目的 研究肝炎肝硬化的原发性 肝癌病人CT灌注参数特征，探讨320排动 态容积CT灌注成像评价肝炎肝硬化的原发 性肝癌病人的肝脏储备功能的临床价值。 方法 运用东芝320排容积CT对35例伴有不 同程度肝炎后肝硬化的原发性肝癌病人进 行CT灌注扫描。按肝功能Child-pugh分级 A级14例，B级11例，C级10例。分析两名 医生所测三项灌注值(HAP、PVP、HAPI)之 间有无统计学差异，取两位医生所测数值 平均值，比较不同Child-Pugh分级患者 灌注值间有无统计学差异，并将全部灌 注值与Child-Pugh分级进行spearman相关 性分析。结果 (1)两位影像科医生所测两 组灌注值无明显统计学差异(P＞0.05)； (2)A、B、C三级病人之HAP无统计学差异 (P＞0.05)，A、B、C三级病人PVP、HAPI 之间有显著统计学差异，(P＜0.05)随C-P 分级增加PVP逐级降低，HAPI逐级升高， A级与B级、A级与C级灌注值比较有统计 学差异(P＜0.05)；(3)HAP变化与Childpugh分级无明显相关性(P＞0.05)，PVP与 C-P分级呈明显负相关，相关系数为r=— 0.773(P＜0.001)，与HAPI呈明显正相 关，相关系数r=0.676，P＜0.001。结论 灌注PVP及HAPI是反应肝脏储备功能的良 好指标，对原发性肝癌的临床治疗有重要 价值。

Objective To study the characters of CT perfusion for patients with hepatitis B cirrhosis accompanied by primary hepatic carcinoma, and to explore the clinical value of the evaluation by 320-row dynamic volume CT perfusion imaging on hepatic function reserve of patients with primary hepatic carcinoma resulting from hepatitis B cirrhosis. Methods The Toshiba "Aqualion One" 320-row dynamic volume CT was taken to conduct CT perfusion scanning on the 35 patients with primary hepatic carcinoma accompanied by different degrees of hepatitis hepatocirrhosis. The patients were divided into three grades, that is, Grade A, Grade B, and Grade C, according to the Child-pugh classification standard (including 14 cases of Grade A, 11 cases of Grade B, and 10 cases of Grade C).Then,comparison was conducted on the three perfusion values obtained by the measurement of the two doctors as well as the perfusion values (HAP, PVP, and HAPI) of the patients graded according to Child-pugh so as to see whether there was of statistical differences, numerical average of two doctors measured were taken,and analysis had been conducted on the spearman correlation between all the perfusion values and Childpugh classification. Results 1.There was no significant statistical differences between the two groups of perfusion values measured by the two doctors from the Department of Radiology (P＞0.05, See Table 3). 2.There was no significant statistical differences among the HAPs of the patients at Grade A, Grade B, and Grade C (P＞0.05), but there were significant statistical differences among the PVPs and HAPIs of the patients at Grade A, Grade B, and Grade C (P＜0.05). Then S-N-K analysis were conducted on PVP, HAPI, and TLP of the patients at Grade A, Grade B, and Grade C, and the results included that there was no statistical difference between Grade B and Grade C (P＞0.05) but there were statistical differences between Grade A and Grade B and between Grade A and Grade C (P＜0.05). 3. There was no significant correlation between the HAP changes and the Child-pugh classification but there was significant correlations among PVP, HAPI, and C-P classifications, among which there was significant negative correlation between PVP and the C-P classification with the correlation coefficients as r=-0.773 (P＜0.001).while there was significant positive correlation between PVP and HAPI with the correlation coefficient as r=0.676 (P＜0.001). Conclusion PVP and HAPI could be act as the important indexes for the evaluation of hepatic function reserve of patients with hepatic carcinoma resulting from hepatitis B cirrhosis, but in this research it has been proved that it was of no great meaning to take HAP to evaluate the hepatic function reserve.