摘要
目的探讨CT动脉增强分数(AEF)直方图参数评价肝硬变严重程度的诊断价值。方法回顾性收集成都医学院第一附属医院2016年1月至2018年12月期间符合纳入标准且经临床确诊为肝硬变患者并按照Child-Pugh评分法分级,同时选取无肝脏疾病患者作为对照组。所有受试者均具有完整的上腹部三期增强CT图像以及肝功能生化检测资料。应用CT Kinetics软件获得AEF直方图,同时计算血清学指标天冬氨酸氨基转移酶和血小板比率指数(APRI)。比较不同Child-Pugh评分级别间AEF直方图参数和血清学指标APRI的差异性,采用受试者操作特征曲线下面积(AUC)评估其诊断效能。结果本研究共纳入85例肝硬变患者,Child-Pugh评分A级25例、B级41例、C级19例,对照组20例。同一观察者前后2次对AEF直方图参数测量和不同观察者间测量的一致性较好(组内相关系数分别为0.938和0.907)。AEF直方图参数中的平均值、中位数、峰度以及血清学指标APRI在肝硬变组A级、B级、C级和对照组间总体比较差异具有统计学意义(P<0.001)且其与肝硬变严重程度呈正相关(对应分别为rs=0.811、P<0.001;rs=0.827、P<0.001;rs=0.731、P<0.001;rs=0.711、P<0.001),其对应诊断A级肝硬变的AUC值分别为0.829、0.841、0.747和0.718,诊断B级肝硬变的AUC值分别为0.847、0.734、0.704和0.736,诊断C级肝硬变的AUC值分别为0.646、0.825、0.782、0.853。结论基于三期增强CT的AEF直方图参数中的中位数和平均值以及血清学APRI分别在诊断肝硬变A、B、C级方面的效能最好。
Objective To investigate the diagnostic performance of parameters of arterial enhancement fraction(AEF) based on enhanced CT with histogram analysis in the severity of liver cirrhosis. Methods The patients with liver cirrhosis clinically confirmed and met the inclusion criteria were included from January 2016 to December 2018 in the First Affiliated Hospital of Chengdu Medical College, then them were divided into grade A, B, and C according to the Child-Pugh score. Meanwhile, the patients without liver disease were selected as the control group. All patients underwent the upper abdomen enhanced CT scan with three-phase and the biochemical examination of liver function. The parameters of AEF histogram were obtained by using the CT Kinetics software, and the aspartic aminotransferase and platelet ratio index(APRI) was calculated. The differences of parameters of AEF histogram and APRI among these patients with liver cirrhosis and without liver disease were analyzed. The diagnostic performance was evaluated by using the area under curve(AUC) of receivers operating characteristic curve. Results Eighty-five patients with liver cirrhosis were included in this study, including 25, 41, and 19 patients with grade A, B, and C of Child-Pugh score, respectively, and there were 20 patients in the control group. The consistencies in measuring the parameters of AEF histogram twice for the same observer and between the two observers were good(intraclass correlation coefficient was 0.938 and 0.907,respectively). The mean, median, and kurtosis of AEF histogram and the APRI among the grade A, B, C of Child-Pugh score, and control group had significant differences(all P<0.001) and these indexes were positively correlated with the severity of liver cirrhosis(rs=0.811, P<0.001;rs=0.827, P<0.001;rs=0.731, P<0.001;rs=0.711, P<0.001). The AUC of the mean, median, kurtosis, and APRI in diagnosing grade A of liver cirrhosis was 0.829, 0.841, 0.747, and 0.718, respectively;which in diagnosing grade B of liver cirrhosis was 0.847, 0.734, 0.704, and 0.736, respectively;in diagnosing grade C of liver cirrhosis was 0.646, 0.825, 0.782, and 0.853, respectively. Conclusion The mean and median of AEF histogram parameters based on enhanced CT with three-phase and serological APRI are useful in diagnosis of grage A, B, and C of liver cirrhosis, respectively.
作者
刘书林
王智
王逸敏
唐芳
李红霞
张志
胡富碧
LIU Shulin;WANG Zhi;WANG Yimin;TANG Fang;LI Hongxia;ZHANG Zhi;HU Fubi(Department of Radiology,The First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2020年第1期97-102,共6页
Chinese Journal of Bases and Clinics In General Surgery
基金
四川省卫健委科研项目(项目编号：140018)
关键词
肝硬变
灌注成像
动脉增强分数
直方图分析
liver cirrhosis
perfusion imaging
arterial enhancement fraction
histogram analysis
