能谱CT在肝癌TACE术后评估中的应用

The application of energy spectral CT in evaluating the therapeutic effect of TACE for hepatocellular carcinoma

目的利用能谱CT探讨TACE在HCC治疗中的价值。方法对44例HCC患者进行能谱CT扫描，利用能谱分析软件（GSI）对图像进行后处理，用混合能量和单能量图像观察病灶，在病灶最大层面测得首次发现未经介入治疗患者的HCC病灶（A组）、TACE术后无碘油沉积的部分病灶（B组）、术后远处新发病灶（C组）动脉期及门静脉期的碘含量并计算其标准化碘浓度（NIC）、肝癌碘浓度比率（ICratio）。结果TACE术后B组ICratio值明显低于A组和C组ICratio值，分别为（0．43±0．09）、（0．66±0．06）、（0．63±0．04），B组和A、C组ICratio值差异均有统计学意义（P〈0．05），A、C两组ICratio值差异无统计学意义（P〉0．05）。4次以上TACE术B组部分病灶ICratio值小于1～4次TACE术后部分病灶ICratio值，分别为（0．38±0．07）、（0．46±0．08），两者差异有统计学意义（P〈0．05），同一病灶术前ICratio值在碘油沉积区（0．65±0．05）与无碘油沉积区（0．61±0．03）差异无统计学意义。结论肝动脉化疗栓塞对术后无碘油沉积HCC病灶部分同样具有一定疗效．且疗效与介入次数有关，而对远处新发病灶并无影响。同时能谱CT可以很好地评价肝动脉化疗栓塞的疗效。

Objective With the help of spectral CT scan to investigate the therapeutic effect of transcatheter arterial chcmoembolization （TACE） for primary hepatocellular carcinoma （HCC）. Methods Energy spectral CT scan was carried out in 44 patients with primary HCC, by using energy spectrum analysis software （GSI） the images were post-processed. The images obtained by mixed energy and single energy were used to observe the lesions. HCC lesions that were first detected on the maximum level of the lesion in patients having not received interventional therapy （group A）, the lesions showing no iodine oil deposit after TACE （group B） and the distant newly developed lesions （group C） were determined. Results After TACE, ICratio value of group B （0.43±0.09） was significantly lower than that of group A and group C （0.66±0.06 and 0.63±0.04 respectively）. The difference in ICratio value was statistically significant between group B and group A as well as between group B and group C （P〈0.05）, while no statistically significant difference in ICratio value existed between group A and group C （P〉0.05）. In group B, the ICratio values of the lesions, which had received TACE procedure over 4 times （0.38±0.07）, were smaller than those of the lesions, which had received TACE procedure 1-4 times and showed no iodine oil deposit （0.46±0.08）, the difference between the two groups was statistically significant （P〈0.05）. Within the same lesion, no statistically significant differences in preoperative ICratio values existed between iodine oil deposit area （0.65±0.05） and without iodine oil deposit area （0.61±0.03）. Conclusion TACE has certain therapeutic effect on HCC lesions that show no iodine oil deposit after TACE, and its effect is well related to the times of ＇FACE procedure, but it has no effect on the distant newly developed lesions. Energy spectral CT scan can effectively evaluate the therapeutic efficacy of TACE.