中晚期肝癌患者行TACE治疗后CT灌注参数与生存期的相关性分析41例  

Correlation between computer tomography perfusion parameters and survival in patients with middle/advanced stage liver cancer after TACE:Analysis of 41 cases

作　　者：何二霞 聂忠仕[2] 朱明月[3] 林海锋[2] 王琳[2] 张英辉[2] 李孟森[3] 

机构地区：[1]海南省农垦总医院肿瘤内科,海南省海口市570311 [2]海南省农垦总医院放射科,海南省海口市570311 [3]海南省肿瘤发生和干预重点试验室 海南医学院,海南省海口市571199

出　　处：《世界华人消化杂志》2013年第27期2843-2848,共6页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;Nos.81360307;81260306;81160261;31060164;教育部新世纪优秀人才基金资助项目;No.NCET-10-0124;教育部重点科技基金资助项目;No.211146;海南省重点科技基金资助项目;No.DZXM20110038;海南省自然科学基金资助项目;Nos.309034;310044;海南省卫生厅科研基金资助项目;No.琼卫2011-71~~

摘　　要：目的:探讨中晚期肝癌经导管动脉化疗栓塞术(transarterial chemoembolization,TACE)后观察CT灌注参数与生存期之间的相关性.方法:41例中晚期肝癌患者TACE术后4 wk行CT灌注扫描,计算肝血流量(hepatic blood flow,HBF)、肝血容量(hepatic blood volume,HBV)、平均通过时间(mean transit time,MTT)、肝动脉分数(hepatic artery fraction,HAF)及表面通透性(perfunctory transit,PT)等参数,术后随访患者1-2年的生存期.结果:41例中晚期肝癌患者TACE术后各灌注参数显示碘油沉积区域肝癌组织血流灌注消失;非碘油沉积区域HBF、HBV及M T T等参数分别为451.67 m L/(100 g·m i n)±121.45 mL/(100 g·min)、31.61 mL/100 g±5.86 mL/100 g和4.01 s±2.11 s,相对应的正常肝组织则分别为88.43 mL/(100 g·min)±12.31 mL/(100 g·min)、12.15 mL/100 g±1.97 mL/100 g和9.13 s±1.89 s,在肝癌组织和正常肝组织这些参数比较有明显差异,均有统计学意义(P<0.05);PT及HAF的肝癌组织值分别为18.745 mL/(100 g·min)±13.669mL/(100 g·min)和0.451%±0.121%,相对应的正常肝组织值为20.114 mL/(100 g·min)±14.613 mL/(100 g·min)和0.395%±0.211%,在肝癌组织和正常肝组织这些参数比较无显著性差异(P>0.05);19例死亡患者非碘油沉积区域HBF、HBV、HAF及PT等灌注参数明显降低,经Speraman相关分析显示这些参数降低与生存期密切相关,和生存者比较有统计学差异(P<0.05),而MTT灌注参数与生存期无明显相关性(P>0.05).结论:CT灌注成像对中晚期肝癌行TACE治疗的预后判断具有重要的临床指导价值;各灌注参数与患者生存期密切相关.AIM： To observe the correlation between com- puted tomography （CT） perfusion parameters and survival in patients who had middle/ad- vanced stage liver cancer after transarterial che- moembolization （TACE）. METHODS： Forty-one patients who had mid- dle/advanced stage liver cancer were selected to observe CT perfusion parameters four weeks after TACE. Hepatic blood flow （HBF）, hepatic blood volume （HBV）, mean transit time （MTT）, hepatic artery fraction （HAF） and perfunctory transit （PT） were measured. The patients were followed for 1-2 years after TACE. RESULTS： The blood flow disappeared in io- dized oil deposited hepatoma regions in all the patients. HBF, HBV and MTT in non-iodized oil deposited hepatoma regions were significantly higher than those in normal liver tissue [451.67 mL/（100 g＇min） ＋ 121.45 mL/（100 g min） vs 88.43 mL/（100 g min） ± 12.31 mL/（100 g min）, 31.61 mL/100 g ± 5.86 mL/100 g vs 12.15 mL/100 g ± 1.97 mL/100 g, 4.01 s ± 2.11 s vs 9.13 s ±1.89 s, all P 〈 0.05]. HAF and PT showed no significant differences between non-iodized oil deposited liver cancer region and normal liver tissue [18.745 mL/（100 g min） ＋ 13.669 mL/（100g min） vs 20.114 mL/（100 g min） ＋ 14.613 mL/（100 g min）, 0.451%± 0.121% vs 0.395% ± 0.211%, both P 〉 0.05]. HBF, HBV, HAF and PT declined signifi- cantly in 19 dead patients compared to 22 surviv- ing patients （all P 〈 0.05）, but MTT showed no significant correlation with survival. CONCLUSION： CT perfusion imaging has im- portant value in predict the prognosis of liver cancer after TACE. CT perfusion parameters may be used to evaluate survival of patients with middle/advanced stage liver cancer.

关 键 词：中晚期肝癌 经导管动脉化疗栓塞术 CT灌注成像 生存期 

分 类 号：R735.7[医药卫生—肿瘤]