The Functional Evaluation For The Cirrhosis By Noninvasive Imaging

Objective:(1) To explore the effect of CT portography(CTP), CT perfusion Imaging(CTPI) and fibroscan, in assessing the severity of the liver, and predicting the occurrence of esophagogastric variceal bleeding in patients with cirrhosis and portal hypertension complicated.(2) We compare the CTPI and Fibroscan, such two functional imaging, their ability in assessing the severity of cirrhosis.Methods :(1) 72 patients with liver cirrhosis underwent CT portography(CTP) to show the portacaval collateral vessels, and we measured the diameter of main portal vein(MPV) and left gastric vein(LGV).Among them, 41 patients also accepted endoscopy to diagnose the esophageal varices. The relationship of diameter of portal venous system and Child-pugh classification was analyzed.Receiver operating characteristic(ROC) curves were worked out, and we calculate the areas under the curves(AUCs), to assess the accuracy of the diameter of MPV and LGV, in predicting esophagogastric varices in cirrhotic patient with portal hypertension complicated.(2)48 cirrhotic patients underwent CT perfusion Imaging(CTPI) to obtain the perfusion parameters. To analyse the change of such perfusion parameters among different grades of liver function, and their changes between patients with the bleeding of esophagogastric variceal and those without.(3) 90 cirrhotic patients accepted LSM by fibroscan. The relationship between LSM and the severity of liver impairment and esophgeal varices(EV) were evaluated. We also included 25 healthy individuals.(4) Medical records of forty-nine cirrhotic patients underwent CTPI and LSM. To compare the diagnostic value of such functional imagings in diagnosis of liver cirrhosis. We also included 10 healthy individuals.Results:(1) The CTP can display the portacaval collateral vessels clearly, and has a good consistency in revealing esophageal varices and gastric fundic varices( Kappa=0.868;0.675); With the reserve function of liver decreased, the diameters of portal vein has no significant difference(P>0.05), while the diameter of left gastric vein was widened gradually(P<0.05);The optimal cut-off values of diameter of MPV and LGV in predicting moderate and severe varices of esophagogastric were 15.47 mm, 5.97 mm, respectively(sensitivity : 60.0%, 88.5%; specificity : 86.7%, 93.3%, respectively); The optimal cut-off values of the LGV diameter in predicting the bleeding of esophagogastric varices in cirrhotic patient with portal hypertension complicated was 6.00mm(sensitivity:82.9%; specificity : 78.4%).(2) Among those parameters of CT perfusion, BF、BV、MTT、PS have no significant difference in different grades of liver function, while HAF was significantly associated with the grade of Child-Pugh score in cirrhotic patients( P <0.05); However, they have no significant difference between patients with the bleeding of esophagogastric varices and those without.(3) In cirrhotic patients, LSM had significant correlation with the score of Child-Pugh.Moreover, decompensated cirrhosis patients owned higher LSM than compensated patients( 36.75 ± 16.54 k Pa vs 17.65 ±10.87 k Pa, P < 0.01). However, there was no significant difference in LSM value between patients with severe EV and those having no or non-severe EV determined by endoscopy(31.00 ± 18.44 k Pa vs 28.18 ± 17.44 k Pa) and multislice spiral CT(29.71 ± 18.39 k Pa vs 24.90 ± 14.80 k Pa), respectively. In cirrhotic patients, EGD and multislice spiral CT has similarity with each other in predicting severe EV.(4) Among those CT perfusion parameters, merely HAF has significant difference in different grades of liver function(P <0.05), furthermore, Differences of HAF were significant between normal control and Child-Pugh B and C, respectively. Between normal control and Child-Pugh A, none of the parameters has significant difference(P >0.05). While LSM was associated with the different grades of liver function significantly,including the normal control(P <0.05).Conclusion:(1) The CTP can be used as a method for evaluating liver cirrhosis with portal hypertension, which has a certain predictive value to the degree of esophageal varices and the possibilities in esophageal variceal bleeding.(2) The whole liver CT perfusion has a certain predictive value to the grade of liver function, however, the role of CTP to assess the EV bleeding needs further confirmation.(3) LSM can be used to evaluate the progression of liver cirrhosis. However, its role in assessing the grades of EV needs further confirmation. In the assessment of portal hypertension,MSCT can serve as an alternative to assess EV accurately.(4) LSM is superior to CTPI for assessment of liver function, and it is a better choice for the diagnosis of early liver cirrhosis, and can be used in the grades of liver function.