Clinical value of hepatic functional reserve:an evaluation on 16-slice spiral CT perfusion imaging combined with CT hepatic volume measurement

Objective To investigate the clinical value of hepatic functional reserve in cirrhosis by 16-slice spiral CT hepatic volume measurement in each lobe combined with CT perfusion imaging (CTPI). Methods CT hepatic volume measurements were performed in 13 normal subjects and 40 patients with cirrhosis (12 in Child A, 15 in Child B and 13 in Child C stage). CTPI were performed in all patients. Data of hepatic volume,percentage of volume, parameters of blood flow perfusion,and liver volume-perfusion index were compared and analyzed between cirrhosis group and normal controls. Correlations between graded fractions of hepatic function and liver volume in each lobe,parameters of perfusion,and liver volume-perfusion index were also analyzed. Results Among the groups of cirrhosis Grade A,B,and C, for the values of liver volumes (LV), left external lobe significantly enlarged in prophase(P0.01)and caudate lobe did not enlarged significantly in prophase but became bigger obviously in advanced stage (P0.01). Among the values of hepatic arterial perfusion(HAP), hepatic portal perfusion (HPP), total liver perfusion (TLP) of the cirrhosis,hepatic arterial perfusion index (HAI) and portal perfusion index (PPI), HAP, HPP and TLP evidently decreased in early Child A and with the rise of the classification of cirrhosis, and HAI evidently increased in advanced stage (P0.05). Among the volume hepatic arterial perfusion index per body surface area (VAPIs), volume perfusion index per body surface area (VPIs) and volume portal perfusion index per body surface area(VPPIs) dropped with the hepatic function from Child A to B to C(P0.05). VAPIs had a descending trend which was significant after Child B. All these data had good correlation. Conclusion Changes of volume in the left external lobe and the caudate lobe, blood flow perfusion of the liver in HPP, TLP and HAI,and volume-perfusion index in VPPIs and VPIs were found to be reasonable to evaluate the different Child-Pugh grading of cirrhosis. In addition, it is closely related to the clinical grading. The CT volume measurement combined with CTPI can be a more comprehensive method in evaluating hepatic functional reserve.