| Objective: To explore the feasibility of dual energy CT iodine parameters in the evaluation of liver hemodynamics,to explore the hemodynamics of normal liver and cirrhosis liver with dual energy CT iodine parameters,and to compare the distribution and difference of blood flow in each liver lobe.On this basis,the changes of iodine parameters and the relationship between iodine parameters and liver reserve function were studied.To provide evidence and basis for the pathophysiological changes of liver cirrhosis,and to provide more imaging information for the noninvasive evaluation of clinical liver cirrhosis.Methods: In the study group,30 patients who met the clinical diagnosis criteria of liver cirrhosis in the guidelines for the diagnosis and treatment of liver cirrhosis were collected and their Child Turcotte Pugh(CTP)scores and grades were obtained.In the control group,including 12 children of Grade A,11 children of grade B and 7 children of grade C.31 healthy people were collected in the control group.The patients in both groups were scanned by Siemens dual source CT with double energy in the upper abdomen.After the unified standard scanning,the image was processed by workstation.The iodine parameters of the whole liver,tail lobe,left outer lobe,left inner lobe,right anterior lobe and right posterior lobe were measured and calculated:Iodine Concentration of arterial phase(Ia)、Iodine concentration of portal venous(Ip)、Arterial Iodine Fraction(AIF)、 Portal Venous Iodine Concentration(PVIC).The iodine parameters of the whole liver and the five lobes of the normal group and the sclerotic group were compared within and between groups,the iodine parameters of different liver cirrhosis CTP grades were compared,the correlation between the iodine parameters of the liver cirrhosis group and the CTP score was analyzed,and the diagnostic efficacy was analyzed with the working curve of the subjects.Result:1.Difference of iodine parameters between normal group and cirrhosis group(1)There was significant difference in the mean of IA(F = 13.559,P < 0.01),IP(F = 4.017,P < 0.01),AIF(F = 5.740,P < 0.01)between the five lobes of liver in the normal group,but there was no significant difference in the mean of PVIC(f = 0.679,P > 0.05).here was no significant difference in the mean of IA,IP,AIF and PVIC among the five lobes of liver in cirrhosis group(F = 1.606,2.145,1.182,0.338,P > 0.05).(2)The IA and AIF of caudate lobe(0.68 ± 0.37,0.32 ± 0.19)were significantly higher than those of right anterior lobe(0.3 ± 0.23,0.17 ± 0.14),right posterior lobe(0.26 ± 0.18,0.15 ± 0.11)and left inner lobe(0.37 ± 0.22,0.21 ± 0.19).The level of IA and AIF(0.52 ±0.26,0.25 ± 0.12)in the left outer lobe was higher than that in the right anterior lobe and the right posterior lobe;the level of IP(2.19 ± 0.52,2.15 ± 0.45)in the tail lobe and the left outer lobe was significantly higher than that in the right anterior lobe(1.81 ± 0.38)and the right posterior lobe(1.86 ± 0.4),the difference was statistically significant(P < 0.01).(3)There were significant differences in AIF and PVIC between cirrhotic group and normal group(P < 0.01).Compared with the normal group,the AIF of the five lobes in the cirrhotic group increased and the PVIC decreased.2、The difference of iodine parameters between normal group and cirrhosis group(1)The average of IA and AIF(0.69 ± 0.44,0.38 ± 0.21)in liver cirrhosis group was higher than that in normal group(0.4 ± 0.2,0.21 ± 0.11),IP,PVIC(2.14 ± 0.54,1.05± 0.36)were lower than those of the normal group(2.21 ± 0.54,1.59 ± 0.45),the difference was statistically significant(P < 0.05).(2)There were significant differences in the mean values of IA,AIF and PVIC in the cirrhosis group(P < 0.05).There was no significant difference in the mean between IP groups(P > 0.05).The IA and AIF of child Pugh A,B and C grades are on the rise,while the PVIC is on the decline.3.Correlation between iodine parameters and liver reserve function and evaluation of liver cirrhosisThere was a positive correlation between IA,AIF and CTP,a negative correlation between PVIC and CTP,and no correlation between LP and CTP(P > 0.05).The AUC of AIF was 0.762,P = 0.000.When the cutoff point was 0.26,the sensitivity was 77%,and thespecificity was 35.5%.Conclusion:1.There were differences in the arterial blood flow,the proportion of blood supply and the total venous blood flow(Ia,AIF,Ip)between the five lobes of the liver in the normal people,with the highest in the caudate lobe and the left lobe.There was no significant difference in PVIC between the five lobes of the liver,and there was no difference in arterial blood flow and its proportion of blood supply,total venous blood flow,and portal perfusion(Ia,AIF,Ip,PVIC)between the five lobes of the liver cirrhosis.2.After liver cirrhosis,the blood flow of arteria hepatica(Ia)and the proportion of blood supply(AIF)increased,higher than that of normal liver,and increased gradually with the aggravation of liver cirrhosis;the portal vein perfusion(PVIC)of liver parenchyma decreased,lower than that of normal liver,and decreased gradually with the aggravation of liver cirrhosis;The total blood supply(Ip)of liver was compensated by liver,slightly lower than that of normal liver,and was no significant difference in different stages of cirrhosis.3.CTP score of reserve function after cirrhosis was positively correlated with Ia and AIF,and negatively correlated with PVIC;AIF had a high evaluation effect on cirrhosis.4.Dual energy CT iodine parameters can not only reflect the characteristics of dual blood supply of the liver,but also quantitatively evaluate the physiological and pathological blood flow perfusion of the liver.At the same time,it can comprehensively and carefully reflect the blood flow distribution differences of each liver lobe,providing a reference for the study of liver diseases.Iodine parameters can quantitatively show the changes of blood flow in different degrees of cirrhosis,and on this basis,evaluate the reserve function of liver,effectively reflect the severity of cirrhosis,quantitatively evaluate cirrhosis,and can be used for clinical dynamic monitoring of disease progress and treatment effect. |
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