CT灌注成像对肝细胞癌经动脉导管化疗栓塞的疗效观察

CT perfusion imaging in evaluating treatment effect of transarterial chemoembolization for hepatocellular carcinoma

目的观察肝细胞癌(HCC)瘤灶的CT灌注参数在经动脉导管化疗栓塞术(TACE)治疗前后的变化。方法 39例经穿刺病理检查或血清学证实的中晚期HCC患者曾经在我院进行TACE介入治疗,患者分别于介入术前1 d及术后4周行CT灌注扫描。数字减影血管造影(DSA)中的肿瘤染色区变化作为判断术后肿瘤存活的相对标准,疗效分组标准参照实体瘤治疗疗效评价标准(RECIST)。分别按不同TACE疗效组,采用配对秩和检验,对介入术前和术后瘤组织的CT灌注参数进行比较。结果术后治疗反应完全缓解(CR)1例,由于瘤区术后表现为灌注信号完全缺失而被除外统计。38例患者中,TACE术后CT灌注参数肝动脉灌注量(HAP)、肝脏灌注分数(HAF)较术前稍有降低(P分别为0.035和0.040),而肝血容量(HBV)、门脉灌注量(PVP)、肝血流量(HBF)、平均通过时间(MTT)、毛细血管表面通透性(PS)在治疗前后差异均无统计学意义。如果划分疗效组:部分缓解(PR)疗效组14例,HCC的TACE术后CT灌注参数(HAP、HAF和HBV)较术前明显降低,差异有统计学意义(P<0.05),同组中HBF、MTT、PS、PVP在治疗前后差异均无统计学意义;稳定期(SD)疗效组14例,所有的CT灌注参数在TACE治疗前后差异均无统计学意义;进展期(PD)疗效组10例,HCC的TACE术后CT灌注参数(HAP、HAF、PVP、HBF)较术前明显增高,差异有统计学意义(P<0.05),同组中的HBV、MTT、PS在治疗前后差异均无统计学意义。结论 CT灌注扫描能够通过TACE治疗前后瘤组织的灌注改变来评估TACE疗效。CT灌注扫描是一种有价值的观测HCC介入治疗疗效的无创医疗技术。

Objective To prospectively assess the changes in parameters of CT perfusion pre-and post-TACE treatment of hepatocellular carcinoma（HCC） in different treatment response groups,and to correlate the changes with various treatment responses to TACE.Methods Thirty-nine patients with histopathologically proven HCC underwent pre-treatment CT perfusion examinations（1 d before TACE） and post-treatment CT perfusion examinations（4 weeks after TACE）.The response evaluation criteria in solid tumors（RECIST） was referred to when distributing of treatment responses.Wilcoxon signed ranks test was used to compare the differences in CT perfusion parameters between pre-and post-TACE in different treatment response groups.Results There was only one case with treatment response of CR and the CT perfusion maps of post-treatment lesion displayed complete absence of signal.In other patients,HAP,HAF of viable tumor post-TACE were decreased compared with pre-TACE（P=0.035 and 0.040,respectively）.In the PR treatment response group,HAP,HAF and HBV of viable tumor post-TACE was reduced compared with pre-TACE,and their difference were statistically significant between pre-and post-treatment（P0.05）.In the SD group,all CT perfusion parameters were not significantly different between pre-and post-TACE;In the PD group,HAP,HAF,PVP and HBF of viable tumor post-TACE were significantly increased compared with pre-TACE（P0.05）,while other parameters were not significantly different between pre-and post-treatment.Conclusion The changes of CT perfusion parameters within viable tumor could correlate with different treatment response for HCC.