128层4D CT全肝灌注成像在肝细胞癌中的初步应用

Preliminary application of 128-slice 4D CT whole-liver perfusion imaging in hepatocellular carcinoma

目的:探讨128层4D CT全肝灌注成像在原发性肝癌(HCC)灌注中的参数特征及其初步临床应用价值。方法:对20例正常对照组、40例经临床或手术病理证实为HCC的患者行128层4D CT灌注扫描,获得灌注参数血流量(BF)、肝动脉灌注量(ALP)、门静脉灌注量(PVP)、肝动脉灌注指数(HAPI)。根据各灌注图像及相关参数评价正常组织与恶性肿瘤、高分化HCC与低分化HCC的血流动力学状态。同时获得270mm扫描覆盖范围内动态4D CTA图像,动态观察对比剂流入及流出情况,判断肿瘤供血动脉的增粗、僵直、门静脉癌栓等。结果:①HCC患者ALP、HAPI、BF明显高于正常组(P<0.01),PVP明显降低(P<0.01)。②高分化HCC患者灌注参数ALP、HAPI低于低分化HCC,PVP明显升高,二者差异有统计学意义(P<0.01)。灌注参数从一方面反映了肿瘤的恶性程度。③40例HCC中,4D CTA显示肿瘤供血动脉25例,13例供血动脉增粗、僵直,门静脉癌栓15例。结论:128层4D CT灌注成像可以通过一次注射对比剂,获得全肝灌注信息及动态的4DCTA,肝灌注模式成像克服了以往灌注成像的不足,简单实用,具有一定的优势。此技术能很好地反映HCC的血流动力学变化,为HCC的早期诊断、指导临床治疗及判断预后提供可靠的依据,具有重要的临床应用价值和广阔的应用前景。

Objective： To study characteristics of 128-slice 4D CT perfusion parameters of hepatic carcinoma and evaluate the clinical application. Methods： Twenty cases of normal control group and 40 patients with HCC diagnosed by clinical data or pathological detections had been performed CT perfusion scanning, then the values of flow perfusion （BF）, arterial liver perfusion （ALP）, portal venous perfusion （PVP） and hepatic perfusion index （HAPI） were calculated respectively. According to the perfusion parameters, we could evaluate hemodynamics of normal control group and hepatic carcinoma, well differentiated and poorly differentiated hepatocellular carcinoma. Meanwhile, dynamic 4D-CTA images were also obtained. Thickening, stiffness and stenosis of feeding arteries and embolisms within portal vein were observed. Results： （I） ALP, HAPI, BF were significantly higher in liver cancer group than the normal control group （ P〈0.01）, but PVP was significantly lower in cancer group than the normal control group（ P〈0.01）. （2）ALP, HAPI in well differentiated HCC were lower,PVP was higher than poorly differentiated HCC. The difference of the two had statistical significance（ P〈0.01）. （3）On 4D-CTA, 25 feeding arteries of tumor were showed in 40 cases primary liver cancer, 13 cases had thickening, stiffness and stenosis of feeding arteries 15 cases had embolisms within portal vein. Conclusion：By whole-liver perfusion CT with 128 slice 4D CT system with administration of one contrast medium bolus, whole-liver perfusion image and dynamic 4D-CTA images can be obtained. The whole-liver perfusion pattern has some advantages, such as simplicity and practice. And the disadvantages of previous patterns of liver perfusion imaging are eliminated in this pattern. This perfusion imaging technology can reflect the hemodynamic changes of hepatocellular carcinoma very well. It can provide a reliable basis for the early diagnosis of liver cancer and also can guide clinical treatment and estimate prognosis. So this technique has important clinical value and broad clinical application foreground.