多排螺旋CT灌注成像对小肝癌诊断价值

Value of multi-slice spiral CT in the diagnosis of small hepatocellular carcinoma

目的研究多排螺旋CT(multi-slice spiral CT,MSCT)动态增强灌注成像对小肝癌(small hep-atocellular carcinoma,SHCC)的诊断价值,提高SHCC的诊断准确率。方法使用多排螺旋CT对23例小肝癌患者行动态增强灌注成像,生成时间-密度曲线(time-density curve,T-DC),测量肝癌病灶及肝实质的CT灌注值包括血流量(blood flow,BF)、血容量(blood volume,BV)、肝动脉分数(hepatic arterialfractin,HAF),平均通过时间(mean transit time,MTT)、血管表面通透性(permeability suface,PS)和对比剂到达时间,并获得相应的灌注伪彩图。分析接受者工作特征曲线(receiver operating characterisiccurves,ROC)。结果小肝癌血流量、血容量及肝动脉分数值均明显高于肝实质(P<0.05),其它的灌注值在两者间差异无统计学意义(P>0.05)。小肝癌T-DC为速升型,峰值明显早于肝实质。肝动脉分数的测定,ROC临界值设为0.31时敏感度与特异度可分别达到100%和90%。结论肝脏CT灌注成像对小肝癌的诊断有重要意义。

Objective To study the diagnostic value of multi-slice spiral CT（MSCT） dynamic contrast-enhanced perfusion imaging in small hepatocellular carcinoma（SHCC） and improve the diagnostic accuracy of SHCC.Methods Multi-slice spiral CT dynamic contrast-enhanced perfusion imaging was used in 23 patients with SHCC,and the time-density curve（T-DC） were gotten.Blood flow（BF）,blood volume（BV）,hepatic arterial fraction（HAF）,mean transit time（MTT）,permeability surface（PS）and time of arrival of SHCC and liver parenchyma were measured,and the colored perfusion maps for each of the above-mentioned parameters were acquired.Also the receiver operating characteristic curves（ROC） were analyzed.Results SHCC showed BF,BV and HAF higher than those of the liver parenchyma（P0.05）,no significant difference was seen in the other perfusion parameters（P0.05）.T-DC of SHCC was fast rise,and its peak was significantly earlier than the liver parenchyma.Especially in hepatic arterial fraction determination,when ROC critical value was set to 0.31,the sensitivity and specificity can be achieved respectively 100% and 90%.Conclusion Hepatic CT perfusion imaging is important for the diagnosis of small hepatocellular carcinoma.