门静脉阻断对门静脉血流量和肝脏弹性的影响
Influence of portal vein occlusion on portal flow and liver elasticity in an animal model
摘要：
肝纤维化导致肝脏硬度增加，这是一个通过弹性成像测量的参数，广泛用作诊断方法。门静脉血栓形成（PVT）的伴随存在意味着肝门流入的变化，也可能影响肝脏弹性。本研究的主要目的是通过弹性成像确定门静脉阻塞对肝脏机械特性的影响程度，并可能导致纤维化和肝硬化的误诊。通过在四只猪的门静脉中插入球囊导管并使其膨胀来产生门静脉闭塞。门静脉血流参数峰值流量（PF）和峰值速度幅度（PVM）和肝脏的机械性能（剪切模量），然后分别使用4D流MRI和MR弹性成像，进行性阻塞门静脉。实验结果表明，$0.8\%\pm0.1\%$、$7.7\%\pm0.4\%$和$12.3\%\pm0.9\%$分别在50%、80%和100%阻塞门静脉段时测量的肝内静脉血流量减少（PF/PVM分别降低29.3%/8.5%、51.0%/32.3%和83.3%/53.6%）导致肝脏硬度降低。虽然这种血管机制对肝脏弹性的影响不足以改变重度纤维化或肝硬化（F4 METAVIR分级）的诊断，但它可能足以减弱中度纤维化（F2-F3 METAVIR分级）引起的硬度增加，从而导致在存在PVT的情况下使用弹性成像进行假阴性诊断。
英文摘要：
Hepatic fibrosis causes an increase in liver stiffness, a parameter measured by elastography and widely used as a diagnosis method. The concomitant presence of portal vein thrombosis (PVT) implies a change in hepatic portal inflow that could also affect liver elasticity. The main objective of this study is to determine the extent to which the presence of portal occlusion can affect the mechanical properties of the liver and potentially lead to misdiagnosis of fibrosis and hepatic cirrhosis by elastography. Portal vein occlusion was generated by insertion and inflation of a balloon catheter in the portal vein of four swines. The portal flow parameters peak flow (PF) and peak velocity magnitude (PVM) and liver mechanical properties (shear modulus) were then investigated using 4D-flow MRI and MR elastography, respectively, for progressive obstructions of the portal vein. Experimental results indicate that the reduction of the intrahepatic venous blood flow (PF/PVM decreases of 29.3%/8.5%, 51.0%/32.3% and 83.3%/53.6%, respectively) measured with 50%, 80% and 100% obstruction of the portal vein section results in a decrease of liver stiffness by $0.8\%\pm0.1\%$, $7.7\%\pm0.4\%$ and $12.3\%\pm0.9\%$, respectively. While this vascular mechanism does not have sufficient influence on the elasticity of the liver to modify the diagnosis of severe fibrosis or cirrhosis (F4 METAVIR grade), it may be sufficient to attenuate the increase in stiffness due to moderate fibrosis (F2-F3 METAVIR grades) and consequently lead to false-negative diagnoses with elastography in the presence of PVT.
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