The Preliminary Research Of Evaluating The Liver Functional Reserve Using CT Perfusion Imaging Combining With Volume Measurement Before Hepatectomy

Objective:â‘ To discuss the method of MSCT volumemeasurement combining with perfusion imaging to evaluate liverreserved function.â‘¡To preliminarily evaluate the value of thevolume-perfusion synthetic indicator in assessment of liver reservedfunction before hepatectomy.â‘¢To preliminarily explore the applicationof MSCT simulation hepatectomy.Methods: (1) scanning methods: 18 normal people, 30 patients withhepatocirrhosis and 35 patients with HCC were undergone CT scanningwith Philips Brilliance^xp 16-slice CT. After plain scan of the whole liver,the portal hepatic slice was chosen to conduct perfusion scanning for 60s(200mA electric current, 120KV voltage, 16×1.5mm scan collimation) atthe same time intravenous bolus injection of 50ml nonionic contrastmedian at 4ml/s through cubital fossa vein. 30 scannings were obtainedtotally with a 2-sec interval scanning time. Conventional contract scanwas made after perfusion scan for 3 minutes with 50ml contrast medianadded at 2.5ml/s. The plain scan and the conventional contract scan hadthe same references (250mA electric current, 120KV voltage, 16×1.5mmscan collimation) and the same range (from the top of diaphragm to thelower edge of the liver or the spleen).(2) Post-processing methods: All datas were transported to the Philips workstation:â‘ Every ROI was drawn and perfusion values wereobtained by its perfusion-3 software;â‘¡The liver 3D images wereformed by its SSD-3D software, and the liver volume was obtained;â‘¢According to the practical hepatectomy, CT simulation hepatectomywas performed at CT workstation.(3) Assessing methods:â‘ The diference in every datum ofperfusion and volume amang every groups was analyzed;â‘¡Thevolume-perfusion synthetic indicator was analyzed to evaluate liverreserved function of hepatacirrhosis, and the correlations of values withC-P degree were analyzed;â‘¢The liver function reserved of liverremained after hepatectomy was assessed using the same meathod. Andcompare the results with C-P degree before hepatectomy and thefollowing-up condition respectively to obtain a safe line and a warningline of hepatectomy.Results: (1) Comparing with normal group, hepatacirrhosis group'sHAP was higher with no statistical significance (P＞0.05), HPP. TLP andPPI were statistical significant lower (P＜0.01). Among these perfusiondatum, PPI had the most significance. With the increase ofhepatacirrhosis C-P degree, HPP was increasing with no statisticalsignificance among groups (P＞0.05); HPP. TLP and PPI weredecreasing with statistical significance between some groups (P＜0.01,P＜0.05) .(2) In normal people, the liver volume was significant positive correlated with body surface area (r=0.883) ,and their relative equationis: LV (ml)=-62.430+795.261×BSA (m²) .(3) LV . LVs and LVrof hepatacirrhosis C-P A group were little increased than normal group.Only LVr had statistical significance (P＞0.05). With the increase ofhepatacirrhosis degree, LV,LVs and LVr were decreasing withstatistical significance between groups (P＜0.01, P＜0.05) .Among thesevolume datum, LVr had the most significance among every group.(4)IPPIrVr were decreasing with significance among the normal groupand hepatacirrhosis C-P A . B. C group decreasing with statisticalsignificance between groups (P＜0.01, P＜0.05) .(5) Each datum haddifferent correlation with C-P degree. IPPIrVr had the biggest r value(0.902). (6)LVR. LVRr. LVRs. TLP. PPI,PPIr and IPPIrVr hadsignificant difference. IPPIrVr had the biggest P value. And two lineswere obtained according to IPPIrVr and LVRr to assess the safe range ofhepatectomy: a safe line (A line: IPPIrVr=1176} and a warning line (Bline: IPPIrVr=908)Conclusion: (1)The normal hepatic portal perfusion was 85.59% tototal liver perfusion. HPP. TLP and PPI were decreasing with theincrease of hepatacirrhosis degree. (2)The normal liver volume wassignificant positive correlated with body surface area. Using theirrelative equation, the standard LV was calculated, then te change ofLVwas found. (3) LV,LVs and LVr were decreasing according to the increase of hepatacirrhosis degree. LVs and LVr had significantdifference among each group of C-P degree. (3) Comparing with simpleperfusion datum or volume datum, volume-perfusion synthetic indicatorcould assess the liver reserved function more sensitively and quantized.It could assess liver reserved function before hepatectomy morecorrectly than C-P degree. (4)In the 3D image of interest region,different CT simulation hepatectomy could be performed repeatedly.Different liver volume remained could be obtained by differentoperation way. Then with the perfusion datum the foundation could beprovided prospectively to choose reasonable operation way and theprognosis could be forecast.