The Value of CT Perfusion Imaging for Evaluating Pre-operative Hepatic Functional Reserve of Primary Liver Cancer Complicated with Hepatic Fibrosis
|School||Luzhou Medical College|
|Keywords||primary liver cancer hepatic fibrosis cirrhosis hepatic functional reserve computed tomography perfusion Child-Pugh classification the standardized estimated liver remnant ratie|
Objective:To observe some cases of primary hepatic cancer complicated with liver fibrosis gived the surgical treatment.The degree of fibrisis was from S1 to S4 .To analyze the relationship between the parameters of CT perfusion,the Child-Pugh classification and the standardized estimated liver remnant ratio and post-operative liver dysfunction.We researched the val- ue of the indicators of 3 aspects for evaluating pre-operative hepatic functi- onal reserve. Methods:The test group included 18 cases of pramary liver cancer complicated with hepatic fibrosis who were gived surgical treatment. All patients were gived pre-operative heptic CT perfusion scan,CT scan and CT general enhanced scan.The post-operative biopsy proved hepatic parenchyma had defferent degree of fibrosis which was from S1 to S4 .The control group included 10 cases of healthy who was gived CTP scan.We hoped find a sensitive parameter of CTP when hepatic parenchyma had fibrosis.The degree of fibrosis was from S 1 to S 4 .Combinating the sensitive parameter of CTP with Child-Pugh classification and STELV, we observed whether patients were complicated with liver dysfunction after suegical treatment.In the same Child-Pugh classification,we put the sensiti- ve parameter of CTP and STELV as discriminant indicators and the emerg- ence of hepatic dysfunction as discriminant result.we carried out statistical analysis and established a discriminant formula for trying to find a means which can analyse hepatic functional reserve of primary hepatic cancer complicated with fibrosis quantitatively. Results:(1)The Child-Pugh classification of all patients in the test group were in A geade.All patients in the test group were confirmed that the hepatic parenchyma had varying degrees of fibrosis through post-operative biopsy.The degree were all in the degree of S1-S4 .(2)Through Pre-operative CT and enhanced CT scan, we did not find obvious change of cirrhosis in shape and profile.(3)In the test group,the average data of HPP is 85.94±6.00ml/min ? 100g.That of the control group was 93.5±9.56ml/min ?100g.There was significant differen- ce in the two groups statistically.HPP of the test group was significant lower than the control group.In the test group,the average data of HAP was 27.89±4.74ml/min?100g.That of the control group was 25.10±2.85ml/ min ? 100g.There was not significant difference in the two groups.In the test group,the average date of TLP was 113.83±2.39ml/min ? 100g.That of the control group was 118.60±7.53 ml/min ? 100g.There was not significant difference in the two groups statistically.In the test group,the average data of PPI about hepatic parenchyma was 0.75±0.10%.That of the control group was 0.78±0.11%.There was not significant difference in the two groups.We can got this conclusion.When the degree of hepatic fibrosis was from S1 to S4 ,the change of TLP,PPI and HAP were not obvious.However, HPP was obvious.HPP is more sensitive than the HAP.So we choosed HPP as one of discriminant indicators for evaluating the hepatic functional reserve.(4) In the same Child-Pugh classification,we put HPP and STELV as discriminant indicators and the the the emergence of hepatic dysfunction as discriminant result.We carried discriminant analysis.At last,we got two discriminant equations:f1=5.533X1+375.418X2 -382.957;f2 =5.221X1+ +354.685X 2 -341.385.Wilks’Lambda value was 0.610,P=0.024<0.05.It were significant discriminant equations.Conclusion:HPP of CTP parameters can measure the change of blood flow in the degree from S1 to S4 .So HPP can be used to analyze the degree of hepatic fibrosis and evaluate hepatic functional reserve.In the base of Child-Pugh classification, combinaton of CTP parameters and STELV are a practical means that can assess pre-operative hepatic functional reserve for primary liver cancer complicated with hepatic fibrosis.