【作者】 沈文；

【导师】 祁吉； 尹建忠；

【作者基本信息】 天津医科大学 ， 影像医学与核医学， 2006， 博士

【摘要】 肝脏早期弥漫性病变的诊断一直是临床影像诊断的难题之一,以反映解剖结构为主的传统影像学难以为该类病变的临床诊断提供有价值的信息,肝脏的血流量是维持其功能的重要因素,肝纤维化不同时期肝脏血液动力学已有改变,因此肝脏血流灌注指标的检测对临床的诊断和治疗有重要价值,磁共振扩散加权成像是目前唯一的通过检测活体组织内水分子运动状态来反映组织的结构特点的技术,若ADC值能准确反映肝脏纤维化程度,与肝脏穿刺活检比较,无疑是一种简便无创的新方法,同时有助于指导治疗和评估预后;磁化传递技术可以间接地,乃至半定量地反映组织中的大分子蛋白含量的变化。本研究利用CT灌注成像、MR扩散成像(DWI)及磁化传递成像(MTI)技术对肝纤维化及肝硬化进行研究。 第一部分 肝纤维化和肝硬化CT灌注成像及与病理对照、血清学指标相关性的研究 研究目的:主要是通过肝纤维化和肝硬化阶段的CT灌注参数的变化,并与正常对照组及相应病理及血清学指标作对照,分析其血液动力学改变及病理基础以及与血清学指标的相关性。 研究方法:分别对39例肝纤维化病人、41例肝硬化病人及28例正常对照组行螺旋CT肝脏灌注扫描,用肝脏灌注分析软件取得不同病变阶段肝实质的灌注参数,包括肝血流量(BF)、肝血容量(BV)、肝动脉血流量(HAF)、更多还原

【Abstract】 Because the morphologic change among different stages(liver fibrosis) is not obvious, so it is difficult for traditional imageology, which demonstrates anatomic structures mainly, to provide evaluated information for the clinical diagnosis of this disease. The blood flow of liver is an important factor to maintain its function, The hemodynamics of the liver is different in different stage of liver fibrosis. therefore the evaluation of blood flow perfusion index values is important to clinical diagnosis and therapy. MR diffusion-weighted imaging is the only technique that reflects the structure character of the tissue through detecting the kinestate of water molecule in live tissue. If the ADC values can reflect exactly the degree of liver fibrosis, it is obviously an simple and noninvasion new method compared to biopsy, at the same time, it is helpful to treat and evaluate the prognosis. Magnetization transfer technique can indirectly or semi-quantitatly reflect the change of molecule protein content. Our study research liver fibrosis and cirrhosis using CT perfusion DWI and MTC technique.Part I The evaluation of CT perfusion to liver fibrosis and cirrhosisand the correlation research with serum index. Objective According to the change of CT perfusion index in liver fibrosis andcirrhosis, and compare with control group ? pathologic and serum index, to analyses correlation among the change of hemodynami^ pathologic basis and serum index.Materials and Methods Dynamic spiral CT perfusion of the liver wereobtained in 39 patients with liver fibrosis, 41 patients with cirrhosis and 28 controlsubjects, perfusion parameter of hepatic parenchyma in different disease stageincluding hepatic blood flow(BF) > blood volume(BV) n hepatic arterialfraction(HAF)> mean transit time(MTT)> permeability surface(PS) were obtainedthrough liver perfusion analysis software, and to do contrast research and statisticanalysis with pathologic change, at the same time, make the correlation analysisamong MTT\ PS and serum index, using SNK-^ test and Dunnett to do theanalysis of variance, the Kruskal-waills to do the non-parameter statistic analysis,the Pearson correlation test and partial correlation test to do the correlationanalysis.Results1. BF(#=9.322,P=0.009)> HAF(F=10.68,PP=0.000)> MTT(F=4.358,JP=0.015) are difference among control group > liver fibrosis group and cirrhosis group, BF and HAF in three groups are increasing gradually, and MTT shorten in cirrhosis group.2. HAF (F=5.189,P=0.009) are different between control group and liver fibrosis S3 group.3. BV(F=3.689,P=0.034) , BF(F=8.933,P=0.001^ HAF(F=8.O33,P=O.OO1)> MTT(F=4.086,JP=0.025)> PS(F=3.479^=0.041) are different among Child A> B, C of cirrhosis, BV, BFs HAF(ChildA> Child B^ Child C) are increasing gradually, MTT shorten in Child C, PS increase in Child C.4. BF(F=10.316,P=0.000)> HAFCF=6.448,/M).000), MTT(F=3.754,ZM).008;k BV (F=4.011,i*=0.006), PS (JF=2.776,P=0.034) are different among S2>S3> Child A^ Child B, Child C, BV> BF are increasing gradually, MTT shorten in Child C.5. BV(F=4.616,/>=0.005;k BF(F=13.91^P=0.000)> HAF(F=16.47,P=0.000), MTT(F=5.703,P=0.002), PS(F=3.687,P=0.016) are different among control group and Child A, Child B, Child C, BF> BV> HAF are increasing gradually, MTT shorten.6. MTT is negative correlation with HA(r=-0.4614,P=0.047), PS is positive correlation with IV collogen (^=0.6653^=0.001).Conclusion BFs HAF, MTT are different among control groups liver fibrosis group and cirrhosis group, BF, HAF are increasing gradually, MTT shorten. MTT > PS can reflect the deposition of collogen and the change of microcirculation.Part II The evaluation of MR diffusion imaging and Magnetization transfer to hepatic fibrosis and cirrhosis, and the correlation researchwith CT perfusion and serum index.Objective: Use DWI and MTI technique to analyze the ADC values of liver fibrosis and cirrhosis, compare it with control group and pathologic to reflex the degree of liver fibrosis, and analyses the correlation with hemodynamic and serum index, the correlation between MTR and serum index in liver fibrosis. Materials and Methods Use DWI(b=500s/mm2) to evaluate the ADC values of 44 patients with hepatic fibrosis, 49 patients with cirrhosis and 46 control subjects, and do contrast research and statistic analysis with pathologic change and blood perfusion parameter, at the same time, use MTI to exam the patients, and contrast the MTR and serum index of hepatic fibrosis patients, use SNK-# test and Dunnett to do the analysis of variance, the Kruskal-waills to do the non-parameter statistic analysis, the Pearson correlation test and partial correlation test to do thecorrelation analysis. Results1. There is difference among control groupn hepatic fibrosis n hepatic cirrhosis when b value is 500 s/ mm2(JF=13.747,i’=0.000)2. There is difference between S2> S3 group and control group when b value is 500 s/ mm2CF=l7.831^=0.000), but there is difference between S2 and S3.3. The ADC values of Child -pugh An B> C has no difference when b value is 500 s/ mm2(F=1.694,P=0.195).4. There is difference between S3 and Child C when b value is 500s/mm2 (F=2.647, P=0.040).5. There is no correlation between ADC values of control and liver fibrosis group and CT perfusion index(P<0.05).6. The ADC values of cirrhosis group is positive correlation with CT perfusion index BV(r=0.456^P=0.003)> . BF(r=0.322vP=0.043).7. The Magnetization transfer rate among control group-, liver fibrosis> cirrhosis has no difference. (#=3.558, P=0.169)8. The Magnetization transfer rate is positive correlation with HA(r=0.8748,P=0.000).Conclusion: When b value is 500s/mm2, the ADC value has difference between liver fibrosis and cirrhosis patients and control group. The ADC value of cirrhosis patients is higher than that of liver fibrosis patients, which is related to the increase of hepatic blood volume;Magnetization transfer rate is positive correlation with HA, which reflect the deposition of collagen.更多还原