| Purpose:To investigate the value and method of functional CT combining liver volume measurement and hepatic perfusion parameters quantitative assessment of liver reserve function and extended hepatectomy in liver cirrhosis.Methods:30 Beagle dogs, male, weighting 10±1kg, were randomly divided into six groups, five in each group. In the experimental group, intraperitoneal injection of soybean oil diluted 50% carbon tetrachloride was given, twice weekly, with each dose of 0.15ml/kg in the first week, each dose of 0.3ml/kg in the second week, each dose of 0.2ml/kg from the seventh week, the overall time was 10 weeks,15% alcohol for drinking and diet control. In the control group the same dosage of normal saline was given by the same route. Spiral CT perfusion scanning was carried out in experimental group before drug use and every second week after drug use. Percutaneous liver biopsy under CT guidance every second week, HE and Masson stained the samples separately. The stage of liver fibrosis was decided by light microscopy. Blood samples were obtained in all dogs before CT examination for normal liver function test. Each group was undergone hepatic resection to define extended hepatectomy and equivalent residual liver volume. Then using student-t test and one-way ANOVA to analyze the differentiation of those parameters, and using linear correlation analysis and multiple regression analysis to study the relationship between them.Results:The total liver volume showed lowering tendency as different stage of fibrosis. From SO to S4,the total liver volume were 579.8 mm3, 548.2 mm3,523.4 mm3,487.5 mm3,385.8 mm3 respectively. There was statistical significance between S1-S4 in comparison with the control group, P<0.05.Statistical significance was not found in comparison between CT perfusion paramenters of the control group(P>0.05). In the experimental groups, from the S0-S4 stage, the hepatic arterial perfusion (HAP) showed gradual rising tendency. Between the control group and the experimental groups, there was no statistical significance at the stage of SO group (P>0.05),but there was statistical significance between the control group and the S1-S4 stage groups (P<0.05).Hepatic portal perfusion (HPP) showed lowering tendency from the S0-S4 stage. Between the control group and the experimental groups, there was no statistical significance at the stage of SO group (P>0.05),but there was statistical significance between the control group and the S1-S4 stage groups (P<0.05).Hepatic total blood flow (HTBF) showed lowering tendency from the S2-S4 stage. Between the control group and the experimental groups, there was no statistical significance at the stage of S0-S2 groups(P>0.05),but there was statistical significance between the control group and the S3-S4 stage groups (P<0.05).Hepatic artery perfusion index (HAPI) showed gradual rising tendency from the S0-S4 stage. There was statistical significance between the control group and the S0-S4 stage groups (P<0.05).Hepatic arterial perfusion went upward progressively along with the rising of cirrhosis severity. There are significant correlation between HAP, HAPI, HPP,TLV and the stage of liver cirrhosis, the coefficient correlation of them were 0.995,0.979,-0.962,-0.950 respectively, P<0.05. The coefficient of multiple correlation of linear regression equation fitting the stage of liver cirrhosis to TLV alone was 0.950, and coefficient of determination R2 was 0.902. The coefficient of multiple correlation of linear regression equation fitting the stage of liver cirrhosis to HAP alone was 0.995, and coefficient of determination R2 was 0.991. The coefficient of multiple correlation of the multiple regression equation fitting the stage of liver cirrhosis to HAP and TLV simultaneously was 0.998, and coefficient of determination R2 was 0.995.In the experimental groups, from the S0-S4 stage, the extended hepatectomy showed gradual lowering tendency. Between the control group and the experimental groups, there was no statistical significance at the stage of SO group(P>0.05),but there was statistical significance between the control group and the S1-S4 stage groups (P<0.05). The equivalent residual liver volume showed gradual rising tendency from the S0-S4 stage. Between the control group and the experimental groups, there was no statistical significance at the stage of SO group(P>0.05),but there was statistical significance between the control group and the S1-S4 stage groups (P<0.05).There are significant correlation between HAP, HAPI, HPP,TLV and the volume of extended hepatectomy, the coefficient correlation of them were-0.990,-0.968,0.946,0.933, respectively, P<0.05. The coefficient of multiple correlation of linear regression equation fitting the volume of extended hepatectomy to TLV alone was 0.933, and coefficient of determination R2 was 0.871. The coefficient of multiple correlation of linear regression equation fitting the volume of extended hepatectomy to HAP alone was 0.990, and coefficient of determination R2 was 0.979. The coefficient of multiple correlation of the multiple regression equation fitting the volume of extended hepatectomy to HAP and TLV simultaneously was 0.996, and coefficient of determination R2 was 0.992.Conclusions:TLV showed gradual lowering tendency long with the rising of cirrhosis severity, TLV can be regard as good parameters in assessing the severity of liver cirrhosis. Portal blood flow decreased obviouly as the stage of liver cirrhosis while arterial blood flow increase at the stage of liver cirrhosis. Hepatic artery perfusion which relate more closely with the severity of liver cirrhosis than the TLV. The combination measurement of hepatic volume and hepatic blood flow can assess liver reserve function better. The hepatic blood parameter and TLV can be regard as good parameters in assessing the liver volume of extended hepatectomy and equivalent residual.
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