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目的探讨多层螺旋CT(MSCT)灌注扫描评价肾脏血流灌注的方法和价值,研究早期肝硬化时肾脏血流灌注的变化规律。资料与方法对19例经B超、CT、血生化检验、肝穿刺等确诊为早期肝硬化患者(早期肝硬化组)及17名体检者(正常组)行MSCT灌注扫描,描出其时间-密度曲线(TDC),测量并对比血流量(BF)、血容量(BV)、平均通过时间(MTI)和对比剂峰值时间(TTP)等灌注参数。结果各病例CT灌注的TDC合乎数据分析要求,正常组的左肾皮质TDC呈迅速上升阶段、峰值、迅速下降阶段和相对缓慢下降或近似平衡期阶段,左肾皮质平均峰值达148.70 HU,到达峰值时间平均为10.53 s。左肾皮质BF为(367.77±39.50)ml.min-1.100 g-1,BV为(21.91±9.82)ml/100g,MTT为(3.91±0.72)s,TPP为(10.53±3.98)s。早期肝硬化组的左肾皮质TDC形态与正常组比较无明显改变,但TDC上升速度相对缓慢,波峰高度有所下降,早期肝硬化组皮质和髓质的BF值均低于正常组,其中皮质的BF下降明显,与正常组间差异有统计学意义(P<0.05);而髓质的BF下降不明显,与正常组间差异无统计学意义(P>0.05);早期肝硬化组皮质和髓质的BV与正常组对比略有下降,两组间差异均无统计学意义(P>0.05);与正常组对比,早期肝硬化组皮质、髓质的MTT和TPP略有延长,但两组间差异均无统计学意义(P>0.05)。结论MSCT可正确评价肾组织血流灌注变化,MSCT灌注扫描能反映早期肝硬化时肾脏的血液动力学及血流灌注的改变特点,能为临床提供早期肾损害信息,对临床的治疗有重要价值。
Objective To investigate the method and value of MSCT perfusion scanning in evaluating renal perfusion and to study the changes of renal perfusion during early cirrhosis. Materials and Methods Nineteen patients with early cirrhosis (early cirrhosis) and 17 subjects (normal group) diagnosed by B-ultrasound, CT, blood biochemistry, liver biopsy and so on were performed MSCT perfusion scanning and their time-density (TDC) were measured and compared with perfusion parameters such as blood flow (BF), blood volume (BV), mean transit time (MTI) and contrast peak time (TTP) Results In all cases, the TDC of CT perfusion was in accordance with the data analysis. The TDC of the left renal cortex in the normal group showed a rapid increase phase, a peak, a rapid decline phase, a relatively slow decrease or an approximate equilibrium phase. The average peak value of the left renal cortex reached 148.70 HU, The average time is 10.53 s. The BF of the left renal cortex was (367.77 ± 39.50) ml.min-1.100 g-1, the BV was (21.91 ± 9.82) ml / 100g, the MTT was (3.91 ± 0.72) s and the TPP was (10.53 ± 3.98) s. The TDC morphology of left renal cortex in early cirrhosis group had no significant change compared with that in normal group, but TDC increased slowly and the peak height decreased. The cortical and medullary BF values in early cirrhosis group were lower than those in normal group, (P <0.05), while the decrease of BF in medulla was insignificant (P> 0.05). There was no significant difference between normal group and normal group (P> 0.05) Medullary BV slightly decreased compared with the normal group, the difference between the two groups was not statistically significant (P> 0.05); compared with the normal group, early cirrhosis group cortical and medullary MTT and TPP slightly longer, but two There was no significant difference between groups (P> 0.05). Conclusion MSCT can correctly evaluate the changes of perfusion in renal tissue. MSCT perfusion scan can reflect the changes of renal hemodynamics and perfusion during early cirrhosis, and provide early renal damage information for clinic, which is of great value to clinical treatment .