portal vein of TTP delayed,them of PV decreased; after TIPS, the liver, spleen and portal vein of TTP in advance, portal vein of PV increased. In addition, according to the severity degree of cirrhosis,TDC graph of spleen has 3 types; after TIPS, TDC graph of spleen has only 1 types similar to the control subjects, which indicatied that the degree of splenic congestion was ease after TIPS.It can be seen, portal pressure and splenic congestion increased after cirrhosis whlie hepatic portal perfusion and total liver perfusion decreased. The portal pressure reduced and splenic congestion ease after TIPS whlie hepatic portal perfusion and total liver perfusion unchanged. Therefore, TIPS is a effective way to treat portal hypertension with hypersplenism.