多层螺旋CT灌注成像在肝转移瘤中的应用

Application of CT perfusion imaging in hepatic metastases

目的通过多层螺旋CT灌注成像来研究肝转移瘤(HMs)血流动力学特征。方法对25例HMs患者进行CT灌注成像扫描,测量肿瘤组织与周围肝实质的CT灌注参数,包括肝血流量(HBF)、肝血容量(HBV)、对比剂平均通过时间(MTT)、表面通透性(PS)、肝动脉分数(HAF),并计算肝动脉灌流量(HAP)和门静脉灌流量(PVP),同时分析富血供和乏血供病灶的时间-密度曲线(TDC)曲线和灌注参数特征。结果富血供HMs的TDC曲线呈速升缓降型,肿瘤组织在肝动脉血流图呈明显高灌注,HBF、PS、HAF和HAP大于周围肝实质,HBV、MTT和PVP小于周围肝实质,均有统计学意义。乏血供HMs的TDC曲线呈缓升缓降型,肿瘤组织在肝动脉血流图表现为低灌注,HBF、HBV、MTT、HAP和PVP小于周围肝实质,PS、HAF大于周围肝实质,其中HBF、HBV、MTT、HAF及PVP存在统计学意义。结论 CT灌注成像可以反映肝转移瘤的血流动力学特征,在疾病的定性诊断和鉴别诊断中具有一定指导意义。

Objective To study hemodynamics characteristics of hepatic metastases by using CT perfusion imaging. Methods CT perfu- sion scans were performed in 25 cases with hepatic metastatic. The perfusion parameters of tumor tissue and peripheral liver parenchyma were measured, including the values of hepatic blood flow（ HBF）, hepatic blood volume （HBV）, mean transit time （MTT）, permeablility （PS）, hepatic arterial fraction （HAP）, and calculate hepatic arterial perfusion （HAP） and portal vein perfusion （PVP）. Meanwhile, the time-density curve（TDC） and perfusion parameters characteristics of hypervasular as well as hypovascular metastases were analyzed. Re- suits In the hypervasular metastases, the TDC was fast risen and slowly fallen, the tumor tissue was hypertransfusion obviously in HBF images. HBF,PS, HAF and HAP were superior to peripheral liver parenchyma while HBV, MTr and PVP were inferior to peripheral liver parenchyma. All parameters were statistically significant. In the hypovascular metastases, the TDC was slowly risen and slowly fallen, the tumor issue was hypotransfusion obviously in HBF images. HBF, HBV, M3T and PVP were inferior to peripheral liver parenchyma while PS and HAF were superior to peripheral liver parenchyma,in which HBF, HBV, MTT, HAF and PVP were ststistically significant. Con- clusion CT perfusion imaging,which can reflect hemodynamic traits of hepatic metastases,has a great bearing on guiding the qualitation diagnosis and differential diagnosis.