| Part I: Establishment of Dynamic CT Scan Protocol Purpose:To establish a reasonable dynamic CT scan protocol for measuring hepatic hameodynamic changes. Subjects and Methods:Liver dynamic CT scan was consecutively performed in 53 individual including 20 control subjects, 33 patients with cirrhosis. The scan sequence separated into two part: 2 second cycle time in the first 52 second and 4 second cycle time in the subsequent 60 second. Hepatic peak time of hepatic time-density curve(TDC) was described. With first 52 second scan data and all 112 second data, the CT perfusion parameters including hepatic blood volume(HBVK hepatic blood flow(HBF), mean transit time(MTT), permeability surface (PS), hepatic artery index (HAI) were calculated respectively with deconvolution model. Results:(1) Peak time of hepatic TDC delayed in patients with cirrhosis (85.92s±18.60s versus 49.17s±12.77s in control subjects[P=0. 001]).(2) When the scan time was 112 seconds , HBV , HBF decreased in patients with cirrhosis (14. 21±4. 17 ml/100ml versus 19.52±5.18ml/100ml in control subjects; 121.05±36.47 ml/min/100ml versus 163.72±35.60 ml/min/lOOml in control subjects, P<0. 05), PS, HAI increased in patients with cirrhosis (42. 04 ± 16. 29 ml/100ml versus 28.65±16.13 ml/lOOml in control subjects, 0.36 ± 0.19 versus 0.20 ± 0.09 in control subjects, P<0. 05). No significant change in MTT was observed. Only PS increased in patients with cirrhosis in the scan time of 52 seconds (P<0. 05)(3)No significant change in control patients with 112 seconds and with 52 seconds was observed, but HBV, HBF, MTT, HAI had significant difference in cirrhosis between them. Conclusion:CT perfusion parameters could be used in clinical practices measuring hepatic haemodynamic change. And the protocol 112 seconds scan time was better than that of 52 seconds for measuring the hepatic perfusion parameters in cirrhosis.Part II: The Study of Parameters of Hepatic Dynamic CT and HepaticPerfusion Correlated With the Liver FunctionPurpose:The aim of our study was to determine if the parameters of hepatic TDC and perfusion measured with dynamic CT in relation to the grade of liver function. Subjects and Methods:Hepatic dynamic CT scan was consecutively performed in 53 individual including 20 control subjects, 33 patients with cirrhosis.15 were classified as Child A, 12 as Child B and 6 as Child C among cirrhosis. Aortic, hepatic and portal venous (PV) time density curve (TDC) and Perfusion parameters maps were automatically portrayed and described by the newest perfusion software. Five TDC parameters including the rising slope of hepatic TDC, the ratio of hepatic TDC and aortic TDC peak density (H/A ratio), the peak density of PV, the peak time of PV, and perfusion parameters such as hepatic blood volume (HBV), hepatic blood flow(HBF) > permeability surface (PS), hepatic artery index(HAI) and a derivative parameter HPV were calculated respectively with deconvolution model. Discriminant analysis of the parameters selecting the cutoff point with a higher sensitivity and a higher specificity. Results:(1)A negative correlation was seen between the rising slope of hepatic TDC and the Child-Pugh classification of liver function (P<0. 05), as well as H/A ratio and that of liver function. No significant correlation between any parameters of PV TDC and that of liver function (P>0. 05).(2) HBV, HBF, HPV were observed to be negative correlated with liver function, and HAI positive correlated with them. PS without correlation with liver function.(3)The value of rising slope of hepatic TDC was 0. 54, the sensitivity of 80.7% and specificity of 73.1% obtained to differentiate between the normals and cirrhosis patients.(4) If HBV, HBF, HPV equal to 14. 5ml/100ml, 145. 5ml/min/100ml, 10. 49ml/100ml were the cutoff point between the better liverfunction(controls and Child A) and the worse liver function (Child Band Child C), the sensitivity of 74. 3%, 65.7%, 82. 9% and specificity of 72. 2%, 66. 7%, 83. 3% was obtain respectively.(5) O... |
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