Experimental And Clinical Research On The Hemodynamic Changes Of Portal Vein Before And After Liver Cirrhosis By Using CT Perfusion And Phase Contrast Magnetic Resonance Imaging

Objectives: To evaluate the hemodynamic changes after hepatic cirrhosis by using CT perfusion and four-dimensional phase contrast magnetic resonance(4D-PCMR)to explore the changes of hemodynamics in liver cirrhosis for different lobes,providing scientific basis and basic for the non-invasive evaluation of blood supply on pathophysiological mechanism.Methods: 1.We used the method of combination with feeding-production and intraperitoneal injection of carbon tetrachloride in Bama miniature pig for liver cirrhosis model.Proven by biopsy and postoperative pathology,using the selective superior mesenteric or splenic arterial catheter for indirect portal vein CT perfusion technique,we measured and compared superior mesenteric venous perfusion(SMVP,ml/[ min·100ml]),splenic venous perfusion(SPVP,ml/[ min·100ml])and the ratio of vein and the splenic vein and superior mesenteric perfusion(SMVP/SPVP)before and after cirrhosis in the total liver and different liver lobes.2.We enrolled 23 cases of hospitalized patients with liver cirrhosis in our hospital from January 2015 to February 2017,15 males and eight females,ranging 35-70 years,average 52.3 years old,including eight cases of the Child-Pugh grade A,seven cases of the grade B and eight cases of the grade C.For the control group we yeild eight healthy volunteers,five males and three females,ranging 25-57 years,average 45 years old.4D-PCMR sequence scans were performed in each group and the changes of portal area,superior mesenteric vein and splenic vein after liver cirrhosis were measured and compared.Results: 1.Confirmed by liver biopsy and postoperative pathology,16 cases of liver cirrhosis were introduced,and the success rate of the model was 80%(16/20).We used Laennec fibrosis scores to stage different liver lobes: mild liver cirrhosis group,eight cases of left hepatic lobe,eight cases of middle hepatic lobe and four cases of right lobe,a total of 20 cases of mild liver cirrhosis;moderate liver cirrhosis group,seven cases of left hepatic lobe,six cases of middle hepatic lobe and eight cases of right lobe,a total of 21 cases of moderate liver cirrhosis;severe liver cirrhosis group,four cases of left hepatic lobe,one case of middle hepatic lobe and two cases of right lobe,a total of seven cases of severe liver cirrhosis.The SMVP and SPVP value(ml/[ min·100ml])of the control group,mild cirrhosis group,moderate cirrhosis group and severe cirrhosis group for the total liver were 77.77 ± 3.68 and 47.45 ± 5.58,48.38 ± 0.94 and 38.03 ± 2.53,43.98 ± 4.93 and 32.28 ± 7.08,42.09 ± 4.92 and 25.22 ± 2.53,respectively,with SPVP and SMVP reduced the during the progression of hepatic cirrhosis and SMVP decreased obviously(P < 0.05).The difference of SMVP(-5.70 ± 5.16 and-0.91 ± 5.38)for the left-right lobe and the middle-right lobe decreased after cirrhosis(P < 0.05),compared with the control group(0.92 ± 7.25 and 4 ± 3.09);the difference of SPVP(5.36 ± 6.47 and 2.37 ± 5.69)for the left-right lobe and the middle-right lobe increased after cirrhosis(P < 0.05),compared with the control group(-1.46 ± 3.14 and-4.53 ± 5.11).2.With the decrease of liver reserve function after liver cirrhosis,portal vein vascular cross-sectional area increased first and then decreased(P < 0.05),the average blood flow increased first and then decreased(P < 0.05),the average velocity decreased gradually(P < 0.05);the left portal vein and right vessel cross-sectional area of liver cirrhosis group less than the normal group,liver cirrhosis group decreased with the increased first and then decreased(P < 0.05),the average blood flow increased first and then decreased(P < 0.05),the average velocity decreased gradually(P < 0.05);superior mesenteric vascular cross-sectional area increased first and then decreased(P < 0.05),the average blood flow change was no significant difference,the average flow rate decreased,there was significant difference;splenic vein vascular cross-sectional area increased first and then decreased(P < 0.05),the average blood flow and the average flow velocity decreased(P < 0.05).Conclusions: 1.In miniature pig hepatic cirrhosis portal vein perfusion process associated with reduced mesenteric venous perfusion decreased;liver cirrhosis and portal vein blood supply left middle coordination change,because the portal vein blood supply from different sources,the left liver(middle)differences between shunt lobe and the right lobe.2.Four dimensional magnetic resonance phase contrast method can provide diversified information for the hemodynamic changes of portal vein before and after cirrhosis.With the damage of liver function,the blood flow of the hepatic portal vein and the splenic vein decreased,and the blood flow of the superior mesenteric vein changed slightly.