CT灌注成像对评估12例5cm以下肝癌介入治疗疗效

Application of CT perfusion imaging in evaluating interventional therapy for small hepatocellular carcinoma: preliminary experience in 12 cases

目的：探讨CT灌注成像在5 cm以下肝癌TACE （transcatheter arterial chemoembolization）治疗前后血流动力学变化方面的临床应用价值。方法12例5 cm以下肝癌患者于TACE术前1-2 d及术后3-4周行肝脏CT灌注成像，通过获取的灌注参数分析栓塞前后的肿瘤组织、栓塞前肿瘤组织与正常组织及栓塞后肿瘤活性组织与正常组织的血流变化情况。结果栓塞前肿瘤组织的血流量（BF），肝动脉分数（HAF），肝动脉灌注量（HAP），表面通透性（PS）较正常组织显著增加（P﹤0.01），而栓塞后肿瘤组织血流各组灌注参数（血容量，BV除外）较栓塞前显著降低（P﹤0.01），栓塞后的肿瘤活性组织较正常组织BF， PS，HAF，HAP增加（P﹤0.05）。结论 CT灌注成像在5 cm以下肝癌的诊断、TACE治疗后的血流动力学变化评估及术后残余活性病灶的显示方面具有较高的临床应用价值。

Objective To investigate the clinical application of CT perfusion imaging in assessing the hemodynamic changes in patients with small hepatocellular carcinoma （〈5 cm） before and after transcatheter arterial chemoembolization （TACE）. Methods Twelve patients with small hepatocellular carcinoma were enrolled in this study. CT perfusion imaging of the liver was performed 1 - 2 days before and 3 - 4 weeks after TACE. By using the perfusion parameters the hemodynamics of the preoperative and postoperative tumor tissue, the hemodynamics of the preoperative tumor tissue and the normal tissue, and the hemodynamics of the postoperative active tumor tissue and the normal tissue were determined , and the results were compared between each other. Results Before TACE, the blood flow （BF）, hepatic arterial fraction （HAF）, hepatic arterial perfusion （HAP） and permeability of surface （PS） in the tumor tissue were significantly higher than those in the normal tissue （P 〈 0.01）, while after TACE all the perfusion parameters except blood volume （BV） were significantly decreased in the tumor tissue （P 〈 0.01）. After TACE, BF, PS, HAF and HAP in the activity tumor tissue were increased more than those in the normal tissue （P 〈 0.05）. Conclusion CT perfusion imaging is of great clinical value in diagnosing 〈 5 cm hepatocellular carcinoma , in evaluating the hemodynamic changes after TACE and in demonstrating the activity of the residual tumor tissue.