CT灌注成像在肝细胞癌诊断中的应用  

CT perfusion imaging in the diagnosis of hepatocellular carcinoma

作　　者：吴嘉兴[1] 梅铭惠[1] 邱维加[2] 丁可[2] 

机构地区：[1]桂林医学院附属医院肝胆外科,541001 [2]桂林医学院附属医院肝胆外科放射科,541001

出　　处：《中华肝胆外科杂志》2011年第7期543-546,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨CT灌注成像在肝细胞癌（HCC）诊断中的价值。方法对21例肝占位患者共26个病灶行CT灌注扫描，获得以下灌注参数：肝血流量（HBF）、肝血容量（HBV）、平均通过时间（MTT）、血管表面通透性（Ps）以及肝动脉分数（HAF）等，并对比病灶和非病灶区灌注参数。HCC患者同时测定血清甲胎蛋白（AFP）值，并与相应病灶的灌注参数作直线相关分析。结果灌注失败3例，共3个病灶；成功18例，共23个病灶，其中HCC18个，肝血管瘤4个，肝局灶性结节增生1个。HCC组病灶灌注参数与非病灶相比较，HAF增大，MTT及PS减小，差异有统计学意义，其中以HAF的差异最为显著，前者是后者的4．11倍。HBF和HBV无统计学差异。血清AFP与HCC病灶的灌注参数无相关性。肝血管瘤组病灶和非病灶各灌注参数的改变与HCC类似，但血管瘤病灶区的HBF较HCC大。肝局灶性结节增生和非结节的灌注参数无明显差异。结论CT灌注成像在AFP阴性和（或）增强CT表现不典型的HCC诊断及鉴别诊断中具有重要的参考价值。Objective To evaluate the value of CT perfusion imaging （CTPI） in the diagnosis of hepatocellular carcinoma （HCC）. Method CTPI was carried out on 21 patients with 26 lesions to ob- tain the following perfusion parameters： hepatic blood flow （HBF）, hepatic blood volume （HBV）, mean transit time （MTT）, permeability surface area product （PS）, and hepatic arterial fraction （HAF）. The parameters from the Iesion and non-lesion areas were compared. In addition, serum AFP was measured in the HCC patients and a linear correlation analysis between the alpha-fetoprotein （AFP） level and the CTPI parameters was performed. Result CTPI failed in 3 patients with 3 lesions and was successful in 18 patients with 23 lesions which included 18 HCC, 4 hemangioma of the liver, and 1 hepatic focal nodular hyperplasia （FNH）. On comparison of the HCC parameters in the lesion and non-lesion areas, significant differences were found in the HAF which was 4.11 times higher in the lesion than the non-lesion areas, while the MTT and PS were significantly lower. There was no significant difference in the HBF and HBV. Correlation between the serum AFP level and the CTPI parameters of the HCC lesion was insignificant. The differences of all the parameters between the le- sion and the non-lesion in hemangioma were similar to those in HCC, except for a higher HBF in the lesion than in HCC. There was no significant difference between the parameters of FNH and the non- nodular part of the liver. Conclusion CTPI played an important role in the diagnosis and differential diagnosis of HCC, especially when the AFP was negative and/or the imaging manifestation was atypi- cal on contrast CT.

关 键 词：CT灌注成像 诊断 肝细胞癌 

分 类 号：R735.7[医药卫生—肿瘤]