CT灌注成像及血管内皮生长因子检测对肝癌灌注栓塞后血供评价的研究

目的探讨16排螺旋CT灌注成像技术(CTPI)与血管内皮生长因子检测在肝细胞癌经导管动脉化学栓塞术(TACE)后血供评价中的价值。方法 32例肝细胞癌(Hepatocellular carcinoma,HCC)患者TACE后1个月行CT灌注成像,计算灌注参数:血流量、血容量、对比剂的平均通过时间、毛细血管通透性和肝动脉分数。检测TACE术前1天、术后1个月外周血管内皮生长因子(Vascular endothelial growth factor,VEGF)浓度,与肝动脉造影结果进行比较分析。实验数据用统计软件包SPSS12.0处理。结果⑴TACE术后肝癌活性灶与非瘤区肝实质的BF、BV、MTT、HAI差异显著(P<0.05)。PS差异不明显(P>0.50)。⑵与肝动脉造影血管减影比较,CTPI的诊断正确率为96.4%。⑶DSA检查无活性患者外周血VEGF较TACE术前明显下降,差异显著,具有统计学意义;而DSA检查病灶有活性的患者差异无统计学意义。结论 ⑴TACE术后肝细胞癌病灶呈高灌注表明病灶具有活性,需要再次TACE。⑵CT灌注成像在肝细胞癌TACE术后活性灶评估中应用价值与DSA相当。⑶VEGF检测结合CT灌注成像可以客观判断肝癌TACE后肿瘤血管生成情况。

Objective To evaluate vasularity assessment with 16 multi-slice spiral CT perfusion imaging （CTPI） and serum level of vascular endothelial growth factor in the follow up of hepatocellular carcinoma（HCC） after transcatheter arterial chemoembolization （TACE）. Methods Thirty-two patients with HCC were enrolled in this study. CTPI was performed after an intravenous bolus injection of 50 mL contrast material （300mgI/ ml）with 4mL/sec 1 month after TACE for patient. The acquired data were analyzed by using GE Perfusion4.3 software station. The value of blood flow （BF）, blood volume （BV）, mean transit time （MTT）, permeability surface （PS） and hepatic arterial fraction （HAF） were measured by using maximum slope method. Results of CTPI and angiography digital subtraction（DSA）or pathology were compared. Results The values of BE, BV, MTT, HAF were significant different （P〈0.05）. Compared with DSA, CTPI had the accuracy of 96.4%. There was significant difference between the serum level of VEGF before TACE and after in the group of lack of blood perfusion .Conclusion The average parameter value of BF, BV, HAF in center lesion is higher after TACE can provide diagnostic images to choose the ideal opportunity of TACE once more. Compared with DSA, Multi-- slice CT perfusion imaging is a noninvasive screening and follow-up method for TACE. CTPI and the serum level of VEGF are new ways to assess vasularity of HCC after TACE.