多层螺旋CT全肝灌注成像对肝脏常见肿瘤血流状态的评价

Evaluation of the blood flow in common hepatic tumors by multi-slice spiral CT whole-liver perfusion imaging

目的应用256层螺旋CT全肝灌注成像技术研究肝脏常见肿瘤血流状态的特点。方法对71例肝脏肿瘤患者行全肝CT灌注成像，其中原发性肝癌27例，肝血管瘤24例，肝转移瘤20例。将感兴趣区分别置于肿瘤组织、瘤周组织以及正常肝脏组织，绘制时间-密度曲线，获取肝脏血流量灌注参数，包括肝动脉灌注量（HAP）、门静脉灌注量（PVP）、总肝灌注量（TLP）和肝动脉灌注指数（HPI），比较各灌注参数的差异。结果原发性肝癌肿瘤组织的HAP、PVP、TLP和HPI分别为（20．00±11．41）ml·min^-1·100ml^-1、（32．31±21．06）ml·min^-1·100ml^-1、（52．31±30．55）ml·min^-1·100ml^-1和（39．67±11．19）％，与瘤周组织和正常肝脏组织比较，差异有统计学意义（均P〈0．05）。肝血管瘤肿瘤组织的HAP、TIJP和HP1分别为（40．39±29．23）ml·min^-1·100ml^-1、（132．72±132．65）ml·min^-1·100ml^-1和（35．51±15．12）％，与瘤周组织和正常肝脏组织比较，差异有统计学意义（均P〈0．05）。肝转移瘤肿瘤组织的HAP、PVP和HP1分别为（17．43±12．27）ml·min^-1·100ml^-1、（36．19±34．99）ml·min^-1·100ml^-1和（37．86±14．49）％，与正常肝脏组织比较，差异有统计学意义（均P〈0．05）。肿瘤组织的HAP、PVP和TLP以及瘤周组织的PVP和HPI在不同肿瘤之间的差异均有统计学意义（均P〈0．05）。结论螺旋CT全肝灌注对肝脏常见肿瘤血流状态的评估有一定的价值。肝脏常见肿瘤不同区域的灌注参数有各自的血流动力学特征。

Objective To study the characteristics of blood flow in common hepatic tumors by 256- slice spiral CT whole-liver perfusion imaging. Methods Seventy-one patients with hepatic tumors were examined retrospectively by 256-slice spiral CT whole-liver perfusion. Among them, twenty-seven cases were of primary hepatic cancer, twenty-four cases of hepatic hemangioma, and twenty cases of hepatic metastases. Regions of interest （ ROIs ） were placed in the tumor parenchyma （ Area A）, peritumoral hepatic parenehyma （ Area B） , and normal hepatic parenchyma （ Area C ） , respectively. The time density curves （ TDC ） were drawn, and perfusion parameters including hepatic arterial perfusion （HAP）, portal venous perfusion （PVP） , total liver perfusion （ TLP ） and hepatic pefusion index （ HPI ） were obtained. The values of ROIs were measured, and the perfusion parameters in the areas A, B, C of different hepatic tumors were statistically analyzed. Results The values of HAP, PVP, HPI in the tumor parenchyma of primary hepatie carcinoma were （20.00±11.41）ml·min^-1·100ml^-1, （32.31±21.06）ml·min^-1·100ml^-1, （52.31±30.55）ml·min^-1·100ml^-1, and （39.67± 11.19）%, showing significant difference as compared with those in peritumoral hepatic parenchyma and in normal hepatic parenchyma （P〈 0.05）. The values of HAP, TLP, and HPI in the tumor parenehyma of hepatic hemangioma were （40.39±29.23）ml·min^-1·100ml^-1, （132.72±132.65） ml·min^-1·100ml^-1, and （35.51±15.12）%, were significantly different as compared with those in the peritumoral hepatic parenehyma and in normal hepatic parenehyma（P〈0.05） .The values of HAP, PVP, HPI in the tumor parenehyma of hepatic metastases were （ 17.43± 12.27）ml·min^-1·100ml^-1 ,（36.19±34.99） ml·min^-1·100ml^-1 , and （ 37.86± 14.49 ） %, significantly different as compared normal hepatic parenchyma （P 〈 0.05 ）. The HAP, PVP, and TLP of tumor tissue and the PVP and HPI of peritumoral tissue in different hepatic tumors were statistically significantly different （P〈0.05）. Conclusions The multi-slice spiral CT whole-liver peffusion has certain value in the diagnosis of common hepatic tumors. Peffusion parameters in different areas of common hepatic tumors have their own hemodynamie characteristics.