Role of volumetric CT perfusion of the liver in portal hypertension considering the level of portal circulation blocking: a prospective study

Relevance. Modern studies focus on the analysis of hemodynamic changes in the liver in diffuse pathologies, as well as the role of mechanisms that increase arterial perfusion with a decrease in portal blood flow. Diffuse liver diseases eventually lead to fibrosis and the risk of cirrhosis, but invasive biopsy remains the only accurate method for staging. Non-invasive methods such as elastography and the Child–Pugh scale help assess the severity of liver cirrhosis. Perfusion CT (PCT) allows you to determine the functional state of hepatocytes and determine their microcirculation. The method is safe, has a high resolution and provides complex parameters of liver perfusion. Wide-detector CT allows you to level out various artifacts, obtain perfusion images of the liver in a single scan and expand the diagnostic capabilities of this technique. The aim: to evaluate the diagnostic effectiveness of volumetric perfusion CT in determining the severity of hemodynamic disorders in patients with portal hypertension (PH), taking into account the level of blockage of the portal circulation. Materials and methods. The prospective study involved 110 patients divided into four groups: 63 patients with liver cirrhosis (LC) (block at the level of the intrahepatic postsinusoidal circulation); 10 patients with liver fibrosis (LF) (block at the level of intrahepatic presinusoidal circulation); 13 patients with PH of extrahepatic etiology (block at the level of the subhepatic circulation), 24 patients in the control group, donors of the liver fragment. The study assessed liver perfusion parameters such as arterial perfusion (AP), portal perfusion (PP) and hepatic perfusion index (HPI). Results. The most pronounced deviations in liver perfusion were verified in subhepatic block (SHB), with a significant increase in the liver index (35.6 ± 1.5%; p < 0.001). In cirrhosis with postsinusoidal block, there was a significant decrease in the portal fraction, a compensatory increase in arterial blood flow to 41.4 ± 0.7 ml/100 ml/min and, accordingly, a higher increase in the liver index (23.8 ± 0.4%; p < 0.001). Paradoxical changes in perfusion parameters with the formation of a hyperkinetic type of blood circulation and an increase in portal blood flow relative to normative values up to 169.4 ± 5.0 ml/100 ml/min (p < 0.01) were obtained in AF. Conclusion. The results confirm the diagnostic effectiveness of volumetric CT perfusion and its significance in assessing and predicting the severity of hemodynamic disorders in patients, taking into account the level of blockage of the portal circulation.