全肝CT灌注扫描对于介入术后肝肿瘤活性的观察

CT Perfusion imaging for whole liver:evaluating viable lesion after transarterial chemoembolization for hepatocellular carcinoma

目的经动脉导管化疗栓塞术(transarterial chemoembolization,TACE)治疗后患者进行全肝灌注扫描,比较增强CT、全肝灌注扫描和DSA三种检查技术对TACE治疗后肝癌瘤灶活性的检出率。方法 17例经过穿刺病理或血清学证实的肝细胞癌患者曾经行TACE介入治疗:患者于介入术后4周行全肝脏CT灌注扫描。明确经过碘油栓塞治疗的病灶44个被列入观察中。肝脏灌注分数(hepatic arterial fracture,HAF)灌注图高参数信号作为判定术后瘤灶存有活性的标准。分别采用增强CT、全肝CT灌注成像和DSA判定介入治疗后肿瘤活性,最后对不同影像技术的肿瘤活性检出率进行比较。结果 DSA造影的肿瘤活性检出率最高,达86.36%,CTP的检出率84.09%,而增强CT扫描的检出率70.45%最低。并且与前两者相比有显著性差异(P=0.016和0.031)。结论作为无创性检查手段,CTP的肿瘤活性检出力明显强于增强CT,并且接近DSA造影。因此,全肝CT灌注扫描是一种有价值的观测肝癌介入治疗疗效的无创医疗技术。

Objective To compare the enhanced CT, DSA with CT-perfusion in detectability to viability of lesion after transarterial chemoembolization for hepatocellular. Methods 17 patients with histopathologically proven HCC underwent post treatment CT perfusion examinations （4 weeks after TACE）. In post-treatment CT-perfusion HAF image, The high- level HAF was clue to viable lesion for hepatocellular carcinoma. McNemar Test was used to compare the differences in detectability to viability of lesion between enhanced CT, DSA with CT-perfusion. Results 44 lesions were involved in this study. The detectability to viability of lesion of DSA and CT-perfusion were superior to enhanced CT, and their differences were statistically significant between DSA, CT-perfusion and enhanced CT （ P =0. 016 and 0. 031, respectively）. Conclu- sion CT perfusion imaging for whole liver is a feasible technique for monitoring viability of lesion and treatment response after TACE.