Hepatic focal nodular hyperplasia in children:Imaging features on multi-slice computed tomography

AIM:To retrospectively analyze the imaging features of hepatic focal nodular hyperplasia(FNH) in children on dynamic contrast-enhanced multi-slice computed tomography(MSCT) and computed tomography angiography(CTA) images.METHODS:From September 1999 to April 2012,a total of 218 cases of hepatic FNH were confirmed by either surgical resection or biopsy in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and the Cancer center of Sun Yat-sen University,including 12 cases(5.5%) of FNH in children(age ≤ 18 years old).All the 12 pediatric patients underwent MSCT.We retrospectively analyzed the imaging features of FNH lesions,including the number,location,size,margin,density of FNH demonstrated on pre-contrast and contrastenhanced computed tomography(CT) scanning,central scar,fibrous septa,pseudocapsule,the morphology of the feeding arteries and the presence of draining vessels(portal vein or hepatic vein).RESULTS:All the 12 pediatric cases of FNH had solitary lesion.The maximum diameter of the lesions was 4.0-12.9 cm,with an average diameter of 5.5 ± 2.5 cm.The majority of the FNH lesions(10/12,83.3%) had well-defined margins.Central scar(10/12,83.3%) and fibrous septa(11/12,91.7%) were commonly found in children with FNH.Central scar was either isodense(n = 7) or hypodense(n = 3) on pre-contrast CT images and showed progressive enhancement in 8 cases in the equilibrium phase.Fibrous septa were linear hypodense areas in the arterial phase and isodense in the portal and equilibrium phases.Pseudocapsule was very rare(1/12,8.3%) in pediatric FNH.With the exception of central scars and fibrous septa within the lesions,all 12 cases of pediatric FNH were homogenously enhanced on the contrast-enhanced CT images,significantly hyperdense in the arterial phase(12/12,100.0%),and isodense in the portal venous phase(7/12,58.3%) and equilibrium phase(11/12,91.7%).Central feeding arteries inside the tumors were observed on CTA images for all 12 cases of FNH,whereas no neovascularization of malignant tumors was noted.In 9 cases(75.0%),there was a spoke-wheel shaped centrifugal blood supply inside the tumors.The draining hepatic vein was detected in 8 cases of pediatric FNH.However,the draining vessels in the other 4 cases could not be detected.No associated hepatic adenoma or hemangioma was observed in the livers of the 12 pediatric cases.CONCLUSION:The characteristic imaging appearances of MSCT and CTA may reflect the pathological and hemodynamic features of pediatric FNH.Dynamic multi-phase MSCT and CTA imaging is an effective method for diagnosing FNH in children.

Primary non-Hodgkin's lymphoma of the liver: sonographic and CT findings

BACKGROUND： A preoperative diagnosis of primary hepatic lymphoma（PHL） can have profound therapeutic and prognostic implications. Because of the rarity of PHL, however, there are few reports on diagnostic imaging. We reviewed the clinical and radiologic findings of 29 patients with PHL, the largest series to date, to evaluate the diagnostic features of this disease.METHODS： Clinical data and radiologic findings at presentation were retrospectively reviewed for 29 patients with pathologically confirmed PHL from January 2005 to June 2013. Imaging studies, including ultrasound（US）（n=29） and contrast-enhanced computed tomography（CECT）（n=24）, were performed within 2 weeks before biopsy or surgery.RESULTS： Among the 29 patients, 23（79%） were positive for hepatitis B virus（HBV） and 26（90%） had a significantly elevated level of serum lactate dehydrogenase（LDH）. There were two distinct types of PHL on imaging： diffuse（n=5） and nodular（n=24）. Homogeneous or heterogeneous hepatomegaly was the only sign for diffuse PHL on both US and CECT, without any definite hepatic mass. For the nodular type, 63%（15/24） of patients had solitary lesions and 38%（9/24） had multiple lesions. On US, seven patients displayed patchy distribution with an indistinct tumor margin and a rich color flow signal. CECT showed rim-like enhancement（n=3） and slightly homogeneous or heterogeneous enhancement（n=14） in the arterial phase and isoenhancement（n=5） and hypoenhancement（n=12） in the portal venous and late phases. Furthermore, in five patients, CT revealed that hepatic vessels passed through the lesions and were not displaced from the abnormal area or appreciably compressed.CONCLUSIONS： The infiltration type of PHL was associated with the histologic subtype. Considered together with HBV positivity and elevated LDH, homogeneous or heterogeneous hepatomegaly may indicate diffuse PHL, whereas patchy distribution with a rich color flow signal on US or normal vessels extending through the lesion on CECT may be the diagnostic indicators of nodular PHL.

Primary lymphoma of the liver-A complex diagnosis

A 59-year-old woman presented with the clinical symptoms and radiologic investigations of a liver lesion suspect of metastasis. However, postoperative histopathology revealed a primary hepatic lymphoma (PHL). The case of a patient with a solitary PHL, which was treated by resection and subsequent chemotherapy, will be discussed with a short overview of the literature.

Correlation between Calcified Liver Metastases and Histopathology of Primary Colorectal Carcinoma in Chinese

The study examined the association between calcified liver metastases and the histopathology of the primary colorectal carcinoma in Chinese.The clinical,pathological and CT data were retrospectively analyzed in 210 patients (mean age:54.2 years) with liver metastases from colorectal carcinoma.Plain CT scanning and contrast-enhanced scanning were performed in all the patients.For the contrast-enhanced examination,iohexol was injected by using a high pressure syringe at a flow rate of 2.5-3.0 mL/s.The arterial phase lasted approximately 25 s and the portal venous phase about 60 s.All patients had no history of chronic liver diseases and had never received interventional treatments.χ 2-test was used to analyze the rate of calcification in the liver metastasis from colorectal cancer of different differentiation degrees.Among the 210 cases of liver metastases,22 patients (10.5%) were found to have calcified liver metastases on CT scan.Two patients with calcified liver metastasis received lumpectomy and developed calcification in recurrent tumors.Another two patients had calcification in newly developed tumor masses.And the calcification in the newly developed masses was similar to that of their primary counterparts in terms of morphology and distribution.On the enhanced CT scan,the tumors exhibited no enhancement during hepatic arterial phase and showed slight rim enhancement during portal venous scan in the 22 cases.The calcification became obscure on contrast-enhanced scans.Histopathologically,the primary tumors were well-differentiated adenocarcinoma in 6 cases,moderately-differentiated adenocarcinoma in 10,poorly-differentiated adenocarcinoma in 4 and mucinous adenocarcinoma in 2 among the 22 cases.No statistical correlation was noted between the incidence of calcified liver metastasis and the pathological subtypes and differentiation degrees of the primary colorectal carcinoma.It was concluded that calcified liver metastases may result from colorectal adenocarcinomata of different differentiation degrees or mucinous adenocarcinomata in Chinese population.There is no correlation between calcification of liver metastases and the pathological subtype of the primary colorectal carcinoma in Chinese,which is different from the findings that calcified metastases were associated with colorectal mucinous adenocarcinoma in other ethnic groups.

Liver involvement in patients with COVID-19 infection:A comprehensive overview of diagnostic imaging features

During the first wave of the pandemic,coronavirus disease 2019(COVID-19)infection has been considered mainly as a pulmonary infection.However,different clinical and radiological manifestations were observed over time,including involvement of abdominal organs.Nowadays,the liver is considered one of the main affected abdominal organs.Hepatic involvement may be caused by either a direct damage by the virus or an indirect damage related to COVID-19 induced thrombosis or to the use of different drugs.After clinical assessment,radiology plays a key role in the evaluation of liver involvement.Ultrasonography(US),computed tomography(CT)and magnetic resonance imaging(MRI)may be used to evaluate liver involvement.US is widely available and it is considered the first-line technique to assess liver involvement in COVID-19 infection,in particular liver steatosis and portal-vein thrombosis.CT and MRI are used as second-and third-line techniques,respectively,considering their higher sensitivity and specificity compared to US for assessment of both parenchyma and vascularization.This review aims to the spectrum of COVID-19 liver involvement and the most common imaging features of COVID-19 liver damage.

18F-FDG PET/CT诊断肺动脉平滑肌肉瘤伴肺转移1例

目的探讨原发性肺动脉平滑肌肉瘤(PPAL)的影像特征,以提高对该肿瘤的认识。方法回顾性分析1例PPAL病人的影像学及病理学表现,并复习相关文献。结果心脏超声检查示右室流出道及肺动脉内低回声团块。增强CT示右心室流出道、肺动脉主干、右肺动脉近端及周围不规则混杂密度肿块,呈不均匀轻度强化,双肺内多个大小不等软组织密度结节。PET/CT示肺动脉病变及右肺结节糖代谢异常增高。右肺结节穿刺病理结果为PPAL肺内转移。结论PPAL影像学表现具有特征性,PET/CT可以指导选择穿刺部位。

Primary Malignant Renal Tumors in Infancy and Childhood: CT Appearances

Objective： To investigate the imaging manifestation of primary malignant renal tumor with CT. Methods： Forty-three cases of surgically and pathologically confirmed primary malignant renal tumor were retrospectively reviewed. Un-contrast and contrast CT was performed in all 43 patients in which 15 patients received MRI examination. Results： The residual normal renal tissue of 29 cases out of 34 cases of Wilms＇ tumor was enhanced and manifested ＂crescent sign＂ or ＂ring sign＂. Four cases of malignant rabdoid tumor （RTK） manifested as large mass with notable necrosis and subcapsular fluid collection; Two cases of clear cell sarcoma （CCS） showed metastases to the skull which could indicate the diagnosis; Renal cell carcinoma （RCC） （n=3） showed calcification in 1 case. Conclusion： CT can precisely delineate the location, size, extent of involvement, imaging characteristics and metastases of renal tumor, which can provide information necessary to the clinical staging, therapy planning and prognosis of the tumors.

Epithelioid angiomyolipoma of the liver:Cross-sectional imaging findings of 10 immunohistochemically-verified cases

AIM： To retrospectively evaluate the computed tomography （CT）/magnetic resonance imaging （MRI） imaging features of epithelioid angiomyolipoma of the liver （Epi-HAML）, with pathology as a reference. METHODS： The CT/MRI findings （number, diameter, lobar location, and appearance of lesions） in a series of 10 patients with 12 pathologically proven epithelioid angiomyolipomas of the liver were retrospectively analyzed. The imaging features, including attenuation/ signal intensity characteristics, presence of fat, hypervascular, outer rim, and vessels within lesion, were evaluated and compared with that of non-Epi- HAML in 11 patients （13 lesions）. The Fisher exact test was used to compare difference in probability of imaging features between the two types. RESULTS： For 21 patients, CT images of 15 patients and MR images of six patients were available. No patient underwent two examinations. For the 15 patients with a CT scan, all HAML lesions in the two groups （10 Epi-HAML and seven non-Epi-HAML） manifested as hypoattenuation. For the six patients with MRI, all lesions （two Epi-HAML and six non-Epi- HAML） were hypointense on TlWI （fat suppression） and hyperintense on T2WI. There were 10 non-Epi-HAML, but only two Epi-HAML lesions showed the presence of fat, which significantly different between the two types （P = 0.005）. On the dynamic contrast enhancement （DCE） imaging, eight Epi-HAML, and 13 non-Epi lesions manifested as hypervascular. Punctate or curved vessels were displayed in 10 Epi-HAML as well as in nine non- Epi lesions and outer rim enhancement could be found with eight Epi-HAML as well as six non-Epi lesions. CONCLUSION： Little or no presence of adipose tissue was found to be an imaging feature of Epi- HAML, compared with the non-Epi type. In addition, hypervascularity with opacification of central punctiform or filiform vessels on DCE would be a characteristic enhancement pattern for Epi-HAML.

Perivascular epithelioid cell tumor of the liver:A report of two cases and review of the literature

Perivascular epithelioid cell tumor (PEComa) is a rare tumor which arises from mesenchymal tissues. It is predominant in the uterus,but very rare in the liver. To the best of our knowledge,less than 5 cases of PEComa of the liver have been reported. Herein we present two pathologically proven cases of PEComa of the liver,retrospectively analyze their clinical and imaging features,and review the literature.

Perfusion CT findings in liver of patients with tumor during chemotherapy

AIM: To investigate the microcirculation changes in liver of patients with tumor during chemotherapy by perfusion computed tomography (CT). METHODS: Sixty patients with tumor and 20 controls were enrolled in this study. Perfusion CT parameters of patients and controls were compared, including hepatic perfusion index (HPI), mean transit time (MTT), and permeability-surface area product (PS). Correlation between perfusion CT parameters, treatment cycle and alanine aminotransferase (ALT) level was studied. RESULTS: No difference was found in HPI (25.68% ± 7.38% vs 26.82% ± 5.13%), MTT (19.67 ± 5.68 s vs21.70 ± 5.43 s) and PS (17.00 ± 4.56 mL/100 mL per min vs 19.92 ± 6.35 mL/100 mL per min) between pa- tients and controls. The HPI and MTT were significantly higher in patients undergoing 2 cycles of chemotherapy than in controls and those undergoing 1 cycle of che- motherapy (29.76% ± 5.87% vs 25.68% ± 7.38% and 25.35% ± 4.05%, and 25.61 ± 5.01 s vs 19.67 ± 5.68 s and 19.74 ± 4.54 s, respectively, P < 0.05). The HPI was higher in patients with hepatic steatosis than in controls and those without hepatic steatosis (30.85% ± 6.17% vs 25.68% ± 7.38% and 25.70% ± 4.24%, P < 0.05). Treatment cycle was well correlated with HPI and MTT (r = 0.40, r = 0.50, P < 0.01). ALT level was not correlated with perfusion CT parameters. CONCLUSION: HPI and MTT are significantly increased in patients with tumor during chemotherapy and well correlated with treatment cycle. Chemotherapy affects hepatic microcirculation in patients with tumor. Changes in hepatic microcirculation can be quantitatively assessed by perfusion CT.

A case of leptospirosis simulating colon cancer with liver metastases

We report a case of a 61-year-old man who presented with fatigue,abdominal pain and hepatomegaly.Computed tomography (CT) of the abdomen showed hepatomegaly and multiple hepatic lesions highly suggestive of metastatic diseases.Due to the endoscopic finding of colon ulcer,colon cancer with liver metastases was suspected.Biochemically a slight increase of transaminases,alkaline phosphatase and gammaglutamyl transpeptidase were present;α- fetoprotein,carcinoembryogenic antigen and carbohydrate 19-9 antigen serum levels were normal.Laboratory and instrumental investigations,including colon and liver biopsies revealed no signs of malignancy.In the light of spontaneous improvement of symptoms and CT findings,his personal history was revaluated revealing direct contact with pigs and their tissues.Diagnosis of leptospirosis was considered and confirmed by detection of an elevated titer of antibodies to leptospira.After two mo,biochemical data,CT and colonoscopy were totally normal.

Multislice spiral CT angiography in evaluation of liver transplantation candidates

BACKGROUND: Orthotopic liver transplantation has be- come the treatment of choice for patients with end-stage liver disease. This study was designed to study whether multislice spiral CT angiography (MSCTA) could be used for preoperative evaluation for orthotopic liver transplanta- tion candidates. METHODS: Eighty consecutive potential candidates for liver transplantation were evaluated with dual-phase three-di- mensional CT angiography (3DCTA). The arterial-phase was used to create vascular maps of the celiac axis (inclu- ding the origin of the hepatic common artery, left gastric artery and splenic artery) and origin of the superior mesen- teric artery. The portal venous-phase was used to analyze portal vein thrombosis and collateral vascularization of the portal vein. Statistical analyses were made using the chi- square test for differences between hepatic arterial anatomy of 80 patients and Michel's anatomy of 200 patients. Appearance of MSCTA and operative results of 16 patients were analyzed. RESULTS; Sixty-two patients (77.5%) showed conven- tional and 18 (22.5%) nonconventional hepatic arterial anatomy. A significant difference was found between the two groups in anatomy of the hepatic artery (P <0.05). Celiac axis stenosis was observed in 6 patients, SA aneu- rysm in 2, small-caliber hepatic arterial vessels in 2, and portal vein thrombosis in 15. Vascular structures of 16 ope- rative patients were well defined. CONCLUSION: As a noninvasive examination, MSCTA can provide a comprehensive preoperative vascular evalua- tion for liver transplantation candidates.

比较核磁共振与CT检查在原发性肝癌诊断中的价值

目的探讨原发性肝癌诊断中应用核磁共振(NMR)与电子计算机断层扫描(CT)检查的价值。方法选取濮阳市油田总医院2020年10月至2021年9月收治的79例疑似原发性肝癌患者作为研究对象,所有患者均接受NMR、CT检查。比较两种检查方法的诊断效能、病灶检出数、阳性率及对不同大小病灶的检出率。结果NMR检查灵敏度、特异度、阳性预测值、阴性预测值分别为94.87%、92.50%、92.50%、94.87%,CT检查分别为79.49%、75.00%、75.61%、78.95%,NMR检查与CT检查相比灵敏度、特异度、阳性预测值、阴性预测值更高,差异有统计学意义(P<0.05);NMR检查与CT检查相比肝内病灶、肝外病灶、病灶检出数更多,差异有统计学意义(P<0.05)。NMR检查与CT检查相比肝内病灶阳性率、肝外病灶阳性率更高,差异有统计学意义(P<0.05);NMR检查与CT检查相比对直径≤3 cm病灶的检出率更高,差异有统计学意义(P<0.05)。结论原发性肝癌诊断中应用NMR检查,具有良好的诊断效能,能够增加病灶检出数,提高阳性率,可更准确地检出直径≤3 cm的病灶。

CT与MRI在原发性肝癌介入术后病灶残留及复发中的应用价值

目的 分析在原发性肝癌(primary liver cancer,PLC)介入术后应用磁共振成像(Magnetic resonance imaging,MRI)与计算机断层扫描(computed tomography,CT)诊断复发及病灶残留中的价值。方法 本次总共抽取2020年1月-2022年2月40例PLC病例(50个病灶)展开研究,回顾性分析其全部的临床资料,所有对象均实施介入术治疗,并采取数字减影血管造影(digital subtraction angiography,DSA)、MRI、CT等于术后3个月进行复查。金标准为DSA,对比PLC介入术后MRI、CT诊断复发、病灶残留的特异度、准确性、敏感度等数据。结果 本组40例患者DSA显示,50个病灶中复发或残留病灶共37个,经MRI检出阳性34个,敏感度91.89%,经CT检出阳性26个,敏感度70.27%,两种方式对比诊断敏感度,MRI明显高于CT(P<0.05);MRI诊断准确性94.0%(47/50),CT为78.0%(37/50),MRI明显高于CT(P<0.05);MRI诊断敏感度100.0%(13/13),CT为100.0%(13/13),两者对比无差异(P>0.05)。结论 在PLC介入术后应用MRI对复发及残留病灶进行诊断准确性和敏感度较CT更高,有利于对介入术效果做出准确评估,并为患者后续术后治疗提供可靠的参考依据,可进一步借鉴推广。

肝脏原发性平滑肌肉瘤CT表现（附3例分析）

本文收集３例经手术病理证实的原发性肝脏平滑肌肉瘤。重点讨论了病理、ＣＴ表现及其鉴别诊断。作者认为：当ＣＴ扫描时肝脏出现巨大混合性占位病灶，且以囊性成份为主时，应考虑肝脏平滑肌肉瘤的可能，但进一步确诊须依靠病理，甚至是电镜和免疫组织化学技术。当肝脏平滑肌肉瘤病灶相对小，无囊性成份出现时，不易与肝细胞癌进行鉴别。

原发性肝癌320排容积CT灌注参数值与肿瘤体积及肝功能Child-Pugh分级的相关性

目的探讨原发性肝癌320排容积CT全肿瘤灌注参数值与肿瘤体积、瘤周肝组织灌注参数值的关系,并分析其与肝脏Child-Pugh分级的相关性。方法选择2013年1月至2015年1月于郑州大学第一附属医院行320排容积CT灌注成像的原发性肝癌患者47例,根据全肿瘤测量法计算肿瘤体积及瘤体、瘤周肝组织的肝动脉灌注量(HAP)、门静脉灌注量(PVP)及肝动脉灌注指数(HAPI),分析瘤体各灌注参数值与肿瘤体积及肝功能Child-Pugh分级的关系。结果肿瘤体积与全肿瘤灌注参数值、瘤周灌注参数值无相关性(P>0.05),全肿瘤灌注参数值与瘤周灌注参数值无相关性(P>0.05)。不同肝功能Child-Pugh分级患者的全肿瘤灌注参数值HAP、PVP及HAPI比较差异有统计学意义(P<0.05)。随着肝功能Child-Pugh分级的增加,瘤体HAP及HAPI逐渐增加,而PVP逐渐减小(P<0.05)。结论原发性肝癌瘤体体积与全肿瘤灌注参数值、瘤周灌注参数值无相关性,全肿瘤灌注参数值与瘤周灌注参数值无相关性;不同肝脏Child-Pugh分级间的各灌注参数值存在差异,全肿瘤测量法获得的灌注参数值可作为反应肝脏储备功能的影像学指标。

^(18)F-FDG PET/CT对显像阳性原发性肝癌^(125)I粒子植入治疗疗效价值的评估

目的:探讨18F-FDG PET/CT对显像阳性的原发性肝癌行125I粒子植入治疗疗效价值的评价.方法:原发性肝癌患者39例,共55个肿瘤病灶,均于放射性125I粒子植入治疗前确定病灶为18F-FDG PET/CT显像阳性;放射性125I粒子植入治疗后2mo行PET/CT检查评价疗效,之后进行常规影像学(CT或MR)随访6mo,随访结果作为肿瘤病灶是否有治疗后残留的标准.结果:55个肿瘤病灶中常规影像学(CT或MR)随访6mo证实有肿瘤残留的病灶为21个,其中19个放射性125I粒子植入治疗后2mo行PET/CT评价为有残留,另外2个PET/CT评价为无残留;随访6mo证实无肿瘤残留的病灶34个,其中31个放射性125I粒子植入治疗后2mo行PET/CT评价为无残留,另外3个PET/CT评价为有残留.18F-FDG PET/CT在判断肿瘤残留方面的灵敏度和特异度分别为90.4%,91.2%.结论:18F-FDG PET/CT对显像阳性的原发性肝癌125I粒子植入后坏死灶与残留灶的区分有较高的灵敏度和特异度,能够较好地评价疗效,并能为进一步治疗提供指导作用.

原发性中晚期肝癌肝动脉介入和分子靶向药物治疗CT和MRI检查时的护理干预

目的探讨肝动脉介入和分子靶向药物在原发性中晚期肝癌治疗后,CT和MRI检查时的护理干预措施。方法选取50例患者入院后均开展索拉非尼以及肝动脉化疗栓塞手术治疗,并在持续治疗三个月后分别开展数字减影血管造影(DSA)、CT以及MRI检查。将DSA检查结果作为判断治疗效果的主要依据。分析DSA、CT以及CT联合MRI复查结果;对比CT与CT联合MRI检查的诊断效能;分析患者满意度情况。结果DSA、CT以及CT联合MRI检查总有效率分别是80.00%、68.00%、78.00%。CT检查在敏感度、阳性预测值、阴性预测值以及准确度方面均低于CT联合MRI检查,但两组对比无差异(P>0.05)。总满意度是96.00%。结论原发性肝癌患者介入治疗和分子靶向治疗效果评估时开展CT联合MRI检查,同时实施有效的护理干预,对于治疗后残留以及复发病灶能够有效检出。

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

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。

原发性肝癌动脉期CT表现与经肝动脉化疗栓塞疗效相关性研究

目的分析肝癌动脉期螺旋CT表现,探讨原发性肝癌的血供特点与经肝动脉化疗栓塞疗效及预后的相关性。方法对69例行至少3次肝动脉化疗栓塞技术(transcatheter arterial chemoembolization,TACE)治疗的原发性肝癌患者进行疗效及预后随访,并与术前螺旋CT动脉期血供分型对比分析。根据术前动脉期肿瘤CT强化程度,将其血供分为富血供型(均匀强化型+不均匀强化型)和乏血供型(强化不明显型+无明显强化型)。根据随访CT肿瘤大小改变、碘油沉积情况及有无新发病变,将近期疗效分为有效和无效。结果 69例中,近期有效27例,近期无效42例。在富血供中有效26例,无效14例;而乏血供中有效仅1例,无效为28例,富血供患者近期疗效优于乏血供(x^2=40.481,P<0.001)。同时近期有效者的生存状况亦优于无效者(x^2=22.39,P<0.001),其6、12、24个月的累积生存率分别为96.30%,89.89%,50.24%和80.95%,45.28%,10.65%。结论原发性肝癌动脉期血供CT分型与TACE术后的疗效及预后相关,利用动脉期螺旋CT表现进行原发性肝癌血供评估,有助于临床预测原发性肝癌的疗效和预后。