肝癌结节血液动力学变化多层螺旋CT灌注成像观察

Hemodynamic study of hepatocellular carcinoma nodules by multi-slice spiral computed tomographic perfusion

目的对原发性肝癌的64层螺旋CT灌注参数进行分析，评价多层螺旋cT灌注参数对肝癌结节血液动力学变化的诊断价值。方法2009年1月至2012年12月收集健康志愿者40名作为对照组。北京中日友好医院37例肝癌患者作为试验组。所有研究对象知情同意后，行cT平扫、CT灌注成像和CT增强扫描。CT灌注扫描程序：120kV，60mA，扫描范围为40mm。以4～5ml／s速率，1．0ml／kg的用量静脉团注造影剂。在注入对比剂5s后行50s连续的扫描，360°旋转／1s。5mm层厚进行图像重建，矩阵大小512×512像素。灌注参数值：肝血流量（HBF），肝血容积（HBV），肝动脉灌注指数（HAI），肝动脉灌注量（HAP），门静脉灌注量（HPP）。感兴趣区包括：癌周肝实质组、肝癌结节和对照肝实质组。感兴趣区进行3次灌注参数测量后取平均值进行灌注结果分析。结果肝癌结节HBF[（215-I-183）ml·min^-1·（100mg。）]、HAP[（150±149）ml·min^-1·（100mg^-1）]、HAI（0．64％±0．18％）升高，与对照组正常肝实质相比[（91±24）ml·min^-1·（100mg。）、（18±5）ml·min^-1·（100mg^-1）、0．20％±0．04％]差异有统计学意义（P〈0．01），肝癌结节HBV升高和HPP降低，与对照组相比差异无统计学意义（P〉0．05）。肝癌结节HAP、HPP、HAI高于癌周肝实质，两组间差异有统计学意义（P〈0．05），肝癌结节HBV降低和HBF升高，但与对照组相比差异无统计学意义（P〉0．05）。结论CT灌注成像能很好地反映肝癌引起的肝血流变化信息，为肝癌血流动力学变化的影像研究提供新的方法。

Objective To analyze the 64-slice computed tomographic （CT） perfusion parameters of hepatocellular carcinoma （HCC） nodule so as to assess the diagnostic value of hemodynamic changes of HCC nodule by this perfusion technique. Methods Forty volunteers without liver disease （control subjects） and 37 HCC patients （experimental group） were selected. After informed consents, all of them underwent plain, perfusion and contrast CT examinations. Perfusion CT scan was performed at 120 kV, 60 mA and a thickness of up to 40 mm. The injection rate of contrast medium was 4 -5 ml/sec at a dose of 1.0 ml/kg body weight. And 50 seconds of continuous scanning time was set at 5 seconds post-injection. The indices were 1 second per 360° revolution, 5 mm slice thickness image reconstruction and a matrix size of 512 ~ 512 pixels. Perfusion parameters associated with changes in hepatic blood flow included blood flow （HBF）, hepatic blood volume （HBV） , hepatic arterial perfusion index （HAI）, hepatic artery perfusion （HAP） and portal venous perfusion （HPP）. Perfusion parameters were measured thrice at each timepoint for each different region of interest （ROI） ： hepatic parenchyma surrounding HCC nodule, HCC nodule and normal liver parenchyma（control group）. Results For HCC nodule, the increased levels of HBF, HAP and HAI were significantly differentiated from normal liver parenchyma of control group （ P 〈 0. 01 ）. Increased HBV and decreased HPP had no difference from control group （P 〉 0. 05 ）. Higher levels of HAP, HPP and HAIin HCC nodules were differentiated from hepatic parenchyma surrounding HCC nodules （ P 〈 0. 05 ）. HBV decreased and HBF increased in HCC nodule. But it had no differences from hepatic parenchyma surrounding HCC nodule （P 〉 0.05）. Conclusion Perfusion CT may visualize the status of liver blood flow caused by HCC nodule so as to serve as a new tool of studying the hemodynamic changes of HCC nodules.