多层螺旋CT灌注评价肝癌患者肝储备功能及手术耐受性的意义

Multi-slice spiral CT perfusion evaluation of hepatic functional reserve and surgical tolerance in patients with hepatocellular carcinoma

目的:探讨CT灌注成像在术前评价肝癌患者肝储备功能及手术耐受性的意义。方法:收集2005年1月～2008年12月在中南大学湘雅二医院行肝叶切除的原发性肝癌患者72例资料,通过测量肝动脉灌注量、门脉灌注量、总肝灌注量、肝脏灌注指数等指标,分析肝癌CT灌注成像特点和肝储备预测性能,并与Child-Pugh分级比较。结果:原发性肝癌CT灌注显像HAP(t=10.316,P=0.000 1)和HPI(t=18.153,P=0.000 1)高灌注,而在PVP(t=15.724,P=0.000 1)、TLP(t=8.728,P=0.000 1)则呈低灌注。并且每项灌注参数都和Child-Pugh分级相关,相关系数rs分别为0.724(t=6.847,P=0.013)、-0.694(t=6.135,P=0.027)、-0.764(t=8.675,P=0.008)和0.733(t=7.156,P=0.011)。4种灌注参数均能有效的进行预测肝储备功能,其ROC曲线下面积分别为0.869(P=0.000 1)、0.772(P=0.000 1)、0.835(P=0.000 1)、0.846(P=0.000 1)。而HAP和Child-Pugh都能独立预测肝储备功能,并有一定互补性,串联诊断效果更好。结论:原发性肝癌CT灌注成像有典型的影像特征,能有效预测肝储备功能和手术耐受性,并且和Child-Pugh有一定互补性,联合预测可提高诊断效能。

Objective： To evaluate the significance of CT perfusion imaging of hepatic functional reserve and surgical tolerance in patients with hepatocellular carcinoma. Methods ： Retrospective analysis were used in January 2005 - December 2008 of 72 cases of patients with hepatectomy for primary liver cancer . CT perfusion imaging characteristics were used to evaluate liver reserves, and compared with Child-Pugh classification. Results： In CT perfusion imaging of primary liver cancer, HAP （t = 10.316,P= 0.000 1 ） and HPI （t = 18.153, P = 0.000 1 ） showed hyperperfusion, and PVP （t = 15.724,P= 0.000 1 ）, TLP （t = 8.728,P= 0.000 1 ） showed hypoperfusion. Each peffusion parameters and Child-Pugh classification have correlation, rs were 0.724 （t= 6.847, P= 0.013）, -0.694（t = 6.135, P = 0.027 ）, -0.764 （t = 8.675, P= 0.008 ） and 0.733（t = 7.156, P = 0.011 ）. Respectively. Four perfusion parameters can effectively predict the hepatic functional reserve, the area under the ROC curve were 0.869（P= 0.000 1 ）,0.772（P= 0.000 1 ）,0.835（P= 0.000 1 ）,0.846 （P= 0.000 1 ）. HAP and the Child-Pugh can be independent predictors of hepatic functional reserve.And they have a certain degree of complementarity. Conclusion： CT perfusion imaging of primary liver cancer has a typical imaging features, which can effectively predict the hepatic functional reserve and surgical tolerance, and have some complementary with Child-Pugh, joint forecasting can improve the diagnosis performance.