肝脏CT灌注成像技术及其在肝硬化中的初步应用

目的　采用单层CT动态成像测定肝脏血流量 ,探讨CT灌注成像测定肝血流量的技术原理。资料与方法　 15例经临床及实验室、B超检查诊断为肝硬化患者 ,其中ChildB级者 10例 ,ChildC级者 5例。对照组为 13例无肝脏疾病者。所有患者均选取同时含有肝脏、脾脏、主动脉和门静脉的层面进行单层CT动态增强扫描 ,绘制感兴趣区时间 密度曲线计算肝脏血流量各参数。结果　正常组肝动脉灌注量 (HAP)为 0 .2 82 3± 0 .0 96 9ml·min-1·ml-1,门静脉灌注量 (PVP)为 (1.1788± 0 .4 0 0 4 )ml·min-1·ml-1,总肝血流量 (THBF)为 (1.4 5 6 3± 0 .4 4 39)ml·min-1·ml-1,肝动脉灌注指数 (HPI)为 (19.73± 5 .81) %。肝硬化时PVP为 (0 .6 12 1± 0 .2 5 4 4 )ml·min-1·ml-1,较正常组降低 ;THBF也减低 ,为 (0 .84 2 6± 0 .32 4 2 )ml·min-1·ml-1。肝硬化患者的HPI较正常组略有升高 ,为 (2 7.16±12 .75 ) % ,但无统计学差异 (P =0 .0 6 5 )。结论　肝脏CT灌注成像可定量测定肝脏血流量参数     

肝转移瘤64层CT灌注成像的临床应用

目的 探讨肝转移瘤64层CT灌注特征及其临床应用价值.方法 对23例(40个病灶)肝转移瘤患者进行CT灌注扫描,获得灌注参数血流量(BF)、patlak血容量(Pbv)、血管通透性(P)、肝动脉灌注量(ALP)、门静脉灌注量(PVP)、肝动脉灌注指数(HPI).结果 (1)正常肝组织的灌注参数BF、 Pbv、 P、ALP、PVP、HPI分别为(47.85±8.11) ml·100 ml-1·min-1、41.25±6.32(1000GA9551)、64.25±11.10 (0.5 ml·100ml-1·min-1)、(24.55±2.96) ml·100ml-1·min-1、(105.24±16.42)ml·100ml-1·min-1、(20.18±3.81)%.(2)病灶中心与正常肝组织比较,BF、Pbv、P、ALP、HPI(P＜0.01),PVP(P＜0.05)有统计学意义;灶周组织与正常肝组织比较,Pbv、ALP、HPI有统计学意义(P＜0.01),而BF、P、PVP无统计学意义;病灶中心与灶周组织比较BF、P(P＜0.01),Pbv、ALP(P＜0.05)有统计学意义.(3)CT灌注图像测得肝转移瘤病灶面积明显较原始图像中所测得的面积大.结论 CT灌注成像对于肝转移瘤早期诊断及鉴别诊断有帮助;对于临床确定手术切除范围及预后有重要意义.     

CT灌注成像在经颈静脉肝内门体分流术中的应用

目的 运用螺旋CT灌注成像评价经颈静脉肝内门体分流 (TIPSS)术后肝脏血流灌注的变化.资料与方法 对15例行TIPSS治疗的肝硬化门脉高压症患者分别于手术前2天和术后1周行螺旋CT单层肝脏动态增强扫描,比较手术前后肝脏灌注参数的变化.结果 TIPSS术前门静脉灌注量(PVP)、肝动脉灌注量(HAP)、总肝灌注量(TLP)和肝动脉灌注指数(HPI)分别为(0.58±0.23) ml·min-1·ml-1、(0.14±0.13) ml·min-1·ml-1、(0.72±0.17) ml·min-1·ml-1和(24.0±10.2)%;TIPSS术后则分别为(0.15±0.04)ml·min-1·ml-1、(0.28±0.05) ml·min-1·ml-1、(0.43±0.07) ml·min-1·ml-1和(64.1±13.9)%;TIPSS术前后肝功能、血氨、门静脉自由压(PFP)等指标组间比较有统计学差异.结论 螺旋CT灌注成像能客观评价肝硬化门脉高压症TIPSS术前后肝血流动力学的变化.     

CT灌注成像对肝硬化血流动力学的临床研究

目的　采用单层CT动态成像测定肝脏血流量 ,研究肝硬化程度与肝脏血流量动态变化的关系。方法　对 2 7例肝硬化患者及 13例对照者选取同时含有肝脏、脾脏、主动脉和门静脉的层面进行单层CT动态增强扫描 ,绘制感兴趣区时间 密度曲线 ,计算肝脏血流量各参数。结果　正常组肝动脉灌注量为 (0 2 82 3± 0 0 96 9)ml·min-1·ml-1,门静脉灌注量为 (1 1788± 0 4 0 0 4 )ml·min-1·ml-1,总肝血流量为 (1 4 5 6 3± 0 4 4 39)ml·min-1·ml-1,肝动脉灌注指数为 (19 73± 5 81) %。肝硬化程度不同时 ,肝动脉灌注量、门静脉灌注量、肝脏总血流量及肝动脉灌注指数变化间差异存在显著性意义。ChildA、B级患者肝动脉灌注量 [(0 16 85± 0 10 6 8)ml·min-1·ml-1,(0 192 1± 0 0 986 )ml·min-1·ml-1]降低 ,而ChildC级患者肝动脉灌注量 [(0 30 72± 0 114 5 )ml·min-1·ml-1]比ChildA、B级患者增加 ,肝动脉灌注指数 [(37 4 8± 16 6 5 ) % ]也增加。ChildB、C级患者门静脉灌注量 [(0 6 331± 0 2 0 70 )ml·min-1·ml-1,(0 5 70 2± 0 35 6 2 )ml·min-1·ml-1]及总肝血流量 [(0 82 5 2± 0 2 95 2 )ml·min-1·ml-1,(0 8774± 0 4 118)ml·min-1·ml-1]下降。结论　肝脏CT灌注成像可定量测     

正常肝脏CT灌注成像技术及灌注参数图像重建方法探讨

目的探讨肝脏CT灌注成像扫描程序、灌注参数计算和灌注参数图像重建方法。方法对30例无任何肝脏疾病的正常肝脏进行同层动态增强扫描,用最大斜率法进行肝脏CT灌注参数的计算,利用去卷积法的图像重建功能,经改进后进行肝脏CT灌注参数图像的重建,重建出肝动脉灌注量(HAP)、门静脉灌注量(PVP)、肝动脉灌注指数(HPI)及门静脉灌注指数(PPI)等4种图像。结果最大斜率法计算的正常肝脏CT灌注参数:HAP、PVP、全肝总灌注量(TLP)、HPI、PPI分别为(0.3355±0.1269)ml·min-1·ml-1、(1.1034±0.2065)ml·min-1·ml-1、(1.4389±0.2398)ml·min-1·ml-1、(23.3±10.2)%、(76.7±10.2)%;在重建出的HAP图像上,肝实质呈中等程度的灌注,在PVP图上肝实质呈明显均匀高灌注,在HPI和PPI图上的表现分别与HAP和PVP类似。在重建图像上测得的HAP、PVP、HPI、PPI分别为(0.3489±0.12)ml·min-1·ml-1、(1.2084±0.37)ml·min-1·ml-1、(22.41±8.31)%、(77.59±8.31)%,并据HAP、PVP计算出的TLP为(1.5573±0.42)ml·min-1·ml-1,与最大斜率法结果比较均无显著性差别。结论采用1次屏气,注射40~50ml对比剂,注射速度为4~5ml·s-1,从注射对比剂后7~9s开始连续扫描45s共45层的扫描方式,基本能反映各组织结构的血液动力学变化过程,是较理想并实用的扫描方案;采用改进后重建方法重建出的灌注参数图像,能直观地反映肝脏的血流灌注特征,是一种简单实用的灌注图像重建方法,值得进一步临床应用和推广。     

肝硬化门静脉高压多层螺旋CT灌注成像的临床应用研究

目的:探讨多层CT灌注成像在肝硬化门静脉高压中的临床应用价值.材料和方法:肝硬化43例,按有无腹水、上消化道出血门静脉高压并发症分4组.采用彩色灌注图法获得各肝脏灌注参数;30例正常人作对照.结果:对照组、单纯肝硬化组、出血组、腹水组、混合组的灌注参数分别为:肝动脉灌注量(HAP)为24.80±5.84、18.09±6.65、23.44±11.08、20.94±7.23、17.29±3.41 ml·min-1·100ml-1,门静脉灌注量(PVP)为104.91±21.70、91.68±20.14、78.43±28.92、67.26±12.95、54.08±3.88 ml*min-1*100ml-1,总肝灌注量(TLP)为 129.90±25.19、109.76±21.22、101.86±25.11、88.20±13.04、71.37±2.89 ml·min-1·100ml-1,肝动脉灌注指数(HPI,%)为19.13±3.33、16.82±5.92、24.42±14.34、23.96±8.18、24.22±4.65.组间存在显著性差异(P＜0.05);以肝硬化组43例的TLP的平均值97.1 ml·min-1·100ml-1为阈值,TLP对腹水/上消化道出血门静脉高压并发症发生的阳性预测值为88.0%,阴性预测值为83.3%.结论:多层螺旋CT灌注成像可评价肝硬化门静脉高压血流灌注变化.TLP对于预测肝硬化门静脉高压并发症有较高的临床应用价值.     

大鼠诱发性肝硬化和肝癌的CT灌注成像研究

目的 探讨肝癌演化过程中,肝脏血液动力学的变化规律. 材料与方法 2～3月龄的雄性Wistar大鼠105只,随机分成4组:A、B 、A1、B1.A组为肝硬化组(35只);B组为肝癌组(60只);A1为A的对照组(5只);B1为B的对照组(5只).A、B两组大鼠分别用浓度为100 ppm的二乙基亚硝胺(DENA)水溶液诱导12周和20周.A1、B1两组大鼠则常规饲养.以0.6 ml的对比剂和0.2 ml/s的注射流率对这4组大鼠进行肝脏CT灌注成像,测量全肝的灌注参数并与病理进行对照. 结果 肝硬化组、肝癌组的肝动脉灌注量(HAP)、肝动脉灌注指数(HPI)分别为(57.7±14.3)ml·min-1·100ml-1、(65.3±16.8)ml·min-1·100ml-1和(61.4±8.8)%、(71.3±10.0)%,均明显高于各自的对照组(F值分别为7.96、11.03、31.67、45.54,P值均＜0.01),而门静脉灌注量(PVP)分别为(35.9±9.7)ml·min-1·100ml-1、(26.9±14.3)ml·min-1·100ml-1,低于相应的对照组(F值分别为27.47、23.30,P值均＜0.01).肝硬化组与肝癌组的HAP无统计学差异(F=1.55,P＞0.05),但后者的PVP更低(F=3.94,P＜0.05),HPI更高(F=7.20,P＜0.01).2个对照组的各项灌注参数差异均无统计学意义. 结论 在从正常肝脏到肝硬化最后发展成肝癌的过程中,肝脏的HAP和HPI逐渐升高,而PVP则逐渐降低.     

CT灌注成像评价前列地尔脂微球对TACE前后非癌肝组织血流灌注的影响

目的 运用CT灌注成像评价前列地尔脂微球(liposome prostaglandin E1,Lipo-PGE1)对经动脉化疗栓塞术(transarterial chemoembolization, TACE)治疗肝细胞癌(hepatocellular carcinoma,HCC)前后非癌肝组织血流的影响.资料与方法 连续搜集46例HCC患者资料,随机分成实验组和对照组,各23例.采用CT灌注扫描比较两组患者的肝血流灌注情况.结果 TACE术前实验组肝动脉灌注量(HAP)、门静脉灌注量(PVP)及总肝灌注量(TLP)分别为(0.18±0.13) ml·min-1·ml-1、(1.64±0.44) ml·min-1·ml-1及(1.82±0.32) ml·min-1·ml-1,对照组则分别为(0.16±0.17) ml·min-1·ml-1、(1.41±0.37) ml·min-1·ml-1、(1.57±0.28) ml·min-1·ml-1, 其中PVP、TLP组间比较差异有统计学意义(P=0.00)、(P=0.01),HAP组间比较差异无统计学意义(P>0.05);对照组TACE术后1个月HAP、PVP、TLP分别为(0.09±0.07) ml·min-1·ml-1、(1.35 ±0.27) ml·min-1·ml-1、(1.44±0.18) ml·min-1·ml-1,与术前HAP、TLP组间比较差异有统计学意义(P=0.00)、(P=0.02);PVP组间比较差异无统计学意义(P>0.05);实验组TACE术后1个月HAP、PVP、TLP分别为(0.19±0.11) ml·min-1·ml-1、(1.71± 0.34) ml·min-1·ml-1)、(1.90±0.33) ml·min-1·ml-1,与术前组间对比差异无统计学意义(P>0.05).结论 CT灌注成像可定量评价TACE前后非癌肝组织血流灌注的变化;Lipo-PGE1能促进肝血流灌注,有利于肝功能的恢复和改善.     

多层螺旋CT肝脏灌注成像评价慢性肝纤维化、肝硬化的价值

目的 探讨MSCT灌注参数评价慢性肝纤维化、肝硬化的价值.方法 对经肝穿刺病理活检确诊的轻度肝纤维化(肝纤维化分期为S1、S2期)31例,重度肝纤维化(肝纤维化分期为S3、S4期)和(或)早期肝硬化34例,具有典型临床症状和影像表现的晚期肝硬化42例以及对照组30例行16层螺旋CT肝脏灌注扫描,取得不同病变阶段肝实质的灌注参数,包括肝动脉灌注量(HAP)、门静脉灌注量(PVP)、全肝总灌注量(TLP)、肝动脉灌注指数(HPI)及达峰时间(TTP)5个指标,并与病理分期作对照研究.各组肝脏不同CT灌注参数值的比较采用方差分析;各灌注参数值与肝纤维化严重程度的相关性采用秩相关分析;采用多因素分析(Logistic回归)探讨肝脏灌注参数值中对肝纤维化病理分期影响最大的指标.结果 对照组、S1、S2期组、S3、S4期组及肝硬化组的HAP值分别为(28.9±8.6)、(24.6±2.4)、(29.2±2.3)和(38.9±7.0)ml·100 ml-1·min-1,表现为先下降后增高,各组间差异有统计学意义(F =40.26,P＜0.01);上述各组PVP分别为(111.3±18.1)、(92.9±5.3)、(73.0±9.0)和(54.1 ±13.8)ml·100 ml-1·min-1,TLP分别为(140.2 ±25.9)、(117.1±4.5)、(102.3±8.7)和(93.0±ll.8)ml.100 ml-1·min-1,差异均有统计学意义(F值分别为136.79、67.40,P值均＜0.01);各组的HPI分别为(20.4±2.6)％、(21.0±2.1)％、(28.5±3.1)％和(42.6±1 1.1)％,TTP分别为(123.7±22.2)、(137.1 ±27.1)、(145.0±28.6)和(166.5 ±25.1)s,差异亦均有统计学意义(F值分别为93.05、17.37,P值均＜0.01).PVP、TLP与肝纤维化严重程度呈显著负相关,r值分别为-0.920和-0.846,P值均＜0.01;HAP、HPI、TTP则与肝纤维化程度呈正相关关系,r值分别为0.611、0.882和0.545,P值均＜0.01.在肝脏CT灌注扫描的参数值中,PVP的标准化回归系数最大(-8.798).ROC曲线判断得到的最佳临界点PVP =84.76 ml· 100 ml-1· min1作为重度肝纤维化S3、S4期和(或)早期肝硬化的诊断阈值,其敏感度和特异度分别为0.890、0.950,准确度达0.931.结论MSCT灌注参数能反映肝纤维化、肝硬化的血流动力学改变;CT灌注成像有助于鉴别重度肝纤维化和(或)早期肝硬化及晚期肝硬化.     

经颈静脉肝内门腔分流术后肝血流变化的综合影像评价

目的 探讨经颈静脉肝内门腔分流术(TIPSS)后肝血流的变化情况以及两者之间的关系.方法 对9例因肝硬化而实施TIPSS的患者术前1周、术后72 h进行CT灌注扫描,并在分流通道建立前、后进行门静脉测压.其中3例患者在术后3个月和6个月复查了CT灌注扫描成像.所有患者在术后48 h内进行了Doppler超声检查,并于术后3个月(9例)和6个月(6例)行Doppler超声复查.2例患者在术后6个月进行了TIPSS支架造影和门静脉测压.结果 全部患者术前门静脉灌注量(PVP)为(0.92±0.18)ml·min-1·ml-1,总灌注量(THBF)为(1.28±0.17)ml·min-1·ml-1,动脉灌注指数(HPI)为(28±8)%,门静脉自由压(PVFP)为(23.92±0.86)mm Hg(1 mm Hg=0.133 kPa);术后72 h测得PVP为(0.21±0.15)ml·min-1·ml-1,THBF为(0.74±0.18)ml·min-1·ml-1,HPI为(74±13)%,PVFP为(12.62±1.54)mm Hg;术后3个月和6个月PVP分别为(0.49±0.05)ml·min-1·ml-1和(0.57±0.03)ml·min-1·ml-1;术前PVP与PVFP之间存在负相关(r=0.678,P＜0.05),术后PVP与PVFP之间无线性相关性(r=0.543,P＞0.05),TIPSS导致PVFP平均值下降梯度与门静脉灌注减少量之间存在正相关(r=0.867,P＜0.01).Doppler超声监测TIPSS术后48 h肝门静脉血流情况:主干为(27.9±3.4)cm/s,支架内为(62.6±6.4)cm/s;肝内门静脉分支均为出肝血流,门静脉左支(18.9±7.2)cm/s、右支为(6.6±3.2)cm/s.术后6个月主干为(15.6±1.1)cm3/s,支架(9.8±5.7)cm3/s.结论 TIPSS术后PVFP平均值下降的同时伴有大量门静脉血流成为无效灌注,无效PVP与PVFP平均值下降直接相关.肝动脉无法代偿门静脉有效灌注量的下降.     

不同肝病患者血清中肝再生增强因子水平的检测及意义

目的 建立血清肝再生增强因子（ALR）的酶联免疫检测方法，了解不同肝病患者血清中ALR水平及其意义。方法 利用ALR的酶联免疫方法检测不同肝病患者外周血清中ALR水平。结果 所建立的ALR酶联免疫方法其最低检测到的ALR浓度为0.1μg/L，在10ng/ml范围内抗体与ALR的反应呈良好的线性关系，与TGF－α，EGF等其它促肝细胞增殖因子无任何交叉反应。重型肝炎患者血清中ALR水平最高，急性肝炎次之，两者均非常显著高于正常人，慢性肝炎，肝炎后肝硬变，原发性肝癌和肝外疾病患者（P＜0.05和P＜0.01)；慢性肝炎和肝炎后肝硬变患者血清中ALR水平亦明显高于正常人（P＜0.05)；原发性肝癌和肝外疾病患者血清ALR水平与正常人无明显差异（P＞0.05)。结论 ALR酶联免疫检测方法对于不同肝病患者血清中ALR的检测具有良好的特异性和敏感性；肝病患者血清ALR的增多可能与肝损害及肝脏的再生有密切关系。     

肝癌药物碘油栓塞术常见并发症

本文报道44例肝癌行82次药物碘油栓塞术所见的并发症及处理。一般反应有术中迷走神经反射,术后栓塞综合征。严重的并发症主要有术后消化道大出血3例:肝癌破裂引起腹腔内及消化道大出血1例;严重感染3例。对消化道及肝癌破裂出血者,作者采用导管动脉灌注血管收缩剂或动脉栓塞止血获得良好效果。     

Focal Nodular Hyperplasia with Retraction of Liver Capsule: A Case Report

Focal nodular hyperplasia (FNH) is characterized by the presence a central scar with radiating fibrous septa. Our case had a capsular retraction, which was the result of an extension of the central scar to the surface. In addition, a hypointense scar on the T2-weighted image and a minimal enhancing central scar on the enhanced T1-weighted image, which was due to dense, sclerotic collagenous tissue, were observed. We report the first case of FNH with a capsular retraction.     

CT灌注扫描在肝肿瘤的临床应用

目的 研究肝脏良恶性肿瘤多层螺旋CT各灌注参数的改变和良恶性肿瘤的鉴别诊断。资料与方法 100名受检者行肝血流的CT灌注扫描,其中良性肿瘤组15例,恶性肿瘤组81例,正常组4例。应用去卷积算法模式计箅相应病变区域的血流量（BF）、血容量（BV）、平均通过时间（MTT）、毛细血管通透性（PS）、肝动脉指数（HPI）和肝动脉灌注量（HAP）。根据不同肿瘤的相关参数图来评价良恶性肿瘤血流动力学状态。结果 81例肝脏恶性肿瘤患者HPI、BF及HAP明显高于良性肿瘤及正常组织,而MTT却明显降低;BV和PS值与良性肿瘤及正常组织无显著差异。结论 灌注参数HPI、BF、MTT和HAP可有效地评价肝脏肿瘤的血流状态,在肝脏良恶性肿瘤的鉴别诊断中有重要的临床应用价值。     

多层面CT在肝移植受体术前评估中的应用

目的:探讨多层面CT在肝移植受体术前评估中的应用价值.材料和方法:我们总结分析了自2003年11月至2004年8月52例接受多层面CT检查的晚期肝病患者.采用薄层动态增强扫描,横断面图像 CT血管造影技术,评估肝脏实质病变及血管变异情况.结果:其中接受肝移植手术26例,其中有6例肝动脉变异,与术前判断完全吻合.5例门脉癌栓形成及5例血栓形成中各有1例误诊.结论:多层面CT是一种快捷、无创、价廉的检查手段,可为肝移植受体术前评估提供详尽且准确的解剖及病变信息.     

Quantitative Evaluation of Liver Function with MRI Using Gd-EOB-DTPA

Objective

Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) is a newly developed MR contrast agent. After intravenous injection, Gd-EOB-DTPA is gradually taken up by the hepatocytes and eventually excreted via the biliary pathway without any change to its chemical structure. Because of these characteristics, it can be used as a tracer for quantitative liver function testing. The purpose of this study is to develop a noninvasive method of quantitation of the hepatic function using Gd-EOB-DTPA through the deconvolution analysis.

Materials and Methods

Adult New Zealand white rabbits (n = 10, average body weight = 3.5 kg) were used in the present study. Hepatic injury was induced to by the intragastric administration of carbon tetrachloride (CCl4) three times a week for three weeks. Liver enzyme (aspartate aminotransferase, AST; alanine aminotransferase, ALT) levels and the plasma indocyanine green (ICG) retention rate 15 minutes after an intravenous injection of ICG (ICG R15), was checked before and after the three-week administration of CCl4. At the end of experimental period, an observer "blinded" to the treatment given the rabbits performed the histological examination. MRI studies were performed before and after the three-week administration of CCl4 on a 1.5 T scanner using a human extremity coil. After intravenous bolus injection of Gd-EOB-DTPA (0.3 mL of Gd-EOB-DTPA freshly prepared in 2.7 mL of normal saline) through the ear vein, the 250 axial single level dynamic MR images were obtained using a fast low angle shot (FLASH, TR/TE = 11/4.2 msec, flip angle = 15, acquisition time 1 second, slice thickness = 5 mm, matrix = 128×128, field of view = 120 mm) sequence with 1.5 sec time intervals. The time-intensity curves were obtained at the abdominal aorta and the liver parenchyma that was devoid of blood vessels. Deconvolution analysis of the aortic (input function) and hepatic parenchymal (output function) time-intensity curves was performed with a modified Fourier transform technique to calculate the hepatic extraction fraction (HEF). The presence and type of hepatic injury were determined by the histopathologic examination and statistical analysis of the changes of the hepatic enzyme levels, the ICG R15 and Gd-EOB-DTPA HEF values between the time before and after CCl4 administration with Wicoxon signed rank test. Correlation between the Gd-EOB-DTPA HEF and the change of the ICG R15 were analyzed with Pearson''s correlation coefficient.

Results

Histopathologic examination showed findings that were compatible with hepatic fibrosis caused by chronic liver injury. The initial blood biochemical studies before the administration of carbon tetrachloride showed that the mean AST and ALT levels were 39.8±5.2 IU/L and 59.1±11.7 IU/L, respectively. The AST and ALT levels increased to 138.4±50.5 IU and 172.0±71.6 IU/L, respectively, after the three week administration of CCl4. The ALT and AST levels were significantly increased after the three weeks of CCl4 administration (p = 0.018). The ICG R15 values were 4.47±2.08% and 19.43±3.98% before and after three-week administration of CCl4, respectively. The ICG R15 values were significantly increased after hepatic injury (p = 0.018). After normalizing the HEF as 100% in each rabbit before CCl4 administration, the deconvoluted curve after CCl4 administration revealed less hepatocyte extraction efficiency with a mean value of 77.7±3.6. There was a significant correlation between the HEF and changes of the ICG R15 by the Pearson correlation coefficient assessment (correlation coefficient = -0.965, p = 0.000).

Conclusion

The Gd-EOB-DTPA HEF could be calculated from deconvolution analysis of aortic and hepatic parenchymal time-intensity curves obtained by dynamic MRI. The Gd-EOB-DTPA HEF was well correlated with changes of the ICG R15, which is the most common parameter used in the quantitative estimation of the hepatic function. The Gd-EOB-DTPA HEF is a direct, noninvasive technique for the quantitative evaluation of liver function. It could be a promising alternative for the determination of noninvasive hepatic function in those patients with liver disease.     

应用背驮式肝移植治疗终末期肝病

通过分析探讨背驮肝移植手术技巧与难点,结合同种异体背驮式肝移植１例手术体会,提出肝移植供体采集中肝素化、原位灌注及供肝切取步骤的重要性,;同时,强调在病肝切除中,肝后下腔静脉处理要点以及供肝植入中良好的肝动脉吻合等。认为背驮式肝移植是可行的方法,适用于终末期肝病的治疗。     

Contribution of Transjugular Liver Biopsy in Patients with the Clinical Presentation of Acute Liver Failure

Purpose Acute liver failure (ALF) treated with conservative therapy has a poor prognosis, although individual survival varies greatly. In these patients, the eligibility for liver transplantation must be quickly decided. The aim of this study was to assess the role of transjugular liver biopsy (TJLB) in the management of patients with the clinical presentation of ALF. Methods Seventeen patients with the clinical presentation of ALF were referred to our institution during a 52 month period. A TJLB was performed using the Cook Quick-Core needle biopsy. Clinical data, procedural complications, and histologic findings were evaluated. Results Causes of ALF were virus hepatitis B infection in 7 patients, drug toxicity in 4, mushroom in 1, Wilson’s disease in 1, and unknown origin in 4. TJLB was technically successful in all patients without procedure-related complications. Tissue specimens were satisfactory for diagnosis in all cases. In 14 of 17 patients the initial clinical diagnosis was confirmed by TJLB; in 3 patients the initial diagnosis was altered by the presence of unknown cirrhosis. Seven patients with necrosis <60% were successfully treated with medical therapy; 6 patients with submassive or massive necrosis (≥85%) were treated with liver transplantation. Four patients died, 3 had cirrhosis, and 1 had submassive necrosis. There was a strict statistical correlation (r = 0.972, p < 0.0001) between the amount of necrosis at the frozen section examination and the necrosis found at routine histologic examination. The average time for TJLB and frozen section examination was 80 min. Conclusion In patients with the clinical presentation of ALF, submassive or massive liver necrosis and cirrhosis are predictors of poor prognosis. TLJB using an automated device and frozen section examination can be a quick and effective tool in clinical decision-making, especially in deciding patient selection and the best timing for liver transplantation.     

Liver transplant rejection and cholestasis: comparison of technetium 99m-diisopropyl iminodiacetic acid hepatobiliary imaging with liver biopsy

To determine whether the scintigraphic evaluation of technetium-99m diisopropyl iminodiacetic acid (DISIDA) uptake and excretion can distinguish among liver transplant patients with biopsy evidence for rejection, cholestasis or neither condition, we reviewed scintigrams and biopsies in 36 patients. There were 76 scintigrams with corresponding biopsies. Uptake and excretion were graded from image data on scales reflecting normal through severely abnormal values. Biopsies were evaluated for findings of cholestasis and rejection. The majority of scintigrams demonstrated normal uptake (60/75, 80%) and delayed excretion (65/76, 85%), which was most marked immediately after transplantation. One-way analysis of variance showed that the mean excretion values significantly differed between patients with normal biopsies and those with cholestasis and/or rejection (P =0.0003). However, mean uptake scores demonstrated no statistically significant difference between these two groups of patients (P =0.1). These findings suggest that ^99mTc-DISIDA scintigraphy can differentiate between transplants with and without rejection/cholestasis but not between rejection and cholestasis. If ^99mTc-DISIDA excretion is normal, rejection and cholestasis are unlikely. Offprint requests to: C.M. Engeler     

Transjugular Core Liver Biopsy with a 19-Gauge Spring-Loaded Cutting Needle

One hundred and five sequential transjugular core liver biopsies (TJLBx) were performed in 101 patients with coagulopathy and/or ascites using the 19-gauge Quick-Core Biopsy (QCB) needle. Two-hundred and seventy-three cores were obtained in 295 passes (92.5%). One-hundred and two of the 105 procedures (97.1%) led to a histopathologic diagnosis. One of the three nondiagnostic biopsies was done because of severe autolysis of the liver. There was one subcapsular hematoma, one hepatic arteriovenous fistula, and one liver capsular puncture. Two minor neck hematomas occurred. One death was reported (unrelated to the procedure). QCB needle TJLBx is an effective and relatively safe way to obtain core liver samples. Received: 0/00/00/Accepted: 0/00/00