CT灌注成像评估经导管动脉化疗栓塞联合阿帕替尼治疗中晚期肝细胞癌的价值

Evaluation of CT Perfusion Imaging in the Treatment of Advanced Hepatocellular Carcinoma by Transcatheter Arterial Chemoembolization Combined with Apatinib

目的 探讨应用CT灌注成像评估经导管动脉化疗栓塞联合阿帕替尼治疗中晚期肝细胞癌患者的临床价值。方法 回顾性分析2019年6月至2022年6月郑州大学附属郑州中心医院收治的88例中晚期肝细胞癌患者的临床资料。将其中仅接受经导管动脉化疗栓塞术治疗的48例设为对照组,接受经导管动脉化疗栓塞联合阿帕替尼治疗的40例设为研究组,在手术前1 d和手术后30 d分别使用CT灌注成像检查,并记录肝癌细胞血液灌注指标[门静脉灌注量(PVP)、肝动脉灌注量(HAP)、肝动脉灌注指数(HPI)、肝血流量(HBF)、肝血容量(HBV)、平均通过时间(MTT)],比较治疗前后肝癌细胞血液灌注指标等。结果 本次研究所有患者均取得满意的CT灌注图像,术前所有患者HAP、HPI、HBF、HBV、MTT指标均为高灌注,其中均匀高灌注53例,不均匀35例。坏死区呈低灌注或无灌注,PVP呈低灌注。术后,38例患者碘化油致密填充,40例碘化油不均匀填充,所有指标均呈无灌注,碘化油缺失或稀疏部位仍呈现高灌注。术后,两组患者肿瘤部位的HAP、HPI、HBF、HBV参数低于术前,且研究组低于对照组(P<0.05),两组患者肿瘤部位的PVP、MTT参数比较,差异无统计学意义(P>0.05)。结论 CT灌注成像评估可以证实中晚期肝细胞癌患者使用经导管动脉化疗栓塞联合阿帕替尼治疗的疗效较好。

Objective To explore the clinical value of CT perfusion imaging in evaluating the therapeutic effect of transcatheter arterial chemoembolization combined with apatinib in patients with advanced hepatocellular carcinoma.Methods The clinical data of 88 patients with advanced hepatocellular carcinoma admitted to Zhengzhou Center Hospital Affiliated to Zhengzhou University from June 2019 to June 2022 were analyzed retrospectively.A total of 48 cases who received transcatheter arterial chemoembolization were set as the control group,and 40 cases who received transcatheter arterial chemoembolization combined with apatinib were set as the research group.CT perfusion imaging was used 1 day before operation and 30 days after operation,and the blood perfusion indexes[portal vein perfusion(PVP),hepatic artery perfusion(HAP),hepatic perfusion index(HPI),hepatic blood flow(HBF),hepatic blood volume(HBV),mean transit time(MTT)]were recorded,and compared before and after treatment.Results Satisfactory CT perfusion images were obtained in all patients in this study.Before operation,the indexes of HAP,HPI,HBF,HBV and MTT were all hyperperfusion,including 53 cases of uniform hyperperfusion and 35 cases of uneven perfusion.The necrotic area showed hypoperfusion or no perfusion,and PVP showed hypoperfusion.After operation,38 patients were densely filled with iodized oil,and 40 patients were unevenly filled with iodized oil.All the indexes showed no perfusion,and the missing or sparse parts of iodized oil still showed high perfusion.After operation,the parameters of HAP,HPI,HBF and HBV in the tumor site of the two groups were lower than those before operation,and those in the study group were lower than those in the control group(P<0.05).There was no statistical difference in PVP and MTT parameters between the two groups(P>0.05).Conclusion CT perfusion imaging evaluation can confirm that transcatheter arterial chemoembolization combined with apatinib is effective in the treatment of patients with advanced hepatocellular carcinoma.