摘要
目的探讨全肝CT灌注成像对肝癌经肝动脉化疗栓塞（TACE）术前、术后瘤灶及瘤旁血流状态变化的定量评估价值。方法收集行TACE的肝癌患者26例，分别于术前2～3d及术后1个月完成全肝CT灌注成像，分别对瘤体、瘤旁1cm及背景肝实质进行肝动脉灌注量（HAP）、门静脉灌注量（PVP）、总肝灌注量（TLP）、肝动脉灌注指数（HPI）及达峰时间（TTP）的测量。据资料不同分别采用方差分析、t检验或秩和检验进行统计学分析。结果共检出34个病灶，根据TACE术后碘油沉积隋况分为碘油密实组（21个）和碘油稀疏组（13个）。肝癌TACE术后病灶长径较术前总体上呈缩小趋势，密实组病灶缩小程度大于稀疏组，术前术后长径比较分别为（3．12±0．58）cm对比（1．93±0．79）cm、（2．98±2．01）cm对比（2．58±2．00）cm，差异有统计学意义（t值分别为15．1、8．65，P〈0．05）。碘油密实组术前瘤区HAP及HPI最高，瘤旁1cm高于背景肝实质，背景肝实质PVP、TLP及TTP最高，瘤旁1cm高于瘤区，对应灌注参数总体上及两两比较差异均有统计学意义（P〈0．05）；术后瘤旁1cm的HAP及HPI高于背景肝实质，PVP、TLP及TTP低于背景肝实质，差异有统计学意义（P〈0．05）；TACE术前术后对应区域的比较，碘油沉积区无血流灌注，术后瘤旁1cmHAP和HPI下降，PVP、TLP及TTP上升，与术前比较差异有统计学意义（P〈0．05），背景肝实质术后血流灌注变化差异无统计学意义（P〉0．05）。碘油稀疏组瘤区术后HAP及HPI下降，PVP及TTP上升，差异有统计学意义（P〈0．05），其他两区域变化差异无统计学意义（P〉0．05）。结论肝癌TACE术后碘油沉积区无血流灌注，瘤旁1cm及碘油稀疏组残余灶肝动脉灌注量下降，门静脉灌注量上升。CT灌注成像能量化评价血流灌注状态，对肝癌TACE术前治疗方案的确定及术后疗效的评价具有重要意义。
Objective To investigate the diagnostic value of whole liver CT perfusion imaging in the quantitative evaluation of hemodynamic changes before and after transcatheter arterial chemoembolization （TACE）. Methods Twenty-six patients with hcpatocellular carcinoma underwent TACE therapies were recruited. Whole -liver computed tomographic perfusion imaging （CTPI） was performed 2 - 3 days before TACE and 1 month after TACE. We measured the following perfusion parameters： hepatic arterial perfusion （HAP）, portal venous perfusion （PVP）, total liver perfusion （TLP）, hepatic arterial perfusion index （HAPI）, and time-to-peak （TTP）.The F-test, t-test and Rank sum test were used for statistical analysis. Results A total of 34 HCC lesions were detected. According to the deposition of lipiodol after TACE, they were divided into a lipiodol dense group （21） and a lipiodol light group （13）. The length of hepatocellular carcinoma lesions after TACE showed a decreasing trend compared with preoperative TACE. The lesions in the lipiodol dense group had smaller lesions than those in the lipiodol light group. The preoperative and postoperative longitudinal diameters were （3.12 ± 0.58） cm vs. （1.93 ± 0.79） cm, （2.98 ± 2.01） cm vs. （2.58 ±2.00） cm, the differences were statistically significant （t = 15.1, 8.65, P 〈 0.05）. The preoperative HAP and HPI of the lipiodol dense group were the highest, and the peritumoral within lcm was higher than that of the surrounding liver parenchyma. The PVP, TLP, and TTP were highest in the surrounding of liver parenchyma, and 1 cm higher than the tumor area in the background. The corresponding perfusion parameters were statistically significant （P 〈 0.05）; HAP and HPI were 1 cm higher than the surrounding liver parenchyma. After the operation, PVP, TLP and TTP were lower than the background liver parenchyma, the difference was statistically significant （P 〈 0.05）; HAP and HPI decreased by 1 cm after the operation, and the PVP, TLP, and TTP increased. There was no significant difference after operation in the blood perfusion of background liver parenchyma （P 〉 0.05）. The HAP and HPI decreased, and the PVP and TTP increased in the lipiodol light group after operation （P 〈 0.05）. There was no significant difference between the other two regions （P 〉 0.05）. Conclusion There was no blood perfusion in the lipiodol deposition area after TACE. The perfusion volume of hepatic artery in the peritumoral 1 cm and lipiodol light group decreased and the portal venous perfusion increased. CTPI can quantitatively evaluate blood perfusion state, which is of great significance for the determination of treatment plans before TACE treatment to assume the postoperative therapeutic effect in liver cancer.
作者
李珊玫
高知玲
吕茜婷
贾晶
朱翩
陈勇
刘玉林
张照喜
Li Shanmei;Gao Zhiling;Lyu Qianting;Jia Jing;Zhu Pian;Chen Yong;Liu Yulin;Zhang Zhaoxi(Tumor Hospital of Hubei Province, Wuhan 430079, China （Li MS, Liu YL, Zhang ZX;General Hospital of Ningxia Medical University, Yinchuan 750004, China （Gao ZL, Lyu QT, Jia J,, Chen Y;The Third Hospital of Wuhan, Wuhan 430079, China （Zhu P)
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2018年第6期429-435,共7页
Chinese Journal of Hepatology
基金
国家自然科学基金（61761039,61061005）
宁夏留学人员创新创业项目（2017-659）
关键词
癌
肝细胞
经肝动脉化疗栓塞
多层螺旋CT
灌注成像
Carcinoma
hepatocellular
Transcatheter arterial chemoembolization
Multiple slice computed tomography
Perfusion imagine
