明胶海绵微粒对动脉化疗栓塞术后肝癌瘤组织CT灌注参数的影响

Assessment of effect of transarterial chemoembolization by gelfoam particles using CT Perfusion imaging

目的运用CT灌注成像评价明胶海绵微粒(GP)对经动脉化疗栓塞术(TACE)治疗肝细胞癌(HCC)后肝癌瘤组织灌注的影响。方法 39例经过穿刺病理检查或血清学证实的中晚期肝细胞癌患者曾经在我院进行TACE介入治疗。患者随机分为相关临床特征无明显差别的GP+碘化油(LP)治疗组和单纯LP治疗组,TACE治疗中分别用GP+LP栓塞治疗和单纯LP栓塞治疗。表柔吡星、羟基喜树碱、5-氟尿嘧啶联合化疗方案(EPI+HCPT+5FU)在2组中的使用是相同的。所有患者分别于介入术前1 d及术后4周行CT灌注扫描。采用秩和检验,对于GP+LP组和单纯LP组间的肝脏活性瘤组织的CT灌注参数进行比较。结果全部被观察资料中,1例GP+LP组病例由于肿瘤区术后表现为灌注信号完全缺失而被剔除;剩余GP+LP组18例和LP组20例比较中,治疗前2组的CT灌注参数差异均无统计学意义;而TACE术后GP+LP组的灌注参数(肝动脉灌注量,肝脏灌注分数和肝血容量)较LP组降低,差异有统计学意义(P=0.030,0.012和0.043),而治疗后2组中肝血流量,平均通过时间,毛细血管表面通透性,门脉灌注量差异都无统计学意义。结论 GP+LP联合栓塞治疗可以有效减少肝癌组织的动脉灌注。CT灌注成像能够反映出GP使用对TACE治疗后肝肿瘤组织灌注的影响。

Objective To compare the therapeutic effect of HCC embolized by the mixture of gelfoam particles（GP） and tipiodol（LP） with that by lipiodol alone using CT perfusion. Methods Thirty nine patients with histopathologically proven HCC underwent pre-treatment CT perfusion examinations （1 d before TACE） and posttreatment CT perfusion examinations （4 weeks after TACE）. Patients were randomly assigned into group GP＋LP （embolized by gelfoam particles combined with lipiodol mixed with anticancer agents） and group LP （embolized by lipiodol mixed with antieancer agents alone）. Transarterial ehemoembolization was performed by 0.1 t0.9 g 350 -710μm gelfoam particles combined with 2-20 ml lipiodol to embolize the tumor bearing artery for treatment to patients in group GP＋LP. HCC-feeding artery of patients in group LP was embolized by lipiodol alone. Before and after therapy, Mann-Whitney test was used to compare the differences in CT perfusion parameters between two groups one by one. Results In 39 patients, there was one case with treatment response of CR and the CT perfusion maps of post-treatment lesion displayed complete absence of signal. Eighteen and 20 patients were assigned into group GP＋ LP and LP respectively. In the group GP＋LP, HAP, HAF and HBV of viable tumor post TACE was reduced compared with that in the group LP, and their difference were statistically significant between two groups （P=0. 030, 0. 012 and 0. 043）. While other parameters were not significantly different between two groups. Conclusion TACE with use of the mixture of gelfoam particles and lipiodol for embolizing HCC was more effective than that by lipiodol alone. CT perfusion imaging is a feasible technique for monitoring the therapeutic effect embolized by gelfoam particles.