iFlow彩色编码技术实时定量测定肝细胞癌经肝动脉化疗栓塞术前后血流动力学改变的可行性探讨

Feasibility of i Flow color-coding technique in quantitative real-time measurement of hemodynamic changes after transarterial chemoembolization for hepatocellular carcinoma

目的探讨使用iFlow彩色血流编码技术在肝细胞癌经肝动脉化疗栓塞术(TACE)前后血流动力学改变的实时量化分析中的价值。方法收集2015年12月-2017年1月于上海市第五人民医院确诊为肝细胞癌患者31例,所有患者均未接受过外科手术、消融等治疗,应用TACE治疗,使用同样的对比剂、高压注射器参数、造影导管位置造影,用iFlow技术生成患者术前、术后的二维彩色编码图像及时间-密度曲线(TDC),测量造影导管口、肿瘤主要供血动脉起点和终点的达峰时间(TTP)以及肿瘤组织与导管口TDC曲线下面积(AUC)的比值。计量资料组间比较采用配对t检验。结果栓塞前、后的肿瘤主要供血动脉终点TTP分别为(4.64±0.49)s、(5.97±0.84)s,肿瘤组织与导管口AUC比值分别为0.53±0.15、0.16±0.12,差异均有统计学意义(t值分别为11.57、25.85,P值均<0.01);而TACE术前、术后造影导管口的TTP及肿瘤主要供血动脉起点的TTP比较,差异均无统计学意义(P值均>0.05)。肿瘤供血动脉TDC栓塞前大致呈"速升-速降"形,斜率、峰值较高;栓塞后呈"上升-平缓-下降"形,并且斜率、峰值均较术前下降。结论 iFlow可术中实时测量感兴趣区的TTP与TDC,定量评价肝细胞癌的血流动力学变化,为判断肿瘤栓塞程度提供客观的定量指标。

Objective To investigate the value of iFlow color-coding technique in quantitative real-time analysis of hemodynamic changes after transarterial chemoembolization(TACE)for hepatocellular carcinoma(HCC).Methods A total of 31 patients who were diagnosed with HCC in Shanghai Fifth People′s Hospital from December 2015 to January 2017 were enrolled.No patient underwent surgical operation or ablation.All patients underwent TACE with the same contrast agent,high-pressure injector parameters,and place of angiographic catheter.The iFlow technique was used to generate two-dimensional color-coded images and time-density curve(TDC)before and after surgery and measure the opening of the angiographic catheter and the time to peak(TTP)of the starting and ending points of the major tumor feeding arteries,as well as the ratio of the areas under the curve(AUC)of TDC of tumor tissue and the opening of the angiographic catheter.The paired t-test was used for comparison of continuous data between groups.Results TTP of the major tumor feeding arteries was 4.64±0.49 s before TACE and 5.97±0.84 s after TACE(t=11.57,P<0.01),and there was a significant difference in AUC between the tumor tissue and the opening of the angiographic catheter(0.53±0.15 vs 0.16±0.12,t=25.85,P<0.01).There was no significant difference in TTP between the opening of the angiographic catheter and the major tumor feeding arteries before and after TACE(P >0.05).Before TACE,the TDC of tumor feeding arteries had a shape of"rapid increase-rapid reduction"with relatively high slope and peak value,while after TACE,the TDC had a shape of"increase-flat-reduction"with reductions in slope and peak value.Conclusion The iFlow technique can perform real-time measurement of TTP and TDC of the region of interest and helps with quantitative evaluation of hemodynamic changes in HCC.Therefore,it can provide objective quantitative indices for evaluating the degree of tumor embolism.