CT灌注随访TACE治疗后肝癌的影响因素初步分析

目的探讨CTPI随访肝脏恶性肿瘤TACE治疗后病灶诊断效力的影响因素。方法收集40例TACE治疗后的肝脏恶性肿瘤患者,共47个DSA诊断阴性同时行CTPI检查的病灶。以CTPI诊断是否与DSA一致分成A组(符合组22个)和B组(不符组25个),分析末次TACE距CTPI检查时间(d),病灶的最大径(cm),患者的肝脏功能分级(Child-Pugh评分)3个因素在2组间的差异。结果 2组间末次TACE距CTPI检查时间和病灶最大直径有显著差异(P<0.05),而Child-Pugh评分无显著差异。结论末次TACE距CTPI检查时间以及病灶大小是影响CTPI随访TACE治疗后肝脏恶性肿瘤诊断准确性的重要因素,考虑TACE术后组织坏死、化疗药物缓释及栓塞物的异物刺激引起病灶周边无癌肝实质内的炎性反应是导致该现象的病理学基础。全肝CTPI检查于炎性反应的消退后可以一定程度上替代DSA检查评价TACE术后病灶区肿瘤组织生长情况。

Objective To explore influencing factors of CT perfusion imaging （CTPI） in the follow-up of hepatocellular carcinoma after transcatheter arterial chemoembolization （TACE）. Methods 40 patients with hepatocellular carcinoma underwent CTPI and DSA after procedure（s） of TACE. These two examinations were completed sequentially within one week. A total of 47 lesions DSA negative diagnosis were found. These cases were divided into group A （22 lesions with the group） and group B （25 lesions not set） according to the diagnosis Results of CTPI and DSA agreement or not. The time （d） from the last TACE to CTPI,the largest diameter of the lesion （cm）,and liver function grade （Child-Pugh score） were estimated and compared between two groups. Results The time （d） from the last TACE to CTPI and the largest diameter of the lesion （cm） were significantly different（P〈0.05）,but Child-Pugh scores were not significantly different. Conclusion The time from the last TACE to CTPI and lesion sizes are important factors affecting hepatocellular carcinoma diagnosis accuracy of CTPI follow-up after TACE. The tissue necrosis after TACE,chemotherapy drug release and embolus tissue stimulated liver parenchyma without cancer of peripheral lesions with inflammation are the pathological basis. CTPI examination can replace the DSA to a certain extent,and assessment tumor tissue growth of lesions after TACE after the extinction of inflammatory reaction.