CT灌注成像观察原发性肝癌TACE术后血供状态对预后的评估价值

The value of blood supply observed through CTPI in evaluating the prognosis of patients with primary liver cancer after TACE

目的研究CT灌注成像观察原发性肝癌患者经肝动脉化疗栓塞术(TACE)后血流状态及对预后的评估价值。方法纳入2014年3月至2019年11月257例接受TACE治疗的原发性肝癌患者作为研究对象,分别在TACE治疗前后行CT灌注成像扫描,记录肝血流量(HBF)、肝动脉灌注指数(HPI)、达峰时间(TTP)及肝动脉灌注量(HAP)。同时取TACE治疗前病灶组织,检测血管内皮生长因子(VEGF)水平与微血管密度计数(MVD)。分析VEGF水平、MVD与CT灌注参数的相关性。记录治疗效果,比较不同疗效患者HBF、HPI、TTP及HAP水平。分析CT灌注成像参数对判断TACE近期预后的价值。结果TACE治疗后3个月复查,257例患者中,完全缓解(CR)38例,部分缓解(PR)128例,疾病稳定(SD)36例,疾病进展(PD)55例。经Pearson线性相关分析显示,VEGF、MVD与HBF、HPI及HAP呈正相关,与TTP呈负相关(P<0.05)。受试者操作特征曲线(ROC)分析结果显示HBF、HPI、HAP及TTP有助于判断TACE治疗效果(P<0.05),根据ROC分析结果建立疗效指数模型:Y=X_(1)+X_(2)+X_(3)+X_(4)(HBF:X_(1),HPI:X_(2),HAP:X_(3),TTP:X_(4)),疗效指数模型判断近期疗效的AUC为0.870(AUC=0.870,S.E.=0.025,95%CI=0.821~0.919,P=0.000)。结论CT灌注成像有助于评估原发性肝癌患者TACE治疗前后血流状态,为近期预后判断提供依据。

Objective To investigate the value of blood supply state in evaluating the prognosis of patients with primary liver cancer after transcatheter arterial chemoembolization(TACE)by computed tomography perfusion imaging(CTPI).Methods A total of 257 patients with primary liver cancer who underwent TACE from March 2014 to November 2019 were included in the study.The parameters of the hepatic blood flow(HBF),hepatic artery perfusion index(HPI),time to peak(TTP)and hepatic artery perfusion volume(HAP)were recorded before and after TACE through CTPI.The levels of vascular endothelial growth factor(VEGF)and microvessel density(MVD)were detected by histopathological biopsy before TACE.The correlations between VEGF,MVD and CT perfusion parameters were analyzed.The therapeutic effects were recorded and the levels of HBF,HPI,TTP and HAP of patients with different effects were compared.The value of CTPI parameters in evaluating the short-term prognosis of patients after TACE was analyzed.Results Three months after TACE,38 patients got complete remission(CR),128 patients got partial remission(PR),36 patients got stable disease(SD)and 55 patients got progressive disease(PD).The Pearson linear correlation analysis showed that VEGF and MVD were positively correlated with HBF,HPI and HAP,and negatively correlated with TTP(P<0.05).The receiver operating characteristic(ROC)curve showed that the HBF,HPI,HAP and TTP were helpful to evaluated the therapeutic effect of TACE(P<0.05).The efficacy index model of Y=X_(1)+X_(2)+X_(3)+X_(4)(HBF:X_(1),HPI:X_(2),HAP:X_(3),TTP:X_(4))was established according to the results of ROC analysis,the area under curve(AUC)of short-term efficacy was 0.870(AUC=0.870,S.E.=0.025,95%CI=0.821-0.919,P=0.000).Conclusion CTPI can be used to evaluate the blood supply of patients with primary liver cancer before and after TACE treatment,and judge the short-term prognosis.