CT灌注成像对原发性肝癌介入术后疗效的评价

CT perfusion imaging in assessing the effect of primary hepatic carcinoma after intervention treatment

目的探讨CT灌注成像（CT perfusion imaging，CTPI）在评价原发性肝癌（Primary hepatic carcinoma，PHC）行经导管动脉化疗栓塞术（Transcatheter arterial chemoembolization，TACE）后的疗效方面的价值。方法收集患有PHC并行TACE术的患者33例，病灶均为单发，所有病例于TACE术前1周及术后1个月行64排CTPI、CT增强和血管造影（Digital subtraction angiography，DSA）检查。以DSA为“金标准”，对生成血流灌注伪彩图和各项灌注参数进行分析比较，评价CTPI在判断肝细胞癌介入术后的疗效方面的价值。结果术后肿瘤组织肝动脉灌注值（Hepatic arterial perfusion，HAP）、肝动脉灌注指数值（Hepatic perfusion index，HPU和全肝总灌注量（Total hepatic blood flow，THBF）与术前相比明显减少（P〈0．01），门静脉灌注值（Portal vein perfusion，PVP）与治疗前相比无明显变化（P〉0．05），碘油沉积区及坏死区无m流灌注，时间密度曲线呈直线；周围正常肝组织的各项CTPI值与术前相比无统计学差异（P〉0．05）。CTPI对PHC行经TACE后局部残留或复发灶的诊断准确性为87．88％，灵敏度为95．83％，特异度为66．67％，与DSA相比，两者的一致性较好（kappas〉0．75）。结论CTPI能够很好地反映PHCTACE术后局部病灶和周围正常组织的血供情况，可部分代替DSA评价PHC经TACE术后的疗效。

Objective To discuss the value of CT perfusion imaging（CTPI） in determining the effet of primary hepatic carcinoma（PHC） after intervention treatment. Methods 33 patients with hepatocellular carcinoma who agreed W accept transcatheter arterial chemoembolization （TACE） were involved in this study. Lesions were solitary. CTPI, enhanced CT and digital subtraction angiography（DSA） were performed one week before and one month after treatment. Taking DSA as the ＂gold standard＂, the acquired blood perfusion colour - picture and the perfusion parameters were analyzed and compared to access the value of CTPI in determining the effect of PHC after TACE. Results Compared with preoperative tumor tissue, the values of the hepatic arterial perfusion （HAP） ,the hepatic perfusion index（HPI） and the total hepatic blood flow（THBF） of the postoperative one were decreased significantly （ P 〈 0.01 ）. The portal vein perfusion （PVP） showed no significant change （ P 〉 0.05 ）, and there was no blood supply in the lipiodol deposition or tumor necrosis area, the time density curve （TDC）of which showed a horizontal line, and compared with preoperative surrounding normal liver tissue. The CTPI value of the postoperative one had no significant change （ P 〉 0.05 ）. CTPI diagnosis accuracy was 93.94% ; sensitivity was 100%, and specificity was 77.78%. CTPI on the detection of residual or recurrent hepatocellular carcinoma had a good agreement with DSA（ kappa = 0. 836,P =0. 000）. Conclusion CTPI can well reflect the blood supply of the local lesion and the surrounding normal hepatic tissue after TACE. It can partly replace DSA to evaluate the effect of PHC after TACE.