The Application Study Of256Slice CT Perfusion Imaging In Hepatitis B Cirrhosis

Objectives:To probe three regions of interest (ROIs) with concentric circle by256slice CT Perfusion imaging, for finding its relationship between size and perfusion results in hepatitis B cirrhosis. To compare three ROIs choosing the largest slice of liver on cross-section images and multiply ROIs on different lobes, for optimizing the postprocessing of computed tomography perfusion (CTP) in Hepatitis B cirrhosis.Getting data of CTP of whole-liver, combining the Child-Turcotte-Pugh grade (for short Child grade), to discuss the severity of hepatitis B cirrhosis, for establishing the quantitative norm of CTP of hepatitis B cirrhosis.Materials and methods:This retrospective study was based on64cases acquired CTP scans of whole-liver. This study included48patients with hepatitis B cirrhosis and16without liver diseases. Initial data were inputted into workstation. First, at the trunk level of the portal vein, ROIs were drawn in the aorta, the portal vein, the spleen and liver. Software automatically outputted the time-density-curve (TDC) and time to peak (TTP) of ROIs. Second, three concentric circles with different size were drawn in lower segment of right posterior lobe of liver. Hepatic arterial perfusion (HAP), hepatic portal perfusion (HPP), total liver perfusion (TLP) and hepatic arterial perfusion index (HPI) of ROIs were recorded. Third, three ROIs on the largest slice of liver cross-section images were drawn, to get their HAP, HPP, TLP and HPI (sections method). Fourth, three ROIs were drawn in left lateral, left medial, right anterior and posterior lobes of liver, to get their HAP, HPP, TLP and HPI, taking12ROIs average as the ultimately perfusion rusults of whole-liver (points method). To compare sections and points methods, then the perfusion results of whole-liver through points method was related to the Child grade. Finally, the influence of collateral circulation on liver perfusion was evaluated.Results:1. Results of perfusion of three ROIs in lower segment of right posterior lobe of liver of hepatitis B cirrhosis were no statistical difference.2. Results of perfusion through sections and points methods were no statistical difference.3. hemodynamics of liver changed in hepatitis B cirrhosis group:3.1Compared with the control group, the TTP of aorta, portal vein, spleen and liver lengthen, except for the TTP of aorta was no statistical difference.3.2The perfusion parameters of whole-liver changed in hepatitis B cirrhosis group:HAP increased gradually along with Child A, B, and C, but there was no statistical difference. HPP decreased gradually along with Child A, B, and C. There was significant statistical difference in HPP, and significant negative correlation with Child grade. TLP decreased gradually along with Child A, B, and C. There was significant statistical difference in TLP, and significant negative correlation with Child grade. HPI increased gradually along with Child A, B, and C. There was significant statistical difference in HPI, and significant positive correlation with Child grade.3.3The perfusion of whole-liver gradually decreased in growing collateral circulations, but there was no statistical difference.Conclusions:1. There was no significant statistical difference among three ROIs with concentric circles, so the size of ROIs was not key factor. Combined with two common senses, when ROIs were drawn, some key factors (for example blood vessels, fringe effect) should be avoided.2. There was no significant statistical difference between sections and points method, so taking the slice that each lobe of liver presented at the same time as the target slice of CTP, for the limitation of each lobes with different perfusion was avoided.3. The256-slice CT hepatic perfusion imaging can accurately reflect hepatic hemodynamic changes in the normal liver and hepatitis B cirrhosis:after hepatitis B cirrhosis, the TTP of the portal vein, spleen and liver lengthen. HPP and TLP decreased gradually along with Child grade, and negatively related to severity of hepatitis B cirrhosis. Further more, the changes of HPP is in favor of the diagnosis of hepatitis B cirrhosis in Child C grade. It was taken as an effective way for fellow-up visit. HPI increased gradually along with Child grade, and positively related to severity of hepatitis B cirrhosis.