胰头动脉弓周围脏器恶性肿瘤状态下的胰腺多层螺旋CT灌注研究

Study of pancreas perfusion in arterial arcades of the pancreatic head around malignant tumor by applying the multi-slices helical CT

目的:应用多层螺旋CT灌注成像技术,评价与胰头动脉弓密切相关的供血动脉所属脏器发生恶性肿瘤时胰头血液循环的变化。方法:选择临床行上中腹增强CT检查77例,按纳入标准分为A、B两组,A组35例为正常胰腺组(A组),B组42例为胰头动脉弓周围脏器恶性肿瘤组,其中,B组根据肿瘤脏器血供来源分为I、Ⅱ两亚组,Ⅰ组为肝癌患者22例,II组为贲门癌及胃癌患者20例。两组均行16层螺旋CT灌注扫描,扫描条件:120 kV,200 mA,1.0 s/r,矩阵512×512,采集层厚2 mm×4,间隔1 s,螺距15(0.986),于肘前静脉团注对比剂碘海醇50 mL,6 mL/s,延迟6 s,数据采集45 s。扫描后的影像数据传输到Vitrea 2.0后处理工作站,采用Toshiba体部灌注软件进行A、B两组胰腺灌注参数三点测量,其平均值视为灌注参数最后值,并行统计学分析。结果:A、B(Ⅰ组,Ⅱ组)两组血流量(blood flow,BF,单位:mL.100g-1.min-1)、血容量(blood vol-ume,BV,单位:mL.100g-1)、表面通透性(permeability surface,PS,单位:mL.100g-1.min-1)和平均通过时间(mean transittime,MTT,单位:0.1 s)的测量值分别为:(134.62±27.41),(43.19±13.76),(218.39±99.20),(299.26±81.99)和(111.91±31.26),(108.58±38.83),(115.58±20.38);(43.52±21.95),(49.38±23.93),(37.08±18.00);(218.67±76.93),(225.53±80.75),(223.51±88.54);(297.93±137.28),(291.37±118.29),(305.15±158.43)。A、B两组BF间差异有统计学意义(P<0.05),BV、PS和MTT间差异无统计学意义(P>0.05);Ⅰ、Ⅱ组和A组的比较中,除I组BF间差异有统计学意义(P<0.05)外,其余组间差异均无统计学意义(P>0.05)。结论:与胰头动脉弓密切相关的供血动脉所属脏器发生恶性肿瘤时,胰头仅有血流量改变,血液循环影响不大。

Objective：To assess the characteristics of blood perfusion of pancreatic head in occurrence of malignant tumors of the organs feeding arteries of arterial arcades of the pancreatic head by applying the multi-slices helical CT perfusion software.Methods： This study randomly choose 77 patients who received enhancement CT examination for the superior or the middle abdomen.These were divided into two groups according inclusive criteria： Group A and Group B.Group A,which served as the control group,consisted of 35 patients with normal pancreas tissue,and Group B consisted of 42 patients with malignant tumor around the pancreatic head.The Group B was further divided into two sub-groups according to the blood supply of the involved organs.Sub-group I consisted of 22 cases with liver cancer,and Sub-group II consisted of 20 cases with cardiac cancer and gastric cancer,both receiving the 16 slices spiral CT perfusion imaging.Condition of imaging： 120 kV,200 mA,1.0 s/r,512×512 matrix,4×2 collimation,interval 1 s,thread pitch 15.Contrast injection was done by using 50.0 mL contrast agent,at a flow rate of 6.0 mL/s with a power injector,and six seconds delay,and data acquisition lasted for 45 seconds.These data were processed on a Start Vitreal 2.0 work station by using Toshiba body software package,and the mean blood flow（BF）,blood volume（BV）,permeability surface（PS）,mean transit time（MTT） were measured and statistically analyzed.Results： The mean BF（mL·100 g-1·min-1）,BV（mL·100 g-1）,PS（mL·100 g-1·min-1） and MTT（0.1 s） of Group A were：（134.62 ± 27.41）,（43.19 ± 13.76）,（218.39 ± 99.20）,（299.26 ± 81.99）,respectively.The mean BF,BV,PS and MTT of Group B（Subgroup I and Subgroup II） were（111.91 ± 31.26）,（108.58 ± 38.83）,（115.58 ± 20.38）,（43.52 ± 21.95）,（49.38 ± 23.93）,（37.08 ± 18.00）,（218.67 ±76.93）,（225.53 ± 80.75）,（223.51 ± 88.54）,（297.93 ± 137.28）,（291.37 ± 118.29）,（305.15 ± 158.43）,respectively.Statistical differences existed between Group A and Group B（P0.05） in BF while no statistical difference was found in either of BV,PS and MTT（P0.05）.In the compareson of the two sub-groups in Group B with Group A,the only statistical difference was found was in the BF between Sub-group I and Group A（P0.05）.There was no statistical difference in other groups in BF,BV,PS and MTT（P0.05）.Conclusion： When the organs of feeding arteries associated arterial arcades of the pancreatic head are present along with malignant tumors,only the blood volume has some change in the pancreatic head,and the blood circulation will not be influenced.