摘要
目的研究电子计算机断层扫描(CT)灌注成像对肝细胞癌患者肝动脉化疗栓塞(TACE)术后疗效的评估价值。方法选择2017年1月至2019年11月在我院行TACE术肝细胞癌患者148例。分别对患者术前3d,术后8d、40d行CT灌注扫描,经灌注系统得到灌注图,并计算门静脉(PVP)、肝动脉灌注量(HAP)、肝动脉灌注指数(HPI)灌注参数值,比较TACE术前、术后肿瘤大小及血流灌注变化,评估其疗效。结果148例患者HAP图呈肝高动脉灌注,56例呈均匀高肝动脉灌注,92例呈不均匀高灌注,PVP图呈门静脉低灌注,低于肝实质;术后8d,99例碘油不均匀填充,49例碘油紧密填充,HPI图碘油较少区呈高肝动脉灌注,且碘油区PVP、HAP图像上无显著血流灌注;148例患者术前、术后8d肿瘤组织灌注参数及肿瘤大小、99例肿瘤残留组织与正常组织术后8d灌注参数、92例肿瘤残留组织术后8d、40d灌注参数与肿瘤大小进行分析;术前、术后8d肿瘤最大径、PVP差异无统计学意义(P>0.05);术前与术后8d HPI、HAP值,差异有统计学意义(P<0.05);且术前HPI、HAP值高于术后(P<0.05);肿瘤残留组织与正常组织术后8d灌注参数比较,术后8d,正常肝组织HPI、HAP低于残留组织,且PVP高于残留组织,差异有统计学意义(P<0.05);肿瘤残留组织术后8d、40d灌注参数与肿瘤大小比较,PVP、肿瘤最大径大小差异无统计学意义(P>0.05);术后40d HAP、HPI高于术后8d,差异有统计学意义(P<0.05)。结论CT灌注成像可监测肝细胞癌患者病灶血供情况,鉴定肿瘤活性,分析病灶部位血流动力变化,在评估TACE术后疗效,具有显著价值。
Objective To investigate the application of computed tomography(CT)perfusion imaging in evaluating the efficacy of transcatheter arterial chemoembolization(TACE)for patients with hepatocellular carcinoma.Methods 148 patients with hepatocellular carcinoma underwent TACE in our hospital from January 2017 to December 2019 were enrolled.CT perfusion scans were performed on patients 3 days before surgery,8 days and 40 days after surgery.The perfusion images were obtained through the perfusion system,and the related parameters including portal vein perfusion(PVP),hepatic arterial perfusion(HAP),and hepatic perfusion index(HPI)were calculated.The tumor size and blood perfusion before and after TACE were compared,then the efficacy was also evaluated.Results 148 patients were manifested as hyper-perfusion in HAP maps,including 56 cases of homogeneous hyper-perfusion and 92 cases of inhomogeneous hyper-perfusion.The lesion showed hypoperfusion of portal vein in PVP map,which was lower than that of liver parenchyma.8 d after TACE,the lesion was partially filled with lipiodol in 99 cases and totally filled with lipiodol in 49 cases.Hyper-perfusion was still observed in the sparsely lipiodol-filled areas.No significant blood perfusion was observed in lipiodol-filled areas in PVP and HAP maps.The maximum tumor diameter and PVP had no significant difference before treatment and 8 d after treatment(P>0.05).HPI and HAP values had significant difference before treatment and 8 d after treatment(P<0.05).HPI and HAP values before treatment were higher than those after treatment(P<0.05).8 d after treatment,HPI and HAP in surrounding normal tissues were lower than that in residual tumor tissues,and PVP was higher than that in residual tumor tissues(P<0.05).PVP and tumor maximum diameter of residual tumor tissues at 8 d and 40 d after treatment had no statistic difference(P>0.05).HAP and HPI at 40 d after surgery were significantly higher than that at 8 d after surgery(P<0.05).Conclusion CT perfusion imaging can monitor the lesion blood supply in patients with hepatocellular carcinoma,identify tumor activity,and analyze the hemodynamic changes at the lesion site,which is of significant value in evaluating the efficacy of TACE.
作者
薛永明
刘兴安
XUE Yong-ming;LIU Xing-an(Department of CT Radiology,Xi'an Eighth Hospital,Xi'an 710061,Shaanxi Province,China;Department of Nuclear Medicine,Southwest Shandong Hospital,Liaocheng 252325,Shandong Province,China)
出处
《中国CT和MRI杂志》
2022年第4期96-98,108,共4页
Chinese Journal of CT and MRI
