多层螺旋CT灌注成像对肝脏占位性病变的诊断与鉴别诊断

Multi-slice spiral CT perfusion imaging in diagnosis and differential diagnosis of focal liver lesions

目的利用多层螺旋CT灌注成像对肝脏肿瘤样病变进行诊断及鉴别诊断。方法先行多层螺旋CT进行灌注扫描,获得图像传至ADW 4.3工作站,利用Perfusion 3软件进行重建,把腹主动脉做为输入动脉,下腔静脉做为输出动脉,选定合适的感兴趣区域,得到灌注图像及灌注参数,计算出BF、BV、MTT、PS和HAF各参数图中的参数值,利用统计学软件,进行分析。结果肝癌组、肝血管瘤组、肝转移瘤组BF、HAF明显高于正常组(P<0.05),MTT明显低于正常组(P<0.01),而三者之间差异无统计学意义,肝癌组、肝血管瘤组、肝转移瘤组PS高于正常组,但肝癌组与正常组间比较差异有统计学意义(P<0.05);肝血管瘤组的BV高于其他三组(P<0.05),并随着时间延长不断继续强化,最后完全充填病灶,灌注量增加,在该区域的BV值均高于其他三组,可与肝癌及转移瘤鉴别,其他三组之间比较差异无统计学意义。结论 BF、MTT、HAF在正常肝组织、肝癌、肝转移瘤和肝血管瘤含量比较差异有统计学意义,BV升高对血管瘤的诊断具有显著意义,并且与其他三组比较差异有统计学意义,然而肝癌与转移瘤的鉴别诊断仍需结合其他临床和影像学资料。

Objective To diagnose and distinguish diagnosis of focal liver lesions by multi-slice spiral CT perfusion imaging. Methods Images obtained by multi-slice spiral CT perfusion scan were transmitted to AW4.3 workstation. Perfusion 3 software was used for reconstruction, with the abdominal aortic artery as input and the inferior vena cava artery as output. The appropriate region was selected for obtaining the perfusion images and perfusion parameters. The values of BF, BV, MTY, PS and HAF were calculated, and then they were analyzed by statistical software. Results The values of BF and HAF in liver cancer group, hepatic hemangioma group and hepatic metastasis group were significantly higher than those in normal liver tissue （P〈0.05）, while the values of MTY were significantly lower than those in the normal group （P〈0.01） without significant difference among the three groups. The values of PS in liver cancer group, hepatic hemangioma group and hepatic metastases group were higher than those in normal liver tissue, but there were significant differences （P〈0.05） between the liver cancer group and the normal group. The values of BV in hepatic heman- gioma group were higher than those in the other three groups （P〈0.05）, and BV continued to strengthen with time pass- ing until the blood finally completely filled lesions. Perfusion increased and all the values of BV in the region were higher than those in the other three groups, namely that hepatic hemangioma could be distinguished from liver cancer and metastases. There was no significant difference among the other three groups. Conclusion There are significant dif- ferences in BF, MTT, HAF in normal liver tissue, liver cancer, hepatic hemangiomas and hepatic metastases. Increase of BV is significantly important in the diagnosis of hepatic hemangioma, and there is a significant difference among the other three groups. However, it requires other clinical and radiological data to distinguish diagnosis of liver cancer and hepatic metastases.