| OBJECTIVE: A new quantitative method and evaluated method were studied to diagnose liver cirrhosis and liver reserve function combining liver-spleen volumetry with CT image by computer and CT grade of liver parenchyma manually before hepatectomy. An automated measurement method and its feasibility were explored by segment technology of image analysis.METHODS (1) 100 subjects were divided into 2 groups, including 50 cases of cirrhosis group and 50 cases of normal group. The liver volume, the component volumes of 4 liver sections and the spleen volume of subjects in both groups were measured. The ratio of spleen volume to liver volume, the ratio of liver volume to weight and liver cirrhosis index were calculated. The differences of means between the two groups were compared, and the correlations of values in the same group were analyzed. A new method for grading liver CT quality was designed by ourselve and was used to grade the 50 cases with liver cirrhosis according to their CTimages. To explore the effect of the technology in combining with CT grade and CT volumetry, comparisons were made for the CT grade indicated above, to the Child-Pugh grade, and to therapy result and to prognosis of these 50 patients. (2) 59 cases of hepatectomy had been studied for the patients who were all checked by two phase contrast CT. The grade difference was analyzed by comparing preoperative liver CT grades of non-tumor area and reservation liver volumes with postoperative pathologic liver fiber grade, clinical liver function grade, preoperative and postoperative biochemical index change curve and survival rate. (3) The algorithm and program of the auto-distinguished liver outline, the auto-measured liver volume and the auto-calculated related index were explored by using image segment technique.RESULTS (1) Liver volumes of 50 subjects in the normal control group varied greatly, and thereby the relative values were more significant statistically than absolute values. Compared to the normal group, the liver cirrhosis group showed a smaller liver volume, higher ratio of spleen to liver, lower liver cirrhosis index and altered liver section ratio as well. Liver CT grades were well correlated to Child-Pugh grades with Rs of 0.8 (P<0.0001). In addition, CT grades exhibited a significant correlation with prognosis (two-sides:p<0.0001) . The level and the number of portal hypertension signs were increasing with CT grade from 1 to 4. The liver volume and cirrhosis index decreased as CT grade increased, whereas the ratio of spleen to liver volume increased as CT grade increased (one-way analysis of variance). (2) The differences in survival rate between the group with low reserve liver volume rates (< 50%) and the group with high reserve liver volume rates (>50%) and between CT grades 0, 1 and CT grades 2, 3 were statistically significant ( x 2 4.9881 and 5.4286, P < 0.05). A warning line can be drawn combining the two methods. The death rate was 13.6% (3/22) above the line, whereas 62.9% (22/35) below the line ( x2=13. 2915, P = 0.0003). The differences between CT grades 1, 2 and 3 in peak and bottom values of ALT, AST, ALB and PAB within 20 days after operation were statistically significant (P<0.05) , whereas the differences between C-P grades A and B in peak value of TBIL, DBIL and PAB were statisticallysignificant (P<0.05) . The correlation of CT grades to pathology liver fibrosis grades was 0.77 (P < 0.0001). The correlation of CT grades to C-P grades was 0.46 ( P = 0.0011 ). (3) Liver volume can be automatically measured by tomography, though it requires manual adjustment. The success rate of liver segment was 68%, which was less than one by manual work and in which the error rate of measured liver area was 5.02%.CONCLUSION The new quantitative method and evaluated method through combining liver and spleen volumetry with CT image by compute-aid and CT grade of liver parenchyma may be one of important indices available. They are very helpful for diagnosis of liver cirrhosis and assessment of liver reserve function before hepat... |
PDF Full Text Request