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目的探讨CT平扫及增强检查在肝硬化门静脉高压伴脾功能亢进的患者的成像特点及其应用价值。方法选择2013年1月至2015年1月经腹部CT、临床检验、超声、胃镜等检查诊断有肝硬化门静脉高压伴脾功能亢进患者72例(观察组),其中男性40例,女性32例;年龄39~69岁,平均年龄43.32岁。随机选取同期排除肝硬化、肝转移瘤及没有造成门静脉系统血流动力学改变的其他系统疾病患者100例(对照组),其中男性58例,女性42例;年龄38~71岁,平均年龄44.01岁。对所有患者行CT平扫及增强检查,测得门静脉强化峰值时间,分别再延迟3 s、5 s、7 s、9 s接受检查。探讨门静脉系统强化峰值平均时间、门静脉主干与肝实质密度差值(P-L_1值)和肝内门静脉细小分支与肝实质密度差异(P-L_2值)、图像质量评分。结果观察组患者门静脉主干达到强化峰值的时间长于对照组,差异有统计学意义(P<0.05)。对照组患者在门静脉主干达到强化峰值之后的第3秒的P-L_1值、P-L_2值和图像质量评分最大,高于第5秒、第7秒、第9秒时值,差异有统计学意义(P<0.05)。观察组患者在门静脉主干达到强化峰值之后第7秒的P-L_1值、P-L_2值和图像质量评分最大,高于第3秒、第5秒、第9秒时值,差异有统计学意义(P<0.05)。结论肝硬化门静脉高压伴脾功能亢进患者的门静脉主干达到强化峰值的时间长于正常人,并且在到达峰值7 s后成像最佳,图像质量评分最高。所以在对这类人进行扫描时应该延长扫描时间,以获得最佳成像。
Objective To investigate the imaging features and application value of CT plain scan and enhanced scan in patients with cirrhosis and portal hypertension with hypersplenism. Methods From January 2013 to January 2015, 72 cases of cirrhotic portal hypertension with hypersplenism (observation group) were diagnosed by CT, clinical examination, ultrasonography and endoscopy, including 40 males and 32 females; the age 39 ~ 69 years old, average age 43.32 years old. 100 patients (control group), including 58 males and 42 females, were randomly selected to exclude cirrhosis, liver metastases and other systemic diseases that did not cause changes of portal hemodynamics. The average age was 44.01 year old. All patients underwent CT scan and enhanced examination, measured portal vein enhanced peak time, respectively, and then delayed 3 s, 5 s, 7 s, 9 s to be examined. To explore the peak mean time of portal vein system enhancement, the difference of P-L value between portal vein and liver (P-L_1) and the difference of P-L_2 value and image quality between hepatic portal vein small branches and liver. Results The peak time of portal vein in observation group was longer than that in control group, with significant difference (P <0.05). In the control group, P-L_1, P-L_2, and image quality scores of the 3rd second after the portal vein peaked were higher than the 5th, 7th and 9th seconds, and the difference was statistically significant Significance (P <0.05). The P-L_1 value, P-L_2 value and the image quality score of the observation group were the highest at the 7th second after the portal vein reached the enhancement peak, which was higher than that at the 3rd, 5th and 9th seconds, the difference was statistically significant (P <0.05). Conclusions The main peak of portal vein in patients with cirrhotic portal hypertension and hypersplenism is longer than that in normal subjects, and the imaging is the best after 7s peak and the highest image quality score. So when scanning this type of person, the scanning time should be extended for optimal imaging.