多排螺旋CT中灌注参数对肝脏占位性病变鉴别诊断的临床价值

The clinical value of multi-phase spiral CT in the differential diagnosis of hepatic occupying lesions

目的探讨多排螺旋CT在鉴别诊断肝脏占位性病变的临床价值。方法收集2016年1月至2017年6月在古浪县人民医院就诊的肝脏占位性病变患者154例,根据临床病理分为3组,A组患者(n=51)为原发性肝癌,B组患者(n=52)为肝脏转移瘤,C组患者(n=51)为肝血管瘤。对患者进行肝脏灌注CT,统计分析肝脏中病灶及周围组织的灌注参数。结果病灶组织灌注CT参数中,HBF指标A组患者明显高于B、C两组,B组明显高于C组(P<0.05);HBV指标A组明显高于B、C两组(P<0.05),B与C组未呈现显著差异(P>0.05);MTT指标中A组明显低于B、C两组,B组明显低于C组(P<0.05)。HAP、PVP、TLP指标C组明显高于A、B两组(P<0.05),HAP、TLP指标A组明显高于B组(P<0.05),PVP指标A组明显低于B组(P<0.05)。HPI指标在3组间无明显差异(P>0.05)。病灶周围肝组织灌注CT参数中,HBF指标C组明显低于A、B组,A组低于B组(P<0.05);HAP指标和HPI指标B组均明显高于A、C两组(P<0.05),A、C组间无明显差异(P>0.05);3组HBV、MTT、PVP、TLP指标未呈现显著差异。正常肝组织灌注CT参数中,MTT指标A组明显低于B、C组(P<0.05),B、C间无明显差异(P>0.05);3组HBF、HBV、HAP、PVP、TLP、HPI指标无显著差异(P>0.05)。结论肝占位性病变患者经过灌注CT检查获得的灌注参数在病灶区及病灶周围区具有较大的差异,因此可以认为灌注参数对于鉴别诊断原发性肝癌、肝转移癌、肝血管瘤等有一定临床价值。

Objective To explore the clinical value of multi-phase spiral CT in the differential diagnosis of hepatic occupying lesions.Methods A total of 154 patients with hepatic occupying lesions examined during Jan.2016 and June 2017 were divided into three groups according to the clinical pathological results.Group A(n=51)was primary hepatic carcinoma,group B(n=52)was metastatic hepatic carcinoma,and group C(n=51)was hepatic hemangioma.Liver perfusion CT was performed to analyze the perfusion parameters of the lesions and surrounding tissues.Results In the perfusion of lesions,the HBF and HBV indexes were the highest in group A,followed by group B and C(P<0.05);there were no significant differences in HBF and HBV between group B and C(P>0.05);the MTT index was the lowest in group A,followed by group B and C(P<0.05);HAP,PVP and TLP were higher in group C than in group A and B(P<0.05);HAP and TLP were higher in group A than in group B(P<0.05);PVP was lower in group A than in group B(P<0.05);there were no significant differences in HPI among the three groups(P>0.05).In the perfusion of surrounding tissues,HBF was the lowest in group C,followed by group A and B(P<0.05);HAP and HPI were higher in group B than in group A and C(P<0.05),and there were no significant differences between group A and C;there was no significant differences in HBV,MTT,PVP and TLP among the three groups(P>0.05).In the perfusion of normal liver tissues,MTT was lower in group A than in group B and C(P<0.05),and there were no significant differences between group B and C(P>0.05);there were no significant differences in HBF,HBV,HAP,PVP,TLP and HPI among the three groups(P>0.05).Conclusion The perfusion CT parameters of liver space-occupying lesions are significantly different between the lesions and the surrounding tissues,which has certain clinical value in the differential diagnosis of primary liver cancer,liver metastatic carcinoma and liver hemangioma.