| Objective.To investigate the rule of size and density changes of liver and spleen,the characteristics of CT signs of portal hypertension and the rule of hepatic haemodynamic changes at different histopathologic stage of liver fibrosis by measuring the size and density of liver and spleen,vascular caliber of portal system and CTP of liver with 16-slices spiral CT,and to offer non-invasive hemodynamic and morphologic indicators for the early diagnosis of hepatic fibrosis and cirrhosis.Materials and methods:Tri-stage enhance volume CT scan of liver and spleen was performed in 84 participants,including 48 patients with hepatic fibrosis which divided into S1(12/48),S2(14/48),S3(9/48)and S4(13/48) confirmed by liver pathologic biopsy,16 patients with liver cirrhosis who had typical clinical and image signs,and 20 healthy subjects as control group.Hepatic CT perfusion(CTP)was performed in 74/84 participants,including 20 patients with mild liver fibrosis(S1-2),18 patients with severe liver fibrosis(S3-4),16 patients with liver cirrhosis and 20 control participants.Measured the volume of the left lateral lobe,medial lobe,right lobe,caudate lobe of liver and spleen respectively,calculated the total liver volume and percentage of each lobe in the liver,volume ratio of liver and spleen;Measured the density and its ratio of liver and spleen;Measured the caliber of left,right branch of portal vein,MPV,SV and SMV at MIP respectively,observed the collateral circulation and ascites;The data of CTP at different stages were obtained with Body perfect CT-syngo CT2007A,including hepatic arterial perfusion(HAP),portal venous perfusion(PVP),total liver perfusion(TLP),hepatic perfusion index(HPI)and time to peak(TTP). Above-mentioned parameter values were control study with histopathologic stage and statistical analysis was performed.Results:(1)The.total liver volume of the control group was(1094.45±119.11)cm~3,the volume and the percentage in the total liver of the left lateral lobe,medial lobe,fight lobe and the caudate lobe were(165.56±21.04)cm~3,(191.31±17.77)cm~3,(712.37±41.84)cm~3,(25.24±3.80)cm~3;(15.08±1.02)%,(17.47±0.74)%,(65.16±1.44)%,(2.30±0.23)%,respectively.From S1 to liver cirrhosis,the left lateral lobe enlarged gradually,showed S1(177.42±27.64) cm~3,S2(190.18±42.61)cm~3,S3(206.40±13.09)cm~3,S4/early stage of hepatic cirrhosis(213.53±28.17)cm~3 and typical cirrhosis(254.35±71.00) cm~3 respectively,and corresponding percentage of the left lateral lobe in the liver was(15.29±1.52)%,(15.22±2.67)%,(17.17±1.23)%,(18.41±2.01) %,(28.10±7.58)%respectively,The volume and percentage of the left lateral lobe in patients with advanced cirrhosis increased markedly and had significant difference contrast other groups,The volume and percentage of the left lateral lobe between S4/early stage of hepatic cirrhosis and the normal liver/S1 had statistic difference.Medial lobe enlarged slightly at S1～S3 but reduced markedly at S4 and liver cirrhosis,from S1 to cirrhosis,the value was(197.78±24.72) cm~3,(205.21±43.40)cm~3,(198.95±27.33)cm~3,(160.32±26.29)cm~3,(128.84±37.78)cm~3 respectively in order,the percentage of the medial lobe in patients with S4 or liver cirrhosis was minimum(＜15%)and had prominent statistic difference contrast other groups.The volume and percentage of the right lobe in patients with advanced cirrhosis decreased markedly and had significant differences contrast other groups,the volume of the right lobe at S2 was significant larger than normal liver and S1,S4.The volume and/or percentage of the caudate lobe in patients with advanced cirrhosis was markedly larger than other groups,but others were not significant.The total liver volume increased in patients with fibrosis but decreased in typical cirrhosis,there was dramatic statistical difference between liver cirrhosis and other groups,the total liver volume of S2 was larger than normal liver and S1,S4 remarkably,but the differences among groups of S1,S3,S4 had no significance.Noticed the total volume of S4/early cirrhosis was smaller than S2 and S3,but still larger than normal liver.(2)The liver borderline showed coarse or mild wave-like changed in 4/13 cases of severe hepatic fibrosis stage S4/early cirrhosis,but such signs can not be found in the cases of S1-3,and the differences between S4/early cirrhosis and other groups were significant(P＜0.05).(3)The splenic volume enlarged gradually with the development of hepatic fibrosis,and showed normal control group(128.55±30.56)cm~3,S1(185.06±37.31)cm~3,S2(261.36±56.80)cm~3,S3(384.54±110.29)cm~3,S4/early stage of hepatic cirrhosis (405.34±187.39)cm~3,typical cirrhosis(677.76±198.57)cm~3,respectively.The differences between advanced cirrhosis and other groups were significant,and the same can be seen between S3,S4 and others,but no significant difference between S3 and S4,S1 and S2.Spearman's rank correlation analysis showed that the correlation coefficient of the splenic volume and the degree of liver fibrosis was 0.894(P＜0.01).Negative correlation(-0.911)was showed between the ratio of hepatic/splenic volume and histopathlogic stage of hepatic fibrosis.Except the difference tetween S3 and S4/early cirrhosis was not significant,statistical significances can be seen among other groups.(4)The density of normal liver, spleen andratioofliver/spleenwere(63.44±4.16)HU,(49.26±3.51)HU, (1.29±0.10),respectively.The density of liver trended to decreased with the development of hepatic fibrosis but increased slightly at typical cirrhosis.The density of liver parenchyma at S4/early cirrhosis was minimus and had prominent statistical difference contrast normal liver and S1～3.The difference of hepatic density between each group of S2～cirrhosis and control group was significant.The differences of splenic density wrer not significant.The ratio of hepatic and splenic density at S4/early cirrhosis was minimus(1.08±0.07)and had prominent statistic difference contrast other groups.The ratio of liver/spleen density of each test group was smaller than control group markedly.(5)The caliber of left branch of portal vein,right branch of portal vein,MPV,SV and SMV were(0.98±0.11)cm,(1.00±0.12)cm,(1.33±0.11)cm,(0.75±0.10)cm,(1.07±0.12)cm respctively,and non-collateral circulation or ascites at control group.SV enlarged gradually in test groups and showed S1(0.86±0.12)cm,S2(0.96±0.11)cm,S3(1.07±0.08)cm,S4/early stage of hepatic cirrhosis(1.09±0.10)cm,advanced cirrhosis(1.18±0.19)cm,respctively.The difference of SV between each group of S1～advanced cirrhosis and control group was significant,and the same can be seen among S3-4,cirrhosis and S1-2.MPV,SMV enlarged gradually with the development of the hepatic fibrosis,and significant difference can be seen between S3-4 and normal group,cirrhosis and S0-2.The left and right branch of portal vein both trended to enlarged at S1-3 and deflated at S4-cirrhosis but still larger than normal.Logistic regression analysis showed that the standardized regression coefficient of SV was largest(2.719)and had statistical significance(P=0.000).The incidence of collateral circulation and ascites in patients with advanced cirrhosis was significant higher than normal liver and every stage of hepatic fibrosis.The incidence of collateral circulation at S4/early cirrhosis was higher than control group and S1-2.The incidence of ascites was not significant difference among the groups of S0-4.(6)Multivariate analysis(logistic regression)found that the following standardized regression coefficients of the CT morphologic indicators of hepatic fibrosis were significant:the ratio of hepatic and splenic volume(-4.716),the percentage of the left lateral lobe in the total liver volume(4.029),the splenic volume(1.856)and the diameter of splenic vein(1.328).The best critical points of above indicators judged by the ROC curve were used as the diagnostic threshold of severe liver fibrosis S3-4/early cirrhosis,the sensitivity,specificity and accuracy were all high.(7)The data of CTP in control group was HAP= (28.33±8.69)ml/(100ml.min),PVP=(108.69±16.05)ml/(100ml.min),TLP= (137.02±19.82)ml/(100ml.min),HPI=(20.57±4.22)%and TTP=(123.28±22.29)S,respectively.HAP decreased slightly at S1-2 and increased at S3-4/liver cirrhosis;PVETLP decreased obviously and the corresponding values was(92.74±15.47)ml/(100ml.min),(117.04±14.78)ml/(100ml.min)at S1-2, (71.19±18.83)ml/(100ml.min),(100.51±18.60)ml/(100ml.min)at S3-4/early stage of hepatic cirrhosis and(43.62±16.25)ml/(100ml.min),(82.55±19.07)ml/(100ml.min)at typical cirrhosis.HPI trended to increased in test groups and(21.10±4.10)%,(28.94±5.17)%,(48.41±16.36)% relating to S1-2,S3-4/early cirrhosis and advanced cirrhosis respectively;TTP prolonged gradually.Statistic analysis showed that the difference of HAP between advanced cirrhosis and other groups,S3-4/early stage of hepatic cirrhosis and S1-2 were significant;The differences of PVP,TLP among groups were all significant;HPI of S3-4/early cirrhosis was significant different from other groups,and the same as typical cirrhosis;Prominent statistic difference was showed between TTP of advanced cirrhosis and others,and the same can be seen between S3-4/early stage of hepatic cirrhosis and control group.Multivariate analysis(logistic regression)showed that the standardized regression coefficient of PVP was largest(-8.798)and had a statistical significance(P=0.031).Best critical point PVP=84.76ml/(100ml.min)was used as the diagnostic threshold of severe liver fibrosis S3-4/early cirrhosis,the sensitivity,specificity and accuracy were 0.890,0.950,0.931,respectively.Conlusion:The volume and percentage of hepatic lobes change with the development of liver fibrosis;The volume and percentage of the left lateral lobe are increased obviously,but the values of the medial lobe are decreased dramatically in S4/early stage of hepatic cirrhosis;The volume and percentage of the left lateral lobe and the caudate lobe are increased markedly,but the values of the right lobe,medial lobe and the total liver volume are decreased dramatically in patients with typical cirrhosis.The liver edge may be showed as coarse or mild wave-like changes in the cases of severe hepatic fibrosis stage S4/early cirrhosis.The volume of spleen has significant positive correlation with histopathologic stage,the splenic volume enlarge with the development of liver fibrosis.The ratio of hepatic and splenic volume can refect the severity of liver fibrosis and cirrhosis sensitively.When chronic liver disease develop to S4/early stage of hepatic cirrhosis,early signs of portal hypertension frequently can be seen on CT scan:veins of gastric fundus varices slightly,spleen-megaly,SV, MPV,SMV are enlarged.In the CT morphologic indicators of hepatic fibrosis,the ratio of hepatic and splenic volume has greatest impact on the severity of hepatic fibrosis,followed by the percentage of left lateral lobe in the total liver volume,the splenic volume and the diameter of splenic vein also have significant impact on the degree of liver fibrosis.CTP can reflect the severity of chronic hepatic fibrosis and cirrhosis and reflect the changes of hepatic blood perfusion;HAP is normal or higher slightly,but PVP,TLP are decreased markedly,HPI is increased obviously and TTP is prolonged dramatically than normal in S3-4/early cirrhosis;HAP,HPI are increased obviously but PVP,TLP are decreased markedly and TTP prolonged dramatically in patients with typical cirrhosis.The detection of above-mentioned signs should be valuable for the early diagnosis,treatment and follow-up of chronic hepatic fibrosis and cirrhosis.
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