摘要
目的:探讨上腹部低剂量动态容积CT灌注成像(dVPCT)在评估急性重症胰腺炎(SAP)肝脏微循环中的价值。方法:前瞻性对2020年2月-2021年3月在本院就诊的309例AP患者在入院后7~10天进行上腹部动态容积CT灌注成像。最终纳入45例SAP患者[改良CT严重指数(MCTSI)评分为8~10分]。将同期因怀疑上腹部病变(但无AP病史、胰腺占位及上腹部器质性病变)而行上腹部动态容积CT灌注成像的40例患者(对照组)纳入本研究。基于CT灌注成像数据重建动脉期、胰腺实质期及门静脉期增强图像,选取肝脏最大层面及其上、下第5层面,沿肝脏轮廓勾画ROI,避开大血管、胆管及肝脏边缘,获取3个层面上肝脏的平均灌注参数值,包括血流量(BF)、血容量(BV)、平均通过时间(MTT)、肝脏动脉灌注(ALP)、肝脏门静脉灌注(PVP)和肝脏灌注指数(HPI)。由两位有经验的放射科医师分别对患者的MCTSI评分进行独立评估,并采用Kappa一致性检验对两者的一致性进行评估。采用独立样本t检验比较SAP组与对照组之间各项肝脏灌注参数值的差异。结果:两位诊断医师对SAP患者的MCTSI评分具有较高的一致性(Kappa系数为0.731)。SAP组与对照组之间各项肝脏灌注参数值的差异均有统计学意义(P<0.05)。其中,两组的BF值分别为(58.12±12.79)和(50.40±16.05)mL/(100mL·min);BV值分别为(7.88±2.12)和(5.80±2.53)mL/100mL;MTT值分别为(8.23±0.94)和(6.73±1.37)s;ALP值分别为(13.18±5.20)和(20.25±9.41)mL/(100mL·min);PVP(84.67±19.89)和(49.49±26.27)mL/(100mL·min);HPI值分别为14.88%±6.46%和41.48%±26.55%。SAP患者的PVP和HPI与MCTSI评分之间无显著相关性(P值分别为0.658及0.675);而BF、BV、MTT和ALP均与MCTSI评分具有显著相关性(r值分别-0.525、-0.563、-0.533和-0.305,P值分别为0.001、0.001、0,001和0.042)。上腹部dVPCT扫描的DLP为(597.30±61.79)mGy·cm,ED为(8.96±0.92)mSv。结论:基于上腹部dVPCT发现SAP组肝脏实质多个灌注参数较对照组有显著改变,反映了SAP可造成肝脏微循环变化,这可能是急性重症胰腺炎肝脏密度改变及肝损伤的原因之一。
Objective:The purpose of this study was to investigate the value of low radiation dose dynamic volume perfusion computed tomography(dVPCT)of the upper abdomen in evaluating hepatic microcirculation in patients with severe acute pancreatitis(SAP).Methods:A prospective study included 309 patients with acute pancreatitis(AP)who presented to our hospital from February 2020 to March 2021.Dynamic volume perfusion CT(dVPCT)scan of the upper abdomen was performed 7~10 days after hospitalization.A total of 45 patients with SAP[based on modified CT severity index(MCTSI)score of 8~10]were ultimately included.During the same period,40 patients with suspected upper abdominal lesions were enrolled as controls based on the following criteria:no history of AP;no pancreatic masses;no organic upper abdominal lesions.Enhanced images of the arterial phase,panc-reatic parenchymal phase,and portal venous phase were reconstructed from dVPCT imaging data.Three slices were selected out for ROIs delineating,the first slice was the center slice on which the liver showed maximal cross-sectional area,and two additional slices were five layers above and below the maximum slice.On each slice,ROIs were manually delineated along the hepatic contour,carefully avoiding large vessels,bile ducts,and the liver margins.Perfusion parameters were measured on three levels.The average values of hepatic perfusion parameters were calculated,including blood flow(BF),blood volume(BV),mean transit time(MTT),arterial liver perfusion(ALP),portal venous perfusion(PVP),and hepatic perfusion index(HPI).Two experienced abdominal radiologists independently reviewed all CT images and calculated the modified CT severity index(MCTSI).Interobserver agreement on MCTSI scoring was assessed using Cohen’s Kappa statistic.t-test was used to compare the hepatic perfusion parameters between the SAP group and the control group.Results:The diagnostic consistency between the two radiologists in evaluating MCTSI was strong,with a kappa coefficient of 0.731.Significant differences in liver perfusion values were observed between the SAP and control groups(all P<0.05).In the two groups,the BF values were(58.12±12.79)and(50.40±16.05)mL/(100mL·min),the BV values were(7.88±2.12)and(5.80±2.53)mL/100mL,the MTT values were(8.23±0.94)and(6.73±1.37)s,the ALP values were(13.18±5.20)and(20.25±9.41)mL/(100mL·min),PVP values were(84.67±19.89)and(49.49±26.27)mL/(100mL·min),and the HPI values were 14.88%±6.46%and 41.48%±26.55%,respectively.In the correlation analysis of SAP MCTSI scores with liver perfusion parameters,no significant correlation was found for PVP and HPI(P-values were 0.658 and 0.675,respectively).However,BF,BV,MTT and ALP of SAP showed significant correlations with MCTSI scores,with P-values of 0.001,0.001,0.001 and 0.042(all P<0.05),and r-values of-0.525,-0.563,-0.533 and-0.305,respectively.The radiation dose of the upper abdominal dVPCT scan was recorded as DLP of(597.30±61.79)mGy·cm(range:538.0~749.9mGy·cm),and effective dose(ED)of(8.96±0.92)mSv(range:8.07~11.25mSv).Conclusion:dVPCT imaging of the upper abdomen revealed significant alterations in multiple hepatic perfusion parameters in SAP patients compared with the control group.SAP can induce changes in hepatic microcirculation,which may contribute to alterations in hepatic density or liver injury in these patients.
作者
兰茜琳
周奕
刘婷
余文庆
张仕勇
俞溪
彭金成
麦刚
明兵
LAN Xi-lin;ZHOU Yi;LIU Ting(Department of Radiology,Deyang People’s Hospital,Sichuan 618000,China)
出处
《放射学实践》
北大核心
2025年第8期989-994,共6页
Radiologic Practice
基金
德阳市科技局社会发展领域创新指导项目(2022SCZ139)。
