超声造影改良双输入模型定量检测犬肝硬化肝血流及其对肝储备功能的影响

Pre-operative assessment of liver reserve function byindocyanine green (ICG)clearance testis an important procedure to determine the amount of liver resection and to reduce the risk of post-operative liver failure. Hepatic blood flow has a large impact on ICG, however, the impact comes from hepatic artery blood flow, portal vein blood flow or total hepatic blood flow is not clear. ICG variation is caused by the change of hepatic blood flow or the variation of hepatic blood flow is caused by ICG change is also not fully understood. The main reason is the lack of accurate, non-invasive and quantitative method for assessing hepatic blood flow. Electromagnetic flow meter is golden standard but invasive, Doppler ultrasound is non-invasive but its accuracy is not convinced. CT has radiation and its temporal resolution is low.In this study, firstly, CC14 fibrosis/cirrhosis models of dog at various stages are established. Dual-input one-compartment model that has mature application on CT liver perfusion technique is introduced into quantitative measurement of hepatic blood flow of dog with contrast-enhanced ultrasound (CEUS). Meanwhile, CEUS-based destruction replenishment method is applied to assess hepatic flow rate constant and flow parameter. Then,electromagnetic flow meter is used as golden standard for measuring the blood flow of hepatic artery and portal vein. The accuracy of flow quantification of hepatic artery, portal vein and liver parenchyma of dog is analyzed.Key technique of CEUS quantification and comprehnsive parameters are screened and determined.Finally, analyze the impact of hepatic blood flow on liver reserve function, and then provide newi deas and technologies for quantifying liver blood flow and evaluating liver reserve function clinically.

术前检测肝脏储备功能（基于吲哚菁绿ICG清除试验）是决定肝切除量及降低术后肝衰的重要举措。然而ICG受肝血流量影响大，但受肝动脉或门静脉还是整体血流影响及血流和ICG改变孰先孰后的研究不多，主要原因是缺乏准确、无创的肝血流定量检测方法。电磁血流计是金标准但有创，超声多普勒检测无创但准确性不高，CT可测定肝灌注但有射线且时间分辨力较低。本研究拟首先建立犬CCl4不同程度肝纤维化/硬化模型，将肝脏CT灌注技术中已成熟应用的双输入单室模型（DIOCM）引入超声造影（CEUS）的犬肝血流定量分析中，并同时应用CEUS击破再灌注法测定肝血流速率常数及流量参数；然后以电磁血流计为金标准，分析CEUS检测犬纤维化/硬化肝肝动脉、门静脉及肝实质血流量的准确性并筛选及确定CEUS定量检测的关键技术及综合参数；最后分析犬肝血流量对肝储备功能的影响。进而为临床定量检测肝血流及评估肝脏储备功能提供新的思路及技术。