64排螺旋CT灌注成像在肝细胞癌介入治疗前后的评估价值  

Value of 64-slice spiral CT perfusion imaging in estimating the efficacy of transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma

作　　者：杨首香[1] 陈勇[2] 赵兴康[1] 李建龙[1] 徐锐[1] 

机构地区：[1]山东省日照市人民医院医学影像科,276826 [2]山东省日照市人民医院药剂科,276826

出　　处：《中华消化病与影像杂志（电子版）》2014年第2期24-27,共4页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

摘　　要：目的探讨64排螺旋CT灌注成像（CTPI）在原发性肝细胞癌（HCC）肝动脉插管化疗栓塞（TACE）术前、后疗效的评估价值。方法选取30例HCC患者，于TACE术前1—3d、术后30～40d应用GELightSpeedVCTXT（64排128层螺旋CT）分别行全肝常规平扫及灌注扫描，运用灌注软件进行分析，计算肝血流量（BF）、血容量（BV）、平均通过时间（MrITr）、肝动脉灌注指数（HAF）、毛细血管通透性（PS）等，统计分析相关参数，以评价HCC介入治疗前后的血流动力学状态。结果TACE术后HCC患者中12例碘油沉积密实，18例碘油沉积不均匀，灌注彩图显示碘油沉积密实区无血流灌注，碘油稀疏区域及碘油缺损区呈不同程度高灌注，TACE术治疗后BF、BV、HAF和Ps值较术前减少，差异均具有统计学意义（P〈0．05），而MTr值在TACE治疗前后差异无统计学意义（P〉0．05）。结论64排螺旋CT肝脏灌注成像可以无创、动态、定量的监测非碘油沉积区的血供变化，对判断肿瘤组织活性有重要意义，在HCC介入疗效评估及指导后续治疗起重要作用。Objective To discuss the clinical value of 64-slice spiral CT perfusion imaging（CTPI） in estimating the efficacy of transcatheter arterial chemoembolization （TACE） for hepatocellular carcinoma （YtCC）. Methods Using 64-slice spiral CT（ GE LightSpeed VCT XT） ,all CT plain scan and perfusion scan were performed in 30 patients with HCC 1-3 days before and 30-40 days after TACE. Using deconvolution through Infusion Software analysis, hepatic blood flow （BF）, blood volume （BV）, the mean transit time （MTT）, hepatic arterial fraction （HAF）, permeability surface （PS）were caculated to evaluate HCC embolization hemodynamic status. Results After TACE, the tumor was totally filled with lipiodol in 12 cases and partially filled with lipiodol in 18 cases. BF, BV, MTT, HAF and PS perfusion maps showed that lack of blood perfusion was found in lipiodol-filling areas, but sparsely or insufficiently lipiodol-filled areas were hyperperfusion. BF, BV, HAF and PS of I-ICC after TACE were lower than those of HCC before TACE （ P 〈 0. 05）, but no statistically significant difference was found in MTT（P 〉 0. 05 ）. Conclusions 64-slice spiral CT liver perfusion imaging can be used to monitor the blood supply changes in non-iodized oil deposits area non-invasively, dynamically, quantitatively, which was very important in judging the tumor tissue survival and played an important role in response evaluation of HCC interventional therapy and guiding the follow-up treatment.

关 键 词：癌 肝细胞 体层摄影术 螺旋计算机 化学栓塞 治疗性 

分 类 号：R735.7[医药卫生—肿瘤] R730.44[医药卫生—临床医学]