Quantitative Study Of Oxaliplatin Induced Hepatic Sinusoidal Injury With CT Perfusion-like Imaging

Objective:To analyze the changes of liver CT perfusion-like imaging parameters and the correlation between CT perfusion-like parameters and biochemical indexes AST,ALT,PLT,hepatic fibrosis index and spleen volume（SV）in patients with tumor treated with oxaliplatin（OXA）chemotherapy regimen before and after treatment,and to explore the clinical value of noninvasive monitoring and quantitative evaluation of hepatic sinus injury induced by oxaliplatin.Method:From July 2017 to September 2020,the clinical and upper abdominal CT enhancement data of 128 patients with gastric and colorectal cancer who received OXA chemotherapy regimen were collected,including 69 males and 59 females with an average age of（51.71±11.51）years.The AST,ALT,PLT and liver protective drug information were collected before and after chemotherapy.The aspartate aminotransferase-platelet ratio index（APRI）and fibrosis index based on 4 factor（FIB-4）were calculated according to the formula.Portal vein infusion（PVP）、arterial enhancement fraction（AEF）and SV were measured by CT post-processing software,and the portal venous perfusion index（PVPI）and spleen volume index（SVI）were calculated.The changes of CT perfusion-like parameters,laboratory indexes and SV were compared by statistical method,and the correlation between PVPI and the changes of laboratory indexes and SVI was analyzed.（1）According to whether the patients were treated with liver protectants during chemotherapy,the patients were divided into three groups:reduce glutathin group（group A）,bevacizumab group（group B）and non-liver protectant group（group C）.The differences of CT perfusion-like parameters between the three groups were compared statistically.（2）Referring to the method of Han et al.^[1,2],two radiologists scored the degree of uneven enhancement of hepatic parenchyma in CT portal venous phase during chemotherapy.According to whether the highest score was≥2,the patients were divided into non-HSOS group（58 cases）and HSOS group（70 cases）.The efficacy of CT perfusion imaging in the diagnosis of hepatic sinus injury was analyzed statistically.Result:（1）Analysis of the changes of CT perfusion-like parameters in the liver of patients before and after chemotherapy:the PVP of patients during chemotherapy was gradually lower than that before chemotherapy,the difference was statistically significant（P<0.05）.There was no significant difference in AEF between before and after chemotherapy（P>0.05）.（2）The changes of laboratory biochemical indexes,hepatic fibrosis index,spleen volume and their correlation with liver CT perfusion-like parameters before and after chemotherapy:AST,ALT,APRI,FIB-4 and spleen volume increased with the increase of chemotherapy cycle,while PLT decreased,the difference was statistically significant（P<0.05）.The changes of PVP in patients with OXA before and after chemotherapy were correlated with the changes of APRI,FIB-4 and SVI in the same period,and the correlation coefficients were-0.182,-0.279 and-0.341,respectively.（3）Analysis of the effect of reduced glutathione and bevacizumab on CT perfusion-like parameters after OXA chemotherapy:At the end of chemotherapy,the PVP of patients in reduced glutathin group and bevacizumab group was higher than that in non-hepatoprotective drug group,and there was significant difference between bevacizumab group and non-hepatoprotective drug group（P<0.05）.The PVPI of the two groups was lower than that of the patients without using liver protection drugs,and the difference was not statistically significant（P>0.05）.（4）The value and diagnostic effectiveness of CT perfusion-like imaging in evaluating sinusoidal injury:PVP in HSOS group was significantly lower than that in non-HSOS group（P<0.05）,and PVPI in HSOS group was significantly higher than that in non-HSOS group（P<0.05）.There was no significant difference in AEF between the two groups（P>0.05）.The AUC of HSOS diagnosed by PVPI was 0.828（95%CI:0.7540.902）,the critical value was 0.212,the sensitivity was 71.9%,and the specificity was 76.8%.Conclusion:（1）Liver CT perfusion-like imaging can quantitatively reflect the changes of hepatic portal vein perfusion before and after OXA chemotherapy based on conventional CT enhanced images:PVP decreased gradually during OXA treatment,and PVPI was correlated with laboratory biochemical indexes of hepatic sinus damage and SVI.（2）（1）Liver CT perfusion-like imaging can reflect the effect of hepatoprotective drugs on hepatic sinusoidal injury induced by OXA:reduced glutathione,bevacizumab and other liver protectants can resist the toxicity of OXA and reduce the injury of hepatic sinuses.（3）CT perfusion-like parameters PVP and PVPI are sensitive indexes to evaluate hepatic sinusoidal injury,which can quantitatively evaluate the occurrence of HSOS.The AUC of HSOS diagnosed by PVPI was 0.828（95%CI:0.754,0.902）,the critical value was 0.212,the sensitivity was 71.9%,and the specificity was 76.8%.