动脉期灌注率预测肝癌肝动脉插管化疗栓塞的疗效

Arterial phase perfusion ratio for assessment of efficacy of transcatheter arterial patients with hepatocellular carcinoma

目的采用超声造影灌注参数预测肝癌肝动脉插管化疗栓塞（TACE）的疗效。方法本院2008年1月至2010年12月的肿瘤直径≥5cm单发肿瘤初诊肝癌69例，首次治疗为TACE。比较患者TACE术前、后肿瘤大小，按RECIST标准进行分组，部分缓解组（PR）21例，疾病稳定组（SD）17例，疾病进展组（PD）31例。采用SonoLiver软件分析肿瘤超声造影灌注曲线的曲线下面积（AUC）、平均渡越时间（mTT）、灌注指数（PI）、达峰时间（TTP）及峰值强度（IMX），采用Image Pro Plus软件分析肿瘤动脉期肿瘤灌注百分率。结果AUC、mTT、PI、TTP及IMX在3组间差异无统计学意义（P〉0．05）。PR组或SD组动脉期肿瘤灌注百分率比PD组大[（78．88±12．19）％，（72．93±15．68）％比（38．97±11．01）％，P〈0．05]。以动脉期肿瘤灌注百分率小于50％为预测指标，筛选PD组病例，诊断符合率为88．4％（61／69），敏感性83．9％（26／31），特异性92．1％（35／38）。结论动脉期肿瘤灌注百分率有可能作为一个新的超声造影参数预测肝癌TACE的疗效。

Objective To predict the efficacy of transcatheter arterial chemoembolization （TACE） in patients with hepatocellular carcinoma （HCC） by using ultrasonographic perfusion parameters. Methods Sixty-nine patients with primary diagnosis of HCC as having single tumor diameter of i〉5 cm and TACE as initial treatment were enrolled from Sun Yat- sen University Cancer Center between January 2008 and December 2010. Patients were divided into partial response group （PR, n=21 ）, stable disease group （SD, n= 17） and progressive disease group（PD, n=31）, respectively, based on the RECIST standard and comparison of pre- and post-operative tumor size. Parameters of tumor ultrasonographic perfusion curve, including area under curve （AUC）, mean transit time （mTT）, perfusion index （PI）, time to peak （TTP） and maximum intensity （IMX） , were analyzed by using SonoLiver software, and the arterial phase perfusion ratio was computed via Image Pro Plus software. Results The differences in AUC, mTT, PI, TTP and IMX did not reach statistical significance among groups （all P〉0.05）. Group PR and SD yielded higher perfusion ratio in arterial phase than group PD [ （78.88±12.19）%, （72.93±15.68）% vs （38.97±11.01）%, P〈0.05]. Arterial phase perfusion ratio 〈50% as a predictor of patients with PD was associated with a diagnostic accuracy of 88.4% （61/69）, sensitivity of 83.9% （26/31） and specificity of 92.1% （35/38）. Conclusion Perfusion ratio in arterial phase may be a novel uhrasonographic perfusion parameter for the prediction of efficacy of TACE treatments in patients with HCC.