超声造影对乙型肝炎肝硬化门静脉高压患者经颈静脉肝内门体分流术后肝血流灌注的诊断

摘要/Abstract

摘要： 目的利用超声造影技术(CEUS)观察乙型肝炎肝硬化门静脉高压患者经颈静脉肝内门体分流术(TIPS)术后肝血流灌注的诊断价值。方法选取2016年1月—2021年4月期间在南京医科大学附属淮安第一医院行TIPS术前、术后采用CEUS检查的患者56例,其中男性30例,女性26例,年龄为20~70岁,平均年龄(51.0±7.5)岁。同时对56例患者进行了彩色多普勒超声(CDUS),对CEUS和CDUS的诊断结果进行比较分析。结果通过CEUS对患者TIPS术前、术后肝血流灌注的诊断结果比较显示,HAP及HPI术后均上升[(28.9±13.4)min·100 mL、(64.2±11.2)%],与术前[(20.0±9.3)min·100 mL、(54.4±19.5)%]比较差异均有统计学意义(P<0.05);PVP及TLP术前与术后比较差异均无统计学意义(P>0.05)。通过CDUS和CEUS的诊断结果比较显示,在绝大多数病例中,CEUS和CDUS的检查结果具有高度的一致性,为89.3%;CEUS诊断灵敏性有98.2%。同时,在某些情况下,相比较CDUS,CEUS可以提供额外的检查信息。结论 CEUS为TIPS术后的随访提供了一种安全有效的成像手段。对比CDUS,CEUS还能够以高空间和时间分辨率动态显示单个微泡,从而能够对支架病理和支架功能障碍进行具体评估。由于CEUS使用造影剂的不良事件很少,且对ePTFE支架有更高的特异性和敏感性,因此CEUS可以应用于非常广泛的患者群体。

关键词: 超声造影, 门静脉高压, 经颈静脉肝内门体分流术, 彩色多普勒超声, 肝血流灌注

Abstract: Objective To observe the diagnostic value of contrast-enhanced ultrasound (CEUS) for liver perfusion post transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatitis B-related cirrhosis and portal hypertension.Methods A total of 56 patients who underwent CEUS examination after TIPS between January 2016 and April 2021 were selected, including 30 males and 26 females, aged from 20 to 70 years, with an average age of (51.0±7.5) years old. At the same time, color doppler ultrasound (CDUS) was performed on 56 patients, and the diagnostic results of CEUS and CDUS were compared and analyzed.Results Comparison of the diagnostic results of hepatic perfusion by CEUS in patients, both HAP and HPI increased [(28.9±13.4) min·100 mL and (64.2±11.2)%] after operation, which were significantly different from those of before operation [(20.0±9.3) min·100 mL and (54.4±19.5)%] (P<0.05). The differences between PVP and TLP before and after surgery were not statistically significant (P>0.05). Comparison of the diagnostic results by CDUS and CEUS showed that in the majority of cases (89.3%), the findings of CEUS and CDUS were highly consistent; the diagnostic sensitivity of CEUS was 98.2%, and the differences were statistically significant (P<0.05). Also, in some cases, CEUS provided additional examination information compared to CDUS.Conclusion CEUS provides a safe and effective imaging method for following-up after TIPS. In contrast to CDUS, CEUS also enables dynamic visualization of individual microbubbles with high spatial and temporal resolution, enabling specific assessment of stent pathology and stent dysfunction. CEUS can be applied to a very broad patient population due to a lower adverse events associated with the use of contrast agents and a higher specificity and sensitivity of ePTFE stents.

Key words: Contrast-enhanced ultrasound, Portal hypertension, Transjugular intrahepatic portosystemic shunt, Color doppler ultrasound, Liver perfusion

张晓丹, 袁莹莹. 超声造影对乙型肝炎肝硬化门静脉高压患者经颈静脉肝内门体分流术后肝血流灌注的诊断[J]. 肝脏, 2023, 28(11): 1293-1295.

ZHANG Xiao-dan, YUAN Ying-ying. The diagnostic value of contrast-enhanced ultrasound for liver perfusion post transjugular intrahepatic portosystemic shunt in patients with hepatitis B-related cirrhosis and portal hypertension[J]. Chinese Hepatolgy, 2023, 28(11): 1293-1295.

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