CT灌注成像在兔早期肝硬化诊断中的应用价值研究

目的:探讨CT灌注成像在兔早期肝硬化诊断中的应用价值。方法:将55只新西兰大白兔随机分为2组,其中实验组45只,对照组10只。实验组给予皮下注射葡萄籽油稀释的50%CCL4,1次/4天,前4次剂量为1.0 m L/kg,第5次剂量为1.35 m L/kg,共注射20次。对照组采用同样方法只注射相同剂量的生理盐水。每注射4次后分别对实验组兔7只和正常对照组兔2只做螺旋CT灌注扫描,分析灌注参数,同时做相应的病理学观察,将二者进行比较及统计学分析。结果:注药4次末,兔血清ALT及AST明显高于注药前,注药8次末,兔血清ALT及AST最高,之后兔血清ALT及AST轻度减低,注药前后兔血清ALT及AST的变化有统计学意义(P0.05)。而血清(ALB)水平变化不明显,仅在注药16次末后,ALB水平稍减低,但差异无统计学意义。对照组肝脏灌注参数正常,实验组从注药4次开始,HAP呈上升趋势,但注药4次末及注药8次末,实验组及对照组之间差异无统计学意义(P0.1),注药12次末后二者之间差异有统计学意义(P0.05);而HPP、HBF及HBV呈下降趋势,MTT逐渐延长,与对照组的差异均有统计学意义(P0.05)。随兔血清ALT及AST的升高,HAP逐渐升高,MTT逐渐延长,而HPP、HBF及HBV逐渐减低。实验组肝小叶正常结构破坏,肝实质被纤维组织分割成大小不一、圆形或近圆形结节(假小叶),间隔较窄,炎症轻,结节边界尚整齐;汇管区内门脉小支扩张,壁增厚。对照组肝小叶结构规整,肝板排列有序,汇管区无扩大,其内个别炎细胞浸润,肝小叶内偶见点灶状坏死。结论:全肝CT灌注功能成像可为早期肝硬化的诊断提供影像学依据,将灌注征象与病理学变化结合有利于肝硬化的早期诊断和治疗。

Application Value of CT Perfusion Imaging for the Early Diagnosis of Liver Cirrhosis in Rabbits

ABSTRACT Objective: To explore the value of CT perfusion imaging in the early diagnosis of liver cirrhosis in rabbits. Methods: Fifty-five New Zealand white rabbits were randomly divided into two groups, 45 were in the experimental group and 10 were in the nor- mal control group. The experimental group was given subcutaneous injection of 50% CCL4 diluted with grape seed oil, 1 dose /4 days, the previous 4 doses were 1.0 mL/kg, the fifth dose was 1.35 mL/kg, with 20 injections. The control group received the same dose of saline in the same way. After each injection of 4 times, spiral CT perfusion scan was performed on 7 rabbits of the experimental group and 2 rabbits of the normal control group, and perfusion parameters were analyzed. Meanwhile, corresponding pathological observations were made and the two were compared and statistically analyzed. Results: At the end of 4 times of drug injection, the serum ALT and AST of rabbits were significantly higher than before and at the end of 8 times of drug injection, and the serum ALT and AST were the highest in rabbits. After that, the serum ALT and AST were slightly decreased, and the changes of serum ALT and AST of rabbits before and after drug injection were statistically significant (P<0.05). However, the serum (ALB) level did not change significantly, and only de- creased slightly after 16 times of drug injection, but the difference was not statistically significant. Liver perfusion parameters were nor- mal in the control group, and HAP was on the rise in the experimental group from 4 times of drug injection, but the difference between the experimental group and the control group was not statistically significant (P>0.1), and the difference was statistically significant after 12 times of drug injection(P<0.05). However, HPP, HBF and HBV showed a downward trend, and MTT was gradually extended, with statistically significant differences from the control group(P<0.05). With the increase of ALT and AST, HAP gradually increased, MTT gradually lengthened, and HPP, HBF and HBV gradually decreased. The normal structure of hepatic lobule was damaged in the experi- mental group, and the hepatic parenchyma was divided into round or nearly circular nodules (false lobules) by fibrous tissue in the liver parenchyma.The inner portal vein of the manifold area expanded and the wall thickened. In the control group, the hepatic lobule structure was orderly, the hepatic plate was arranged in an orderly way, and there was no expansion of the sink area. Conclusion: Whole liver CT perfusion imaging can provide imaging basis for the diagnosis of early liver cirrhosis, and the combination of perfusion signs and patho- logical changes is helpful for the early diagnosis and treatment of liver cirrhosis.